Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY 10032, USA.
Eur J Heart Fail. 2012 Dec;14(12):1356-65. doi: 10.1093/eurjhf/hfs138. Epub 2012 Sep 18.
Abnormal bone metabolism and progressive demineralization have been described in patients with heart failure (HF). We hypothesized that mechanical unloading through implantation of a ventricular assist device (VAD) with subsequent haemodynamic improvement would correct abnormal bone metabolism in patients with advanced HF.
Serum was collected from 14 controls, 20 patients with moderate HF, 34 patients with advanced HF undergoing VAD implantation, and 34 patients at the time of VAD explantation (mean duration: 169 ± 125 days). Bone metabolism markers were measured using enzyme-linked immunosorption assay (ELISA) or chemiluminescence immunoassay (CLIA). Compared with controls, HF patients showed increased parathyroid hormone (PTH: 42 ± 19 vs. 117 ± 117 pg/mL in HF; P < 0.02) with decreased 25-hydroxyvitamin D [25(OH)D: 29 ± 14 vs. 21 ± 11 ng/mL in HF; P = 0.05]. While procollagen-1 N-terminal peptide (P1NP) and osteocalcin were similar, cross-linked C- and N-telopeptides of type I collagen (CTX and NTX) were both higher in HF (NTX: 14 ± 6 vs. 20 ± 11 ng/mL; P < 0.05; CTX: 0.35 ± 0.13 vs. 1.05 ± 0.78 ng/mL; P < 0.01 for controls and HF, respectively). P1NP increased markedly after VAD implantation (49 ± 37 vs. 121 ± 62 ng/mL; P < 0.0001), with a mild decrease in CTX and NTX levels indicating a shift towards anabolic bone formation. Serum PTH correlated with estimated glomerular filtration rate (r = -0.245, P < 0.05).
Patients with advanced HF are characterized by increased levels of biochemical markers of bone resorption potentially as a result of secondary hyperparathyroidism and uncoupling of bone remodelling. Haemodynamic improvement and mechanical unloading after VAD implantation lead to correction of bone metabolism and increased levels of anabolic bone formation markers.
心力衰竭（HF）患者存在异常的骨代谢和进行性脱矿。我们假设，通过植入心室辅助装置（VAD）实现机械卸载，并随后改善血液动力学，将纠正晚期 HF 患者的异常骨代谢。
从 14 名对照者、20 名中度 HF 患者、34 名接受 VAD 植入的晚期 HF 患者和 34 名 VAD 取出时的患者（平均持续时间：169±125 天）采集血清。使用酶联免疫吸附测定（ELISA）或化学发光免疫测定（CLIA）测量骨代谢标志物。与对照组相比，HF 患者的甲状旁腺激素（PTH）升高（42±19 vs. 117±117 pg/mL 在 HF 中；P<0.02），25-羟维生素 D[25（OH）D]降低（29±14 vs. 21±11 ng/mL 在 HF 中；P=0.05）。虽然原胶原-1 N 端肽（P1NP）和骨钙素相似，但 I 型胶原交联 C 和 N 末端肽（CTX 和 NTX）在 HF 中均升高（NTX：14±6 vs. 20±11 ng/mL；P<0.05；CTX：0.35±0.13 vs. 1.05±0.78 ng/mL；P 分别<0.01 和<0.05 用于对照和 HF）。VAD 植入后 P1NP 显著增加（49±37 vs. 121±62 ng/mL；P<0.0001），CTX 和 NTX 水平略有下降，表明向合成代谢骨形成转变。血清 PTH 与估计肾小球滤过率（r=-0.245，P<0.05）相关。
晚期 HF 患者的生化标志物骨吸收水平升高，可能是继发性甲状旁腺功能亢进和骨重塑脱偶联的结果。VAD 植入后血液动力学改善和机械卸载导致骨代谢纠正和合成代谢骨形成标志物水平升高。
