Purpose: In heart failure with reduced ejection fraction, catabolic mechanisms have a
strong negative impact on mortality and morbidity. The relationship between anabolic
hormonal deficiency and heart failure with preserved ejection fraction (HFpEF) has still
been poorly investigated. On the other hand, oxidative stress is recognized as a player in
the pathogenesis of HFpEF. Therefore, we performed a cohort study in HFpEF aimed to
(1) define the multi-hormonal deficiency prevalence in HFpEF patients; (2) investigate the
relationships between hormonal deficiencies and echocardiographic indexes; (3) explore
the modulatory activity of anabolic hormones on antioxidant systems.
Methods: 84 patients with diagnosis of HFpEF were enrolled in the study. Plasma
levels of N-terminal pro-brain natriuretic peptide, fasting glucose, insulin, lipid pattern,
insulin-like growth factor-1, dehydroepiandrosterone-sulfate (DHEA-S), total testosterone
(T, only in male subjects) were evaluated. Hormonal deficiencies were defined according
to T.O.S.C.A. multi-centric study, as previously published. An echocardiographic
evaluation was performed. Plasma total antioxidant capacity (TAC) was measured
using the system metmyoglobin –H2O2 and the chromogen ABTS, whose radical
form is spectroscopically revealed; latency time (LAG) in the appearance of ABTS• is
proportional to antioxidants in sample.
Results: Multiple deficiencies were discovered. DHEA-S deficiency in 87% of patients,
IGF-1 in 67% of patients, T in 42%. Patients with DHEA-S deficiency showed
lower levels of TAC expressed by LAG (mean ± SEM 91.25 ± 9.34 vs. 75.22 ±
4.38 s; p < 0.05). No differences between TAC in patients with or without IGF-1
deficiency were found. A trend toward high level of TAC in patients without hormonal
deficiencies compared with patients with one or multiple deficiencies was found.
Regarding echocardiographic parameters, Left Atrial and Left Atrial Volume Index were
significantly higher in patients with low IGF-1 values (mean ± SD 90.84 ± 3.86 vs.
72.83 ± 3.78mL; 51.03 ± 2.33 vs. 40.56 ± 2.46 mL/m2, respectively; p < 0.05).
Conclusions: Our study showed high prevalence of anabolic deficiencies in HFpEF.
DHEA-S seems to influence antioxidant levels; IGF-1 deficiency was associated with
alteration in parameters of myocardial structure and dysfunction. These data suggest a
role of anabolic hormones in the complex pathophysiological mechanisms of HFpEF and
could represent the basis for longitudinal studies and investigations on possible benefits
of replacement therapy.
|Number of pages||8|
|Journal||Frontiers in Endocrinology|
|Publication status||Published - 2020|