Key result
Multiple hormonal and metabolic deficiency syndrome linked to ~93% higher mortality and CV hospitalizations.
Why the study?
Multiple hormonal and metabolic deficiency syndrome occurs in chronic heart failure, but no large observational study had unequivocally demonstrated its impact on progression and outcomes.
Does multiple hormonal and metabolic deficiency syndrome (MHDS) predict increased all-cause mortality and cardiovascular hospitalizations in patients with heart failure (EF ≤45%)?
Observational (n=480)
Yes
Does multiple hormonal and metabolic deficiency syndrome (MHDS) predict increased all-cause mortality and cardiovascular hospitalizations in patients with heart failure (EF ≤45%)?
Hazard Ratio: 1.93 (95% CI 1.37–2.73)
Absolute Event Rate: 62% vs 41%
p-value: p=<0.001
Multiple hormonal and metabolic deficiency syndrome is common in chronic heart failure and independently predicts increased all-cause mortality and cardiovascular hospitalizations.
Should not yet guide HF management; leaves open whether MHDS screening or intervention improves outcomes.
AIMS: Recent evidence supports the occurrence of multiple hormonal and metabolic deficiency syndrome (MHDS) in chronic heart failure (CHF). However, no large observational study has unequivocally demonstrated its impact on CHF progression and outcome. The T.O.S.CA. (Trattamento Ormonale nello Scompenso CArdiaco; Hormone Treatment in Heart Failure) Registry has been specifically designed to test the hypothesis that MHDS affects morbidity and mortality in CHF patients. METHODS AND RESULTS: The T.O.S.CA. Registry is a prospective, multicentre, observational study involving 19 Italian centres. Thyroid hormones, insulin-like growth factor-1, total testosterone, dehydropianoandrosterone sulfate, insulin resistance, and the presence of diabetes were evaluated. A MHDS was defined as the presence of ≥2 hormone deficiencies (HDs). Primary endpoint was a composite of all-cause mortality and cardiovascular hospitalizations. Four hundred and eighty heart failure patients with ejection fraction ≤45% were enrolled. MHDS or diabetes was diagnosed in 372 patients (77.5%). A total of 271 events (97 deaths and 174 cardiovascular hospitalizations) were recorded, 41% in NO-MHDS and 62% in MHDS (P < 0.001). Median follow-up was of 36 months. MHDS was independently associated with the occurrence of the primary endpoint [hazard ratio 95% (confidence interval), 1.93 (1.37-2.73), P < 0.001] and identified a group of patients with a higher mortality [2.2 (1.28-3.83), P = 0.01], with a graded relation between HDs and cumulative events (P < 0.01). CONCLUSION: MHDS is common in CHF and independently associated with increased all-cause mortality and cardiovascular hospitalization, representing a promising therapeutic target. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT023358017.
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Cittadini et al. (2021) conducted an observational in chronic heart failure (n=480). Multiple hormonal and metabolic deficiency syndrome (MHDS) vs. No MHDS was evaluated on composite of all-cause mortality and cardiovascular hospitalizations (HR 1.93, 95% CI 1.37-2.73, p=<0.001). Multiple hormonal and metabolic deficiency syndrome increased the risk of all-cause mortality and cardiovascular hospitalizations compared to no MHDS (HR 1.93; 95% CI 1.37-2.73; P<0.001).
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