Jankowska Ewa A, Filippatos Gerasimos, Ponikowska Beata, Borodulin-Nadzieja Ludmila, Anker Stefan D, Banasiak Waldemar, Poole-Wilson Philip A, Ponikowski Piotr
Cardiology Department, Military Hospital, Wroclaw, Poland.
J Card Fail. 2009 Jun;15(5):442-50. doi: 10.1016/j.cardfail.2008.12.011. Epub 2009 Feb 10.
We investigated whether anabolic deficiency was linked to exercise intolerance in men with chronic heart failure (CHF). Anabolic hormones (testosterone, dehydroepiandrosterone sulfate, insulin-like growth factor 1 [IGF1]) contribute to exercise capacity in healthy men. This issue remains unclear in CHF.
We studied 205 men with CHF (age 60 +/- 11 years, New York Heart Association [NYHA] Class I/II/III/IV: 37/95/65/8; LVEF [left ventricular ejection fraction]: 31 +/- 8%). Exercise capacity was expressed as peak oxygen consumption (peak VO(2)), peak O(2) pulse, and ventilatory response to exercise (VE-VCO(2) slope). In multivariable models, reduced peak VO(2) (and reduced peak O(2) pulse) was associated with diminished serum total testosterone (TT) (P < .01) and free testosterone (eFT; estimated from TT and sex hormone globulin levels) (P < .01), which was independent of NYHA Class, plasma N-terminal pro-brain natriuretic peptide, and age. These associations remained significant even after adjustment for an amount of leg lean tissue. In multivariable models, high VE-VCO(2) slope was related to reduced serum IGF1 (P < .05), advanced NYHA Class (P < .05), increased plasma NT-proBNP (P < .0001), and borderline low LVEF (P = .07). In 44 men, reassessed after 2.3 +/- 0.4 years, a reduction in peak VO(2) (and peak O(2) pulse) was accompanied by a decrease in TT (P < .01) and eFT (P <or= .01). Increase in VE-VCO(2) slope was related only to an increase in plasma NT-proBNP (P < .05).
In men with CHF, low circulating testosterone independently relates to exercise intolerance. The greater the reduction of serum TT in the course of disease, the more severe the progression of exercise intolerance. Whether testosterone supplementation would improve exercise capacity in hypogonadal men with CHF requires further studies.
我们研究了合成代谢不足是否与慢性心力衰竭（CHF）男性的运动不耐受有关。合成代谢激素（睾酮、硫酸脱氢表雄酮、胰岛素样生长因子1[IGF1]）有助于健康男性的运动能力。在CHF中，这个问题仍不明确。
我们研究了205名CHF男性（年龄60±11岁，纽约心脏协会[NYHA]心功能分级I/II/III/IV：37/95/65/8；左心室射血分数[LVEF]：31±8%）。运动能力用峰值耗氧量（peak VO₂）、峰值氧脉搏和运动通气反应（VE-VCO₂斜率）表示。在多变量模型中，peak VO₂降低（以及峰值氧脉搏降低）与血清总睾酮（TT）降低（P<.01）和游离睾酮（eFT；根据TT和性激素结合球蛋白水平估算）降低（P<.01）相关，这与NYHA心功能分级、血浆N末端脑钠肽前体和年龄无关。即使在调整腿部瘦组织量后，这些关联仍然显著。在多变量模型中，高VE-VCO₂斜率与血清IGF1降低（P<.05）、NYHA心功能分级进展（P<.05）、血浆NT-proBNP升高（P<.0001）以及临界低LVEF（P=.07）相关。在44名男性中，经过2.3±0.4年重新评估，peak VO₂（和峰值氧脉搏）降低伴随着TT降低（P<.01）和eFT降低（P≤.01）。VE-VCO₂斜率增加仅与血浆NT-proBNP升高（P<.05）相关。
在CHF男性中，低循环睾酮独立与运动不耐受相关。疾病过程中血清TT降低越多，运动不耐受进展越严重。睾酮补充是否能改善性腺功能减退的CHF男性的运动能力需要进一步研究。
