Endocrine Abstracts

Background: In heart failure with reduced ejection fraction (HFrEF), catabolic mechanisms have a strong negative impact on morbidity and mortality. The relationship between anabolic hormonal deficit, thyroid function and heart failure with preserved ejection fraction (HFpEF) has still been poorly investigated. For this reason, we tried to define the prevalence of multi-hormonal deficiencies in HFpEF patients and the relationships between hormonal deficits and echocardiographic indexes.

Materials and methods: 40 patients, 27 men and 13 women, aged 59–92 years, were enrolled. Mean BMI was 28.22±4.96 kg/mq. Thirty-six patients showed a moderate degree of diastolic dysfunction (90%) and four patients a mild grade one (10%). Twenty-nine patients (72.5%) were in NYHA III functional class, eleven in NYHA II functional class (27.5%). After an overnight fast, a basal sample was collected for evaluation of N-terminal pro-brain natriuretic peptide, fasting glucose, thyroid-stimulating hormone, free triiodothyronine, free thyroxine, insulin-like growth factor-1, dehydroepiandrosterone-sulfate, total testosterone (only in male subjects). An echocardiography evaluation was performed.

Results: Only one patient (2.5%) did not exhibit hormonal deficit, eight patients (20%) had deficit of one hormone, 18 patients (45%) of two axes, 12 patients (30%) of three axes, one patient (2.5%) of all four axes. Among them: 97.5% had DHEAS deficiency, 67.5% IGF-1 deficiency, 37% testosterone deficiency, 22.5% a ‘Low-T3 syndrome’, 20% subclinical hypothyroidism. Patients with IGF-1 deficit showed higher values of left atrial volume, of systolic pulmonary artery pressure (SPAP), of tricuspidal peak velocity (TPV), and lower values of tricuspid annular plane systolic excursion (TAPSE) and TAPSE/SPAP ratio. Patients with testosterone deficiency had higher SPAP and TPV; patients with low T3 syndrome had higher value of right ventricular mid cavity diameter. Hormonal dysfunction was independent from the presence of comorbidities, and there was no difference between male and female subjects.

Conclusions: Multi-hormonal deficits are associated with right ventricular dysfunction and diastolic dysfunction in patients with HFpEF. Therefore they can be considered as an independent factor negatively influencing natural history of the syndrome.