Abstract
Background
Testosterone deficiency in patients with heart failure (HF) is associated with
decreased exercise capacity and mortality; however, its impact on hospital
readmission rate is uncertain. Furthermore, the relationship between testosterone
deficiency and sympathetic activation is unknown.
Objective
We investigated the role of testosterone level on hospital readmission and
mortality rates as well as sympathetic nerve activity in patients with HF.
Methods
Total testosterone (TT) and free testosterone (FT) were measured in 110
hospitalized male patients with a left ventricular ejection fraction < 45% and
New York Heart Association classification IV. The patients were placed into low
testosterone (LT; n = 66) and normal testosterone (NT; n = 44) groups.
Hypogonadism was defined as TT < 300 ng/dL and FT < 131 pmol/L. Muscle
sympathetic nerve activity (MSNA) was recorded by microneurography in a
subpopulation of 27 patients.
Results
Length of hospital stay was longer in the LT group compared to in the NT group (37
± 4 vs. 25 ± 4 days; p = 0.008). Similarly, the cumulative hazard of readmission
within 1 year was greater in the LT group compared to in the NT group (44% vs.
22%, p = 0.001). In the single-predictor analysis, TT (hazard ratio [HR], 2.77;
95% confidence interval [CI], 1.58–4.85; p = 0.02) predicted hospital readmission
within 90 days. In addition, TT (HR, 4.65; 95% CI, 2.67–8.10; p = 0.009) and
readmission within 90 days (HR, 3.27; 95% CI, 1.23–8.69; p = 0.02) predicted
increased mortality. Neurohumoral activation, as estimated by MSNA, was
significantly higher in the LT group compared to in the NT group (65 ± 3 vs. 51 ±
4 bursts/100 heart beats; p < 0.001).
Conclusion
These results support the concept that LT is an independent risk factor for
hospital readmission within 90 days and increased mortality in patients with HF.
Furthermore, increased MSNA was observed in patients with LT.
Collapse