Nägele Matthias P, Barthelmes Jens, Kreysing Leonie, Haider Thomas, Nebunu Delia, Ruschitzka Frank, Sudano Isabella, Flammer Andreas J
Cardiology University Heart Center Zurich, University Hospital Zurich Zurich Switzerland.
Health Sci Rep. 2022 Oct 28;5(6):e880. doi: 10.1002/hsr2.880. eCollection 2022 Nov.
Sustained neurohormonal activation plays a central role in the progression of heart failure (HF). Other endocrine axes may also be affected. It was the aim of this study to examine the endocrine profile (thyroid, parathyroid, glucocorticoid, and sex hormones) in a contemporary sample of patients with HF and reduced ejection fraction (EF) on established disease-modifying therapy.
This study prospectively measured morning fasting hormones in 52 ambulatory and stable HF patients with EF < 50% on disease-modifying therapy (mean age 63 ± 11 years, 29% female, mean LVEF 32 ± 9.6%) and compared them to 54 patients at elevated risk for HF (61 ± 12 years, 28% female) and 62 healthy controls (HC; 61 ± 13 years, 27% female). Main comparisons were performed using one-way analysis of variance. Associations with biomarkers were studied with linear regression.
HF patients showed a reduced free triiodothyronine (fT3)/free thyroxine (fT4) ratio compared to HC (0.30 ± 0.06 vs. 0.33 ± 0.05, = 0.046). Parathyroid hormone (PTH) and cortisol were increased in HF compared to both HC (median [IQR] 59 [50-84] vs. 46 [37-52] ng/L, < 0.001 and 497 ± 150 vs. 436 ± 108 nmol/L, = 0.03, respectively) and patients at risk (both < 0.001). Total testosterone was reduced in male HF compared to HC (14.4 ± 6.6 vs. 18.6 ± 5.3 nmol/L; = 0.01). No differences in TSH, estradiol, progesterone, and prolactin were found. Lower fT3 levels were found in HF with EF < 40% versus EF 40%-49% (4.6 ± 0.3 vs. 5.2 ± 0.7 pmol/L, = 0.009). In HF patients, fT3 was an independent predictor of NT-proBNP and high-sensitivity troponin T in multiple regression analysis. PTH was positively associated with NT-proBNP.
There is evidence of endocrine hormonal imbalance in HF with reduced EF beyond principal neurohormones and despite the use of disease-modifying therapy.
持续的神经激素激活在心力衰竭（HF）进展中起核心作用。其他内分泌轴也可能受到影响。本研究旨在检查接受既定疾病改善治疗、射血分数（EF）降低的HF患者当代样本中的内分泌谱（甲状腺、甲状旁腺、糖皮质激素和性激素）。
本研究前瞻性测量了52例接受疾病改善治疗、EF<50%的门诊稳定HF患者（平均年龄63±11岁，29%为女性，平均左心室射血分数[LVEF]32±9.6%）的清晨空腹激素水平，并将其与54例HF高危患者（61±12岁，28%为女性）和62例健康对照者（HC；61±13岁，27%为女性）进行比较。主要比较采用单因素方差分析。通过线性回归研究与生物标志物的关联。
与HC相比，HF患者的游离三碘甲状腺原氨酸（fT3）/游离甲状腺素（fT4）比值降低（0.30±0.06 vs. 0.33±0.05，P = 0.046）。与HC（中位数[四分位间距]59[50 - 84] vs. 46[37 - 52] ng/L，P<0.001）和高危患者相比，HF患者的甲状旁腺激素（PTH）和皮质醇均升高（两者P<0.001）。与HC相比，男性HF患者的总睾酮降低（14.4±6.6 vs. 18.6±5.3 nmol/L；P = 0.01）。未发现促甲状腺激素（TSH）、雌二醇、孕酮和催乳素存在差异。EF<40%的HF患者的fT3水平低于EF为40% - 49%的患者（4.6±0.3 vs. 5.2±0.7 pmol/L，P = 0.009）。在HF患者中，多元回归分析显示fT3是N末端脑钠肽前体（NT-proBNP）和高敏肌钙蛋白T的独立预测因子。PTH与NT-proBNP呈正相关。
有证据表明，在EF降低的HF患者中，除主要神经激素外，尽管使用了疾病改善治疗，但仍存在内分泌激素失衡。
