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Secondary hyperparathyroidism prevalence and prognostic role in elderly males with heart failure

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Abstract

Aim

Evaluation of secondary hyperparathyroidism (SHPT) and its prognostic impact on all-cause mortality in elderly males with heart failure (HF).

Methods

Seventy three males (67 ± 7 years old) with systolic HF were included. Baseline PTH was measured. Patients were grouped according to PTH cut-off levels of 65 pg/ml (>65 pg/ml = SHPT vs. normal PTH). All-cause mortality was evaluated at 6-year follow-up.

Results

SHPT was diagnosed in 43 (59 %) patients. They were more severe compared to the patients with normal PTH regarding NYHA functional class (2.4 ± 0.5 vs. 2.1 ± 0.2, p = 0.001), quality of life score (34 ± 14 vs. 24 ± 12, p = 0.005), 6-min walking distance (378 ± 79 vs. 446 ± 73 m, p < 0.0001), left ventricular ejection fraction (27 ± 8 vs. 31 ± 7 %, p = 0.019), and NT-proBNP [2452 (3399) vs. 918 (1372) pg/ml, p < 0.0001]. No differences in age, vitamin D status, and renal function were noted between studied groups. A total of 41 (56 %) patients died within 6 years of follow-up. Kaplan–Meier survival analysis showed impaired long-term survival in patients with SHPT versus patients with normal PTH (p = 0.009). The rate of death was highest (75 %) in the group of patients with SHPT and NT-proBNP levels above median value (p = 0.003). Cox regression analysis demonstrated that NT-proBNP was the single independent predictor of all-cause mortality at 6-year follow-up [HR 3.698 (1.927–7.095), p < 0.0001].

Conclusion

SHPT was highly prevalent in elderly males with HF and was associated with impaired survival. HF patients with SHPT had more severe disease compared to the patients with normal serum PTH. Determination of serum PTH levels provided additional value to NT-proBNP for risk stratification in these patients.

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Abbreviations

25OHD:

25-Hydroxy vitamin D

CrCl:

Creatinine clearance

LVEF:

Left ventricular ejection fraction

NT-proBNP:

N-terminal pro-brain natriuretic peptide

NYHA:

New York Heart Association

PTH:

Parathyroid hormone

SHPT:

Secondary hyperparathyroidism

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Acknowledgments

This work was supported by Serbian Ministry of Science (Grant 175033).

Author information

Authors and Affiliations

  1. Cardiology Department, Clinical Hospital Zvezdara, Dimitrija Tucovica 161, Belgrade, 11 000, Serbia

    G. Loncar & N. Cvetinovic

  2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia

    G. Loncar, B. Putnikovic & V. Popovic

  3. Institute for Medical Research, Military Medical Academy, Belgrade, Serbia

    B. Bozic

  4. Institute for Physiology and Biochemistry, University of Belgrade, Belgrade, Serbia

    B. Bozic

  5. Department of Cardiology, Campus Virchow, Charité Universitätsmedizin Berlin, Berlin, Germany

    H.-D. Dungen & T. Trippel

  6. Departments of Cardiology and Research and Education, General Hospital Celje, Celje, Slovenia

    M. Lainscak

  7. Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia

    M. Lainscak

  8. Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Medicine Göttingen, Göttingen, Germany

    S. von Haehling

  9. Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Campus Virchow-Klinikum, Berlin, Germany

    S. von Haehling

  10. Center for Stroke Research Berlin, Charite University Medical School, Berlin, Germany

    W. Doehner

  11. Institute for Statistics, Faculty of Organizational Sciences, University of Belgrade, Belgrade, Serbia

    Z. Radojicic

  12. Cardiology Department, Clinical Hospital Center Zemun, Belgrade, Serbia

    B. Putnikovic

  13. Institute of Endocrinology, Clinical Center of Serbia, Belgrade, Serbia

    V. Popovic

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  1. G. Loncar
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  2. B. Bozic
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  8. Z. Radojicic
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Correspondence to G. Loncar.

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The authors declare no conflict of interest.

Ethical approval

The study was conducted according to the principles outlined in the Declaration of Helsinki. The Ethics Committee of Clinical Hospital Zvezdara approved the study protocol, and all participants gave their written consent.

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Written informed consent was obtained from all patients prior to inclusion into the study.

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Loncar, G., Bozic, B., Cvetinovic, N. et al. Secondary hyperparathyroidism prevalence and prognostic role in elderly males with heart failure. J Endocrinol Invest 40, 297–304 (2017). https://doi.org/10.1007/s40618-016-0561-2

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  • DOI: https://doi.org/10.1007/s40618-016-0561-2

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