Anabolic hormones and heart failure with preserved ejection fraction: looking for Ariadne’s thread

Q: What is the clinical evidence from this study?

Study design: Review. Population: Heart failure with preserved ejection fraction (HFpEF). Intervention: Hormonal biomarkers (NPs, Testosterone, DHEA-S, IGF-1, Thyroid hormones).

Mariarosaria De Luca; Giulia Crisci; Federica Giardino; Valeria Valente; Ilaria Amaranto; Olimpia Iacono; Roberta D’Assante; Francesco Giallauria; Alberto M. Marra

doi:10.4081/monaldi.2021.1743

August 3, 2021Monaldi Archives for Chest DiseaseOpen Access

Anabolic hormones and heart failure with preserved ejection fraction: looking for Ariadne’s thread

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Key result

Anabolic hormone deficiencies emerge as prevalent biomarkers and potential therapeutic targets in HFpEF.

Why the study?

HFpEF is a complex syndrome with no targeted treatment and debated clinical utility of multi-hormonal biomarkers for diagnosis and prognosis.

Structured PICO

P

Population

Patients with heart failure with preserved ejection fraction (HFpEF)

Anabolic hormone deficiencies, including testosterone, DHEA-S, and thyroid hormones, may serve as novel prognostic biomarkers for risk stratification in patients with heart failure with preserved ejection fraction.

Limitations

Lack of large longitudinal studies to confirm the prognostic value of low testosterone and DHEA-S levels in HFpEF
Lack of specific clinical trials focused on thyroid hormone supplementation in HFpEF patients
The clinical utility of several emerging hormonal biomarkers remains debated

Implication

May aid HFpEF risk stratification; leaves open whether hormone repletion alters outcomes.

Abstract

Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome that accounts for more than half of all heart failure patients. Identification, early diagnosis and management of patients are still complex, and no targeted treatment is available, since all tested drugs were not able to lower hard clinical outcomes. A multi-hormonal deficiency syndrome has been described in HFpEF patients suggesting that different hormones may represent new biomarkers of the disease, but their clinical utility is still debated. The natriuretic peptides are the cornerstone biomarker in heart failure, predicting cardiovascular death and heart failure hospitalization. Testosterone and DHEA-S deficiencies have been reported in HFpEF and associated with right ventricular impairment and diastolic dysfunction. IGFBP-1/IGF-1 axis correlates with echocardiographic parameters of HFpEF patients and with several prognostic biomarkers including NT-proBNP and C reactive protein. Low triiodothyronine syndrome is frequently found in HFpEF and thyroid hormones should represent a potential biomarker of risk stratification and prognosis.

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Cite This Study

Luca et al. (2021) conducted a review in Heart failure with preserved ejection fraction (HFpEF). Hormonal biomarkers (NPs, Testosterone, DHEA-S, IGF-1, Thyroid hormones) was evaluated. Anabolic hormone deficiencies, including testosterone, IGF-1, and thyroid hormones, are prevalent in HFpEF and may serve as novel biomarkers for diagnosis, prognosis, and therapeutic targets.

synapsesocial.com/papers/6aacff48dc117c478f48852a https://doi.org/10.4081/monaldi.2021.1743