Abstract 13608: Parathyroid Hormone as Predictor of Cardiac Function and Outcome in Individuals With Heart Failure - Results From the MyoVasc Study

• Published in: Circulation (New York, N.Y.) Vol. 140; no. Suppl_1 Suppl 1; p. A13608
• Main Authors: Müller, Felix, Heidorn, Marc W, Troebs, Sven Oliver, Hermanns, Iris, Steck, Stefanie, Schwuchow-Thonke, Soeren, Schulz, Andreas, Göbel, Sebastian, Panova-Noeva, Marina, Wagner, Bianca, Koeck, Thomas, Rapp, Steffen, Lackner, Karl J, Gori, Tommaso, Münzel, Thomas, Wild, Philipp S, Prochaska, Jürgen H
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 19.11.2019
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.140.suppl_1.13608

BackgroundAlthough mounting evidence links excess parathyroid hormone (PTH) concentrations to the development and progression of the heart failure (HF) syndrome, comprehensive data on the relevance of PTH for HF-specific clinical outcome are scarce.MethodsA sample of 2,000 participants of the MyoVasc study, a prospective cohort study on HF, underwent extensive clinical phenotyping including echocardiography. PTH concentrations were measured via a commercially available immunoassay (Diasorin, Italy). The relevance of PTH concentrations for cardiac structure and function, and for HF-specific outcome was investigated by multivariable regression models.ResultsIn total N=1,888 individuals (age 66.6±9.9, 28.5% female) were available for analysis. Symptomatic HF was present in 58.7%. In multivariable regression analysis adjusted for age, sex, vitamin D status as well as season, cardiovascular risk factors (CVRF), renal function, clinical profile, cardiac structure and function, the increase of PTH concentration by 1 standard deviation (SD) independently predicted worse left ventricular (LV) ejection fraction (βper SD=-0.67 [-1.18;-0.16], p=0.01), diastolic function (E/E’, βper SD=0.35 [0.04;0.67], p=0.027) and increased LV mass/height (βperSD=0.85 [0.04;1.65], p=0.039). During a follow up of 3 years, PTH constituted a robust predictor of worsening of HF independent of age, sex, vitamin D status, season, CVRF, renal function, and clinical profile (hazard ratio (HR) per SD=1.20 [1.07;1.36], p=0.003). Similarly, PTH was associated with a 1.3-fold increased risk for HF hospitalization (HRper SD=1.31 [1.07;1.6], p=0.01) and cardiac death (HRper SD=1.31 [1.06;1.63], p=0.014) per SD increase. Analytical adjustment for cardiac structure and function attenuated this association (HRper SD=1.12 [0.98;1.28], p=0.093 for worsening of HF), demonstrating that the effect of PTH on HF outcome is mainly explained by cardiac structural and functional alterations.ConclusionPTH is an independent predictor of HF-specific outcome. This association is likely mediated by its direct myocardial effects. Investigating secondary hyperparathyroidism in distinct HF phenotypes may advance our etiological understanding of the HF syndrome.