Multiple hormonal and metabolic deficiency syndrome predicts outcome in heart failure: the T.O.S.CA. Registry

Cittadini, Antonio; Salzano, Andrea; Iacoviello, Massimo; Triggiani, Vincenzo; Rengo, Giuseppe; Cacciatore, Francesco; Maiello, Ciro; Limongelli, Giuseppe; Masarone, Daniele; Perticone, Francesco; Cimellaro, Antonio; Filardi, Pasquale Perrone; Paolillo, Stefania; Mancini, Antonio; Volterrani, Maurizio; Vriz, Olga; Castello, R.; Passantino, Andrea; Campo, Michela; Modesti, Pietro Amedeo; Giorgi, Alfredo De; Monte, Ines; Puzzo, A; Ballotta, Andrea; D’Assante, Roberta; Arcopinto, Michele; Gargiulo, Paola; Sciacqua, Angela; Bruzzese, Dario; Colao, Annamaria; Napoli, Raffaele; Suzuki, Toru; Eagle, Kim A.; Ventura, Héctor O.; Marra, Alberto M.; Bossone, Eduardo

doi:10.1093/eurjpc/zwab020

Cited by 33 publications

(27 citation statements)

References 31 publications

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“…As elsewhere described (11), T2D and IR were associated with poor outcome [HF 1.34 (1.03-1.73), p = 0•03]; however, when considered separately, T2D and not IR patients showed a signi cant association with the primary endpoint, reaching 70% of the patients with T2D and 52% in the patients without T2D (P = 0.001). Interestingly, among diabetic patients, those displaying a greater decline in CPET performance (i.e., peak VO 2 ) and right ventricular pulmonary arterial coupling (i.e., TAPSE/PASP) were burdened by a worse prognosis.…”

Section: Discussionmentioning

confidence: 67%

“…However, it is unclear whether the higher mortality observed in patients with diabetes and HF is due to hyperglycaemia per se or whether the presence of IR is already capable of affecting the HF progression. In this regard, data from the TOSCA Registry (10,11) recently con rmed that the presence of insulin impairment (IR de ned by HOMA index > 2.5 or T2D) was signi cantly associated with CV hospitalization and all-cause mortality. Of note, when adjusted for confounders, T2D alone and not HOMA-IR predicted outcome whereas HOMA-IR alone.…”

Section: Introductionmentioning

confidence: 99%

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Progressive right ventricular dysfunction and exercise impairment in patients with heart failure and diabetes mellitus: insights from the T.O.S.CA. Registry

Salzano

D’Assante

Iacoviello

et al. 2022

Preprint

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Background Findings from the T.O.S.CA. Registry recently reported that patients with concomitant chronic heart failure (CHF) and impairment of insulin axis (either insulin resistance- IR or diabetes mellitus- T2D) display increased morbidity and mortality. However, little information is available on the relative impact of IR and T2D on cardiac structure and function, cardiopulmonary performance, and their longitudinal changes in CHF. Methods Patients enrolled in the T.O.S.CA. Registry performed echocardiography and cardiopulmonary exercise test at baseline and at a patient-average follow-up of 36 months. Patients were divided into three groups based on the degree of insulin impairment: euglycemic without IR (EU), euglycemic with IR (IR), and T2D. Results Compared with EU and IR, T2D was associated with increased filling pressures ( E/e’ ratio : 15.9 ± 8.9, 12.0 ± 6.5, and 14.5 ± 8.1 respectively, p < 0.01) and worse right ventricular(RV)-arterial uncoupling (RVAUC) (TAPSE/PASP ratio 0.52 ± 0.2, 0.6 ± 0.3, and 0.6 ± 0.3 in T2D, EU and IR, respectively, p < 0.05). Likewise, impairment in peak oxygen consumption (peak VO2) in TD2 vs EU and IR patients was recorded (respectively, 15.8 ± 3.8 mL/Kg/min, 18.4 ± 4.3 mL/Kg/min and 16.5 ± 4.3 mL/Kg/min, p < 0.003). Longitudinal data demonstrated higher deterioration of RVAUC, RV dimension, and peak VO2 in the T2D group (+ 13% increase in RV dimension, -21% decline in TAPSE/PAPS ratio and − 20% decrease in peak VO2). Conclusion The higher risk of death and CV hospitalizations exhibited by HF-T2D patients in the T.O.S.CA. Registry is associated with progressive RV ventricular dysfunction and exercise impairment when compared to euglycemic CHF patients, supporting the pivotal importance of hyperglycaemia and right chambers in HF prognosis. Trial registration ClinicalTrials.gov identifier: NCT023358017

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Section: Discussionmentioning

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Progressive right ventricular dysfunction and exercise impairment in patients with heart failure and diabetes mellitus: insights from the T.O.S.CA. Registry

Salzano

D’Assante

Iacoviello

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…However, it is unclear whether the higher mortality observed in patients with diabetes and HF is due to hyperglycaemia per se or whether the presence of IR is already capable of affecting the HF progression. In this regard, data from the TOSCA Registry [10,11] recently confirmed that the presence of insulin impairment (IR defined by HOMA index > 2.5 or T2D) was significantly associated with CV hospitalization and all-cause mortality. Of note, when adjusted for confounders, T2D alone and not HOMA-IR predicted outcome whereas HOMA-IR alone.…”

Section: Introductionmentioning

confidence: 94%

“…Study procedures have been previously published in detail [10,11]. In brief, blood samples were collected by venipuncture after overnight fast.…”

Section: Study Proceduresmentioning

confidence: 99%

Progressive right ventricular dysfunction and exercise impairment in patients with heart failure and diabetes mellitus: insights from the T.O.S.CA. Registry

Salzano

D’Assante

Iacoviello

et al. 2022

Cardiovasc Diabetol

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Background Findings from the T.O.S.CA. Registry recently reported that patients with concomitant chronic heart failure (CHF) and impairment of insulin axis (either insulin resistance—IR or diabetes mellitus—T2D) display increased morbidity and mortality. However, little information is available on the relative impact of IR and T2D on cardiac structure and function, cardiopulmonary performance, and their longitudinal changes in CHF. Methods Patients enrolled in the T.O.S.CA. Registry performed echocardiography and cardiopulmonary exercise test at baseline and at a patient-average follow-up of 36 months. Patients were divided into three groups based on the degree of insulin impairment: euglycemic without IR (EU), euglycemic with IR (IR), and T2D. Results Compared with EU and IR, T2D was associated with increased filling pressures (E/e′ratio: 15.9 ± 8.9, 12.0 ± 6.5, and 14.5 ± 8.1 respectively, p < 0.01) and worse right ventricular(RV)-arterial uncoupling (RVAUC) (TAPSE/PASP ratio 0.52 ± 0.2, 0.6 ± 0.3, and 0.6 ± 0.3 in T2D, EU and IR, respectively, p < 0.05). Likewise, impairment in peak oxygen consumption (peak VO2) in TD2 vs EU and IR patients was recorded (respectively, 15.8 ± 3.8 ml/Kg/min, 18.4 ± 4.3 ml/Kg/min and 16.5 ± 4.3 ml/Kg/min, p < 0.003). Longitudinal data demonstrated higher deterioration of RVAUC, RV dimension, and peak VO2 in the T2D group (+ 13% increase in RV dimension, − 21% decline in TAPSE/PAPS ratio and − 20% decrease in peak VO2). Conclusion The higher risk of death and CV hospitalizations exhibited by HF-T2D patients in the T.O.S.CA. Registry is associated with progressive RV ventricular dysfunction and exercise impairment when compared to euglycemic CHF patients, supporting the pivotal importance of hyperglycaemia and right chambers in HF prognosis. Trial registration ClinicalTrials.gov identifier: NCT023358017

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“…28-3.83), p = 0.01]. The more the number of HDs, the more the cumulative risk of worse prognosis [18].…”

Section: Hormonal Disorders In Chf Patientsmentioning

confidence: 99%

Endocrine system dysfunction and chronic heart failure: a clinical perspective

et al. 2021

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Chronic heart failure (CHF) leads to an excess of urgent ambulatory visits, recurrent hospital admissions, morbidity, and mortality regardless of medical and non-medical management of the disease. This excess of risk may be attributable, at least in part, to comorbid conditions influencing the development and progression of CHF. In this perspective, the authors examined and described the most common endocrine disorders observed in patients with CHF, particularly in individuals with reduced ejection fraction, aiming to qualify the risks, quantify the epidemiological burden and discuss about the potential role of endocrine treatment. Thyroid dysfunction is commonly observed in patients with CHF, and sometimes it could be the consequence of certain medications (e.g., amiodarone). Male and female hypogonadism may also coexist in this clinical context, contributing to deteriorating the prognosis of these patients. Furthermore, growth hormone deficiency may affect the development of adult myocardium and predispose to CHF. Limited recommendation suggests to screen endocrine disorders in CHF patients, but it could be interesting to evaluate possible endocrine dysfunction in this setting, especially when a high suspicion coexists. Data referring to long-term safety and effectiveness of endocrine treatments in patients with CHF are limited, and their impact on several “hard” endpoints (such as hospital admission, all-cause, and cardiovascular mortality) are still poorly understood.

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Multiple hormonal and metabolic deficiency syndrome predicts outcome in heart failure: the T.O.S.CA. Registry

Cited by 33 publications

References 31 publications

Progressive right ventricular dysfunction and exercise impairment in patients with heart failure and diabetes mellitus: insights from the T.O.S.CA. Registry

Progressive right ventricular dysfunction and exercise impairment in patients with heart failure and diabetes mellitus: insights from the T.O.S.CA. Registry

Progressive right ventricular dysfunction and exercise impairment in patients with heart failure and diabetes mellitus: insights from the T.O.S.CA. Registry

Endocrine system dysfunction and chronic heart failure: a clinical perspective

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