Plasma Levels of Intact Parathyroid Hormone and Congestion Burden in Heart Failure: Clinical Correlations and Prognostic Role

Abstract

Circulating parathyroid hormone (PTH) concentrations increase in heart failure (HF) and are related to disease severity. The relationship between PTH and congestion is still a matter of debate. The objective of this analysis was to evaluate the role of PTH as a marker of congestion and prognosis in HF. We enrolled 228 patients with HF. Intact PTH concentrations and HYDRA score (constituted by: B-type natriuretic peptide, blood urea nitrogen–creatinine ratio, estimated plasma volume status, and hydration status) were evaluated. The study endpoint was all-cause mortality. PTH levels were higher in acute compared with chronic HF and in patients with clinical signs of congestion (i.e., peripheral oedema and orthopnea). PTH concentrations significantly correlated with NYHA class and HYDRA score. At multivariate analysis of HYDRA score, estimated glomerular filtration rate (eGFR), and corrected serum calcium were independently determinants of PTH variability. Fifty patients (22%) died after a median follow-up of 408 days (interquartile range: 283–573). Using univariate Cox regression analysis, PTH concentrations were associated with mortality (hazard ratio [HR]: 1.003, optimal cut-off: >249 pg/mL—area under-the-curve = 0.64). Using multivariate Cox regression analysis, PTH was no longer associated with death, whereas HYDRA score, left ventricular ejection fraction, and eGFR acted as independent predictors for mortality (HR: 1.96, 0.97, and 0.98, respectively). Our study demonstrated that intact PTH was related to clinical and subclinical markers of congestion. However, intact PTH did not act as an independent determinant of all-cause death in HF patients.

U-shaped association between serum calcium and in-hospital mortality in diabetes patients with congestive heart failure: a cohort study

“…For example, different types and doses of diuretics, patient enuresis status, and patient resistance to diuretics have a certain impact on the treatment and management of heart failure in patients. And the role of parathyroid hormone is related to calcium serum levels and prognosis of patients with HF 43 . Similarly, we used total serum calcium level rather than corrected values of calcium because it is readily available.…”

Heart Diseases of Uncertain Etiology: A New Definition of Heart Failure for Epidemiological Studies

“…The etiology of HDUE, although probably multiple, is still vague and elusive, and the need of a systematic search seems of great importance. Future investigations need to be stimulated, as we believe it essential to segregate HDUE from CHD when relationships are investigated among risk factors [ 51 ] and outcomes either individually or when multiple definitions (such as in the case of CVD) are adopted for both mortality and incidence [ 52 ]. In fact, mixing up HDUE and IHD/CHD cases might impact, by dilution, results and conclusions and impinge upon the relevance that older and new risk factors might have and/or on their capacity to predict outcomes.…”

Advances in the Use of Conducting Polymers for Healthcare Monitoring

“…Given that thiophene is an electron-rich aromatic ring that can be oxidized, highly conductive PTh can be obtained through p-doping. The electrochemical oxidation process promotes the formation of robust, adherent polymeric films, and the thickness of the polymer films can be varied by varying the polymerization duration in the electropolymerization process [197]. PTh has the advantage of being optically controllable, apart from exhibiting typical CP characteristics.…”