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Chen D, Lee C, Tsai M, Hsieh M, Chuang C, Pang S, Chen S, Tseng C, Chang S, Chu P, Hsieh I, Wu VC, Huang W. Cancer Therapy-Related Cardiac Dysfunction in Patients With Prostate Cancer Undergoing Androgen Deprivation Therapy. J Am Heart Assoc 2023; 12:e030447. [PMID: 37750600 PMCID: PMC10727237 DOI: 10.1161/jaha.123.030447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/24/2023] [Indexed: 09/27/2023]
Abstract
Background The risk of cardiac dysfunction for patients with prostate cancer undergoing androgen deprivation therapy (ADT) in the real-world setting remains unclear. Methods and Results A total of 1120 patients with prostate cancer and a baseline echocardiography scan were identified from Chang Gung Research Database between January 1, 2001 and December 31, 2019. Patients were treated with gonadotropin-releasing hormone agonist therapy, gonadotropin-releasing hormone antagonist therapy, or bilateral orchiectomy. Changes in left ventricular ejection fraction (LVEF) were further assessed in 421 patients using repeated measurements of LVEF before and during ADT treatment. The incidence of cancer therapy-related cardiac dysfunction (CT-RCD) was evaluated and defined as a ≥10% absolute decline in LVEF from baseline to a value of <53%. Among 421 patients undergoing ADT, LVEF declined from 66.3±11.3% to 62.5±13.6% (95% CI of mean difference: -5.0% to -2.7%) after a mean follow-up period of 1.6±0.8 years. CT-RCD occurred in 58 patients (13.7%) with a nadir LVEF of 40.3±9.1% after ADT. Lower baseline LVEF was significantly associated with CT-RCD (odds ratio, 1.07 [95% CI, 1.04-1.10]). The area under the curve of baseline LVEF for discriminating CT-RCD was 75.6%, with the corresponding optimal cutoff value of 64.5% (sensitivity, 79.3%; specificity, 67.2%). Conclusions ADT with gonadotropin-releasing hormone agonist therapy, gonadotropin-releasing hormone antagonist therapy, and bilateral orchiectomy were associated with an increased risk of CT-RCD in patients with prostate cancer. In addition, lower baseline LVEF was a significant predictor of CT-RCD in patients with prostate cancer undergoing treatment with ADT.
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Affiliation(s)
- Dong‐Yi Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital at LinkouChang Gung University College of MedicineTaoyuanTaiwan
- Chang Gung University College of MedicineTaoyuanTaiwan
| | - Cheng‐Hung Lee
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital at LinkouChang Gung University College of MedicineTaoyuanTaiwan
- Chang Gung University College of MedicineTaoyuanTaiwan
| | - Ming‐Lung Tsai
- Division of CardiologyNew Taipei Municipal TuCheng HospitalNew Taipei CityTaiwan
- Chang Gung University College of MedicineTaoyuanTaiwan
| | - Ming‐Jer Hsieh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital at LinkouChang Gung University College of MedicineTaoyuanTaiwan
- Chang Gung University College of MedicineTaoyuanTaiwan
| | - Cheng‐Keng Chuang
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at LinkouChang Gung University College of MedicineTaoyuanTaiwan
| | - See‐Tong Pang
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at LinkouChang Gung University College of MedicineTaoyuanTaiwan
| | - Shao‐Wei Chen
- Chang Gung University College of MedicineTaoyuanTaiwan
- Department of Thoracic and Cardiovascular SurgeryChang Gung Memorial Hospital at LinkouTaoyuanTaiwan
- Center for Big Data Analytics and Statistics, Department of Medical Research and Development, Chang Gung Memorial Hospital at LinkouTaoyuanTaiwan
| | - Chi‐Nan Tseng
- Chang Gung University College of MedicineTaoyuanTaiwan
- Department of Thoracic and Cardiovascular SurgeryChang Gung Memorial Hospital at LinkouTaoyuanTaiwan
| | - Shang‐Hung Chang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital at LinkouChang Gung University College of MedicineTaoyuanTaiwan
| | - Pao‐Hsien Chu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital at LinkouChang Gung University College of MedicineTaoyuanTaiwan
- Chang Gung University College of MedicineTaoyuanTaiwan
| | - I‐Chang Hsieh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital at LinkouChang Gung University College of MedicineTaoyuanTaiwan
- Chang Gung University College of MedicineTaoyuanTaiwan
| | - Victor Chien‐Chia Wu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital at LinkouChang Gung University College of MedicineTaoyuanTaiwan
- Chang Gung University College of MedicineTaoyuanTaiwan
| | - Wen‐Kuan Huang
- Chang Gung University College of MedicineTaoyuanTaiwan
- Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at LinkouChang Gung University College of MedicineTaoyuanTaiwan
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Di Lodovico E, Facondo P, Delbarba A, Pezzaioli LC, Maffezzoni F, Cappelli C, Ferlin A. Testosterone, Hypogonadism, and Heart Failure. Circ Heart Fail 2022; 15:e008755. [PMID: 35392658 DOI: 10.1161/circheartfailure.121.008755] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Male hypogonadism is defined as low circulating testosterone level associated with signs and symptoms of testosterone deficiency. Although the bidirectional link between hypogonadism and cardiovascular disease has been clarified, the association between testosterone and chronic heart failure (HF) is more controversial. Herein, we critically review published studies relating to testosterone, hypogonadism, and HF and provide practical clinical information on proper diagnosis and treatment of male hypogonadism in patients with HF. In general, published studies are extremely heterogeneous, frequently have not adhered to hypogonadism guidelines, and suffer from many intrinsic methodological inaccuracies; therefore, data provide only low-quality evidence. Nevertheless, by selecting the few methodologically robust studies, we show the prevalence of testosterone deficiency (30%-50%) and symptomatic hypogonadism (15%) in men with HF is significant. Low testosterone correlates with HF severity, New York Heart Association class, exercise functional capacity, and a worse clinical prognosis and mortality. Interventional studies on testosterone treatment in men with HF are inconclusive but do suggest beneficial effects on exercise capacity, New York Heart Association class, metabolic health, and cardiac prognosis. We suggest that clinicians should measure testosterone levels in men with HF who have symptoms of a testosterone deficiency and conditions that predispose to hypogonadism, such as obesity and diabetes. These patients-if diagnosed as hypogonadal-may benefit from the short- and long-term effects of testosterone replacement therapy, which include improvements in both cardiac prognosis and systemic outcomes. Further collaborative studies involving both cardiologists and endocrinologists are warranted.
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Affiliation(s)
- Elena Di Lodovico
- Department of Clinical and Experimental Sciences, University of Brescia, Italy (E.D.L., P.F., L.C.P., C.C., A.F.)
| | - Paolo Facondo
- Department of Clinical and Experimental Sciences, University of Brescia, Italy (E.D.L., P.F., L.C.P., C.C., A.F.)
| | - Andrea Delbarba
- Unit of Endocrinology and Metabolism, ASST Spedali Civili, Brescia, Italy (A.D., F.M., C.C., A.F.)
| | - Letizia Chiara Pezzaioli
- Department of Clinical and Experimental Sciences, University of Brescia, Italy (E.D.L., P.F., L.C.P., C.C., A.F.)
| | - Filippo Maffezzoni
- Unit of Endocrinology and Metabolism, ASST Spedali Civili, Brescia, Italy (A.D., F.M., C.C., A.F.)
| | - Carlo Cappelli
- Department of Clinical and Experimental Sciences, University of Brescia, Italy (E.D.L., P.F., L.C.P., C.C., A.F.).,Unit of Endocrinology and Metabolism, ASST Spedali Civili, Brescia, Italy (A.D., F.M., C.C., A.F.)
| | - Alberto Ferlin
- Department of Clinical and Experimental Sciences, University of Brescia, Italy (E.D.L., P.F., L.C.P., C.C., A.F.).,Unit of Endocrinology and Metabolism, ASST Spedali Civili, Brescia, Italy (A.D., F.M., C.C., A.F.).,Now with Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Italy (A.F.)
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Chung CC, Lin YK, Kao YH, Lin SH, Chen YJ. Physiological testosterone attenuates profibrotic activities of rat cardiac fibroblasts through modulation of nitric oxide and calcium homeostasis. Endocr J 2021; 68:307-315. [PMID: 33115984 DOI: 10.1507/endocrj.ej20-0344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Testosterone deficiency is associated with poor prognosis among patients with chronic heart failure (HF). Physiological testosterone improves the exercise capacity of patients with HF. In this study, we evaluated whether treatment with physiological testosterone contributes to anti-fibrogenesis by modifying calcium homeostasis in cardiac fibroblasts and we studied the underlying mechanisms. Nitric oxide (NO) analyses, calcium (Ca2+) fluorescence, and Western blotting were performed in primary isolated rat cardiac fibroblasts with or without (control cells) testosterone (10, 100, 1,000 nmol/L) treatment for 48 hours. Physiological testosterone (10 nmol/L) increased NO production and phosphorylation at the inhibitory site of the inositol trisphosphate (IP3) receptor, thereby reducing Ca2+ entry, phosphorylated Ca2+/calmodulin-dependent protein kinase II (CaMKII) expression, type I and type III pro-collagen production. Non-physiological testosterone-treated fibroblasts exhibited similar NO and collagen production capabilities as compared to control (testosterone deficient) fibroblasts. These effects were blocked by co-treatment with NO inhibitor (L-NG-nitro arginine methyl ester [L-NAME], 100 μmol/L). In the presence of the IP3 receptor inhibitor (2-aminoethyl diphenylborinate [2-APB], 50 μmol/L), testosterone-deficient and physiological testosterone-treated fibroblasts exhibited similar phosphorylated CaMKII expression. When treated with 2-APB or CaMKII inhibitor (KN93, 10 μmol/L), testosterone-deficient and physiological testosterone-treated fibroblasts exhibited similar type I, and type III collagen production. In conclusion, physiological testosterone activates NO production, and attenuates the IP3 receptor/Ca2+ entry/CaMKII signaling pathway, thereby inhibiting the collagen production capability of cardiac fibroblasts.
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Affiliation(s)
- Cheng-Chih Chung
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Yung-Kuo Lin
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Yu-Hsun Kao
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Medical Education and Research, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Shyh-Hsiang Lin
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Yi-Jen Chen
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Cardiovascular Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Diaconu R, Donoiu I, Mirea O, Bălşeanu TA. Testosterone, cardiomyopathies, and heart failure: a narrative review. Asian J Androl 2021; 23:348-356. [PMID: 33433530 PMCID: PMC8269837 DOI: 10.4103/aja.aja_80_20] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Testosterone exerts an important regulation of cardiovascular function through genomic and nongenomic pathways. It produces several changes in cardiomyocytes, the main actor of cardiomyopathies, which are characterized by pathological remodeling, eventually leading to heart failure. Testosterone is involved in contractility, in the energy metabolism of myocardial cells, apoptosis, and the remodeling process. In myocarditis, testosterone directly promotes the type of inflammation that leads to fibrosis, and influences viremia with virus localization. At the same time, testosterone exerts cardioprotective effects that have been observed in different studies. There is increasing evidence that low endogenous levels of testosterone have a negative impact in some cardiomyopathies and a protective impact in others. This review focuses on the interrelationships between testosterone and cardiomyopathies and heart failure.
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Affiliation(s)
- Rodica Diaconu
- Department of Cardiology, University of Medicine and Pharmacy, Craiova 200349, Romania
| | - Ionuţ Donoiu
- Department of Cardiology, University of Medicine and Pharmacy, Craiova 200349, Romania
| | - Oana Mirea
- Department of Cardiology, University of Medicine and Pharmacy, Craiova 200349, Romania
| | - Tudor Adrian Bălşeanu
- Department of Physiology, University of Medicine and Pharmacy, Craiova 200349, Romania
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Men with Latent Autoimmune Diabetes and Type 2 Diabetes May Have Different Change Patterns in Free Testosterone. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6259437. [PMID: 32775431 PMCID: PMC7396077 DOI: 10.1155/2020/6259437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/09/2020] [Accepted: 06/29/2020] [Indexed: 11/23/2022]
Abstract
Objective Type 2 diabetic (T2D) male patients with low total testosterone (TT) levels are at an increasing risk of all-cause mortality. However, the levels of TT in male patients with latent autoimmune diabetes in adults (LADA) remain largely unknown. Research Design and Methods. This was a single-center, open, observational study. The inclusion criteria were male patients who were diagnosed with LADA, and sex, body mass index, C-peptide, and glycated hemoglobin (HbA1c) levels matched with those of T2D patients. Islet function/sensitivity and sex hormone concentrations were determined at baseline and 1-year follow-up. The primary endpoint was the changes in androgen levels from baseline to 1-year follow-up in patients with LADA. Results Our data showed that TT and Bio-T levels remained unchanged, while FT levels significantly decreased from baseline to 1-year follow-up in patients with T2D. However, TT, Bio-T, and FT concentrations dramatically increased in the LADA group from baseline to 1-year follow-up. Furthermore, a Spearman analysis showed that changes of TT, FT, and Bio-T levels from baseline to endpoint were significantly negatively correlated with Δ homeostasis model assessment-2 IR (ΔHOMA2-IR), respectively. Conclusions The FT change patterns in patients with LADA may differ from those in patients with T2D. Our data also indicated the significant negative correlation between insulin sensitivity and changes of TT, FT, and Bio-T levels along with the diabetic duration in patients with T2D and LADA.
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