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Objective To assess the impact of serum intact parathyroid hormone (PTH) levels on haemodynamic state and their relations by comparing plasma B-type natriuretic peptide (BNP) levels.
Design Cross-sectional study in molecular epidemiology.
Setting Mie University Hospital, Tsu, Japan.
Patients Consecutive 105 patients with chronic heart failure (CHF)...
Citations
... Nevertheless, the in-depth evaluation of the possible association of PTH with congestion status in HF is still a matter of debate and there is scarce evidence in the current literature. Higher PTH plasma concentrations were related to worse New York Heart Association (NYHA) class [5,[15][16][17][18][19], the increase in N-terminal Pro-B-Type Natriuretic Peptide (NT-pro BNP) [5,7,[15][16][17][19][20][21] and BNP [19,21,22], the severity of lower extremity oedema [23], augmentation in pulmonary capillary wedge pressure, and reduction of stroke volume index/cardiac index [24]. No data actually exist about the possible link to other well-established congestion biomarkers in HF such as those derived from bioimpedance vector analysis (BIVA), intravascular signs of congestion such as plasma volume status, and/or venous markers of congestion such as blood urea nitrogen to creatinine ratio (BUN/Cr ratio) [25]. ...
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.
... Hagström et al. demonstrated that high PTH levels can predict nonischemic heart failure (HF), and higher plasma parathyroid levels were significantly correlated with the advanced New York Heart Association (NYHA) level [5]. Meanwhile, plasma PTH level may have a positive value in the diagnostic criteria of HF [6,7]. Several mechanisms may contribute to HF in high PTH circumstances, such as specific vascular endothelial dysfunction promotion and atherosclerosisinduced cardiac ischemia, or direct detrimental myocardial effects such as myocyte hypertrophy and fibrosis [5]. ...
Background:
Secondary hyperparathyroidism is a common complication of end-stage renal disease (ESRD), which may be associated with cardiovascular diseases. Thus, this study aimed to explore myocardial damage using non-contrast cardiovascular magnetic resonance (CMR) in ESRD patients undergoing hemodialysis and further investigate its relationship with parathyroid hormone (PTH) toxicity.
Methods:
Seventy-two adult ESRD patients receiving regular hemodialysis and 30 healthy subjects underwent CMR examination. Continuous CMR cine sections from the mitral valve level to the left ventricular (LV) apex in the short-axis plane, cine series of vertical two-chamber long-axis plane, and horizontal four-chamber plane were acquired. Native T1 mapping was obtained using modified Look-Locker inversion recovery (MOLLI) sequences. Native T1 values and myocardial strain were analyzed. Immunoreactive parathyroid hormone (iPTH) was obtained from all enrolled patients.
Results:
Forty (55.6%) hemodialysis ESRD patients were found to have increased iPTH levels. LV ejection fraction (LVEF) of both ESRD patients with targeted and increased iPTH levels was decreased compared with healthy subjects (55.9 ± 12.0% vs. 65.0 ± 4.5%; 51.7 ± 12.8 vs. 65.0 ± 4.5%, both P < 0.05). The mean peak radial strain (PRS), peak circumferential strain (PCS), and peak longitudinal strain (PLS) were lowest in ESRD patients with increased iPTH; however, no significant difference was observed among these three groups. Segmentally, from base to apex, the native T1 of ESRD patients with increased iPTH levels tended to be higher than those with targeted iPTH and healthy subjects (all P < 0.05). In ESRD patients with targeted iPTH, both native T1 of basal and middle segments were significantly higher than normal subjects (basal, 1304 ± 41 ms vs. 1238 ± 36 ms, P = 0.001; middle, 1300 ± 43 ms vs. 1242 ± 50 ms, P < 0.001). Comparing global native T1 values in the three groups, ESRD patients with targeted and increased iPTH level showed increased native T1 (1305 ± 41 ms vs. 1251 ± 49 ms, P = 0.001; 1334 ± 40 ms vs. 1251 ± 49 ms, P < 0.001, respectively). Native T1 values of the basal segment and global native T1 were moderately associated with iPTH (r = 0.4, P < 0.001; r = 0.5, P < 0.001). Multiple linear regression analysis showed that global native T1 values (beta = 1.0, P = 0.01) were independently associated with iPTH.
Conclusions:
Elevated iPTH level was associated with and was an independent risk factor for myocardial damage in ESRD patients undergoing maintenance hemodialysis.
Trial registration:
Chinese Clinical Trial Registry ( http://www.chictr.org.cn/index.aspx ) ChiCTR-DND-17012976, 13/12/2017, retrospectively registered.
... PTH has also been shown to increase HR in rat isolated hearts (Shimoyama et al., 2001). In a clinical study involving chronic heart failure patients, there was a positive correlation between endogenous PTH levels and HR, suggesting a role for PTH in the associated increased HR (Sugimoto et al., 2013). Similarly, in two studies of patients undergoing kidney dialysis, increased endogenous PTH was associated with a decrease in HR variability, implicating PTH in the ANS dysfunction that occurs in individuals with kidney failure (Ussawawongaraya et al., 2013;Poulikakos et al., 2014). ...
The sinoatrial node is perhaps one of the most important tissues in the entire body: it is the natural pacemaker of the heart, making it responsible for initiating each-and-every normal heartbeat. As such, its activity is heavily controlled, allowing heart rate to rapidly adapt to changes in physiological demand. Control of sinoatrial node activity, however, is complex, occurring through the autonomic nervous system and various circulating and locally released factors. In this review we discuss the coupled-clock pacemaker system and how its manipulation by neurohumoral signaling alters heart rate, considering the multitude of canonical and non-canonical agents that are known to modulate sinoatrial node activity. For each, we discuss the principal receptors involved and known intracellular signaling and protein targets, highlighting gaps in our knowledge and understanding from experimental models and human studies that represent areas for future research.
... Более высокие уровни ПТГ, даже в пределах нормальных значений, были ассоциированы с низким ударным объемом и более высоким функциональным классом ХСН по классификации Нью-Йоркской кардиологической ассоциации (NYHA). Уровень ПТГ у пациентов с ХСН нарастал по мере увеличения давления заклинивания легочных капилляров и снижения ударного объема и коррелировал с уровнем NT-proBNP [42]. ...
Calcium pyrophosphate crystal deposition disease (CPPD) is an inflammatory joint disease associated with abnormal accumulation of inorganic pyrophosphate. CPPD is frequently associated with metabolic disorders, such as hyperparathyroidism, hemochromatosis, hypomagnesemia, and hyperphosphatasia. It is important that pathological calcification can develop in both the joints and vessel wall. It is assumed that the deposition of calcifications in the endothelium, the crystal-induced chronic inflammation characteristic of CPPD, and its accompanying oxidative stress, as well as metabolic disorders that are a cause of secondary CPPD, can significantly increase the risk of cardiovascular diseases.
... However, all these results are derived from studies with small sample sizes, and some conclusions are inconsistent (21). Studies have shown that parathyroid hormone (PTH) is a cardiovascular biomarker which is closely associated with various diseases including arteriosclerosis, hypertension, left ventricular hypertrophy, and coronary artery and valvular calcification, and it as an independent predictor of HF (22)(23)(24)(25)(26)(27)(28)(29). However, as the existing studies did not distinguish between left and right HF, the association between PTH levels and right HF remains unclear. ...
... According to the comparisons between the control and experimental groups, serum PTH levels were increased in patients with right HF compared with the controls. Although age, sex and LVEF were different between the two groups, and PTH release increases with age and left HF (27,29), the results of the binary logistic regression analysis further confirmed that PTH levels was an independent predictor of right HF. In the right HF group, the serum PTH levels increased with increased NT-proBNP levels, right ventricular diameter, tricuspid valve reverse flow and the degree of lower extremity edema, with statistically significant partial correlations. ...
Parathyroid hormone (PTH) is a novel cardiovascular biomarker which is particularly useful for detection and assessment of heart failure (HF). However, previous studies examining PTH in heart failure have primarily focused on left HF; thus, the relationship between PTH and right HF remains unclear. The aim of the present study was to evaluate the serum PTH levels in patients with chronic right HF. A total of 154 patients with chronic right HF were enrolled in the present study. A binary logistic regression analysis model was used to assess the independent predictive value of PTH levels in chronic right HF. Partial correlative analysis was used to demonstrate the relevance of PTH levels on the parameters of assessment of right heart function. A multiple linear regression analysis model was used to evaluate the independent factors of PTH levels in patients with right HF. The results showed that the serum PTH levels in the right HF group were significantly higher compared with the control group. After adjusting for predictors of right HF, serum PTH levels were associated with right HF with an odds ratio of 1.066 (95% confidence interval: 1.030-1.102, P<0.001. Serum PTH levels were independently correlated with plasma N-terminal pro-B-type natriuretic peptide levels, right ventricular end-diastolic diameter and severity of lower extremity edema (all P<0.05). Therefore, based on the results of the present study, PTH may be a useful biomarker for detection and assessment of right HF.
... Previous studies have shown that serum PTH levels are closely associated with heart failure, high blood pressure, and myocardial hypertrophy. [7][8][9] The cardiovascular system may also be affected by PTH levels via pro-inflammatory pathways stimulating cytokine release from inflammatory cells. [10] Studies on the relationship between CAD and PTH levels are inconclusive. ...
Background:
The presence of vitamin D, and parathyroid hormone receptors has been demonstrated in the vascular endothelium. Variations in vitamin D, and parathyroid hormone levels may affect coronary flow and cause the coronary slow-flow phenomenon (CSF).
Methods:
We enrolled 93 patients who had undergone coronary angiography and had near-normal coronary arteries. Blood samples were taken to determine the calcium, phosphorus, 25-hydroxy vitamin D, and parathyroid hormone levels. Vitamin D deficiency was defined as a serum 25-hydroxy vitamin D level of less than 20 ng/mL. We divided the study population into two groups according to thrombolysis in myocardial infarction frame count (TFC) levels.
Results:
Patients with TFC ≤27 were in the control group (n = 39), and those with TFC >27 were in the CSF group (n = 54). 25-Hydroxy vitamin D levels were similar in both groups: 17.5 [3.3-36.1] ng/ml in the CSF group and 15.2 [5.3-34] ng/ml in the control group (P = 0.129). When we analyzed TFC for each of the coronary arteries, we found a weak negative correlation between vitamin D level and TFC of the right coronary artery in the CSF group (r = -0.314, P = 0.021). Parathyroid hormone levels were similar in both groups: 48 [16-140] pg/ml in the CSF group and 52 [25-125] pg/ml in the control group (P = 0.297).
Conclusion:
The study failed to demonstrate a relationship between serum parathyroid hormone level and CSF. However, a weak negative correlation was found between vitamin D level and TFC of the right coronary artery.
... Additionally, PTH levels were associated with worse hemodynamic, echocardiographic, and laboratory parameters [7,35]. Another study done by Sugimoto et al. [36] showed the association between PTH levels and hemodynamic state in HF patients. PTH levels were positively correlated with pulmonary capillary wedge pressure and inversely related with stroke volume index even after adjustment for confounding factors. ...
AimEvaluation of secondary hyperparathyroidism (SHPT) and its prognostic impact on all-cause mortality in elderly males with heart failure (HF). Methods
Seventy three males (67 ± 7 years old) with systolic HF were included. Baseline PTH was measured. Patients were grouped according to PTH cut-off levels of 65 pg/ml (>65 pg/ml = SHPT vs. normal PTH). All-cause mortality was evaluated at 6-year follow-up. ResultsSHPT was diagnosed in 43 (59 %) patients. They were more severe compared to the patients with normal PTH regarding NYHA functional class (2.4 ± 0.5 vs. 2.1 ± 0.2, p = 0.001), quality of life score (34 ± 14 vs. 24 ± 12, p = 0.005), 6-min walking distance (378 ± 79 vs. 446 ± 73 m, p < 0.0001), left ventricular ejection fraction (27 ± 8 vs. 31 ± 7 %, p = 0.019), and NT-proBNP [2452 (3399) vs. 918 (1372) pg/ml, p < 0.0001]. No differences in age, vitamin D status, and renal function were noted between studied groups. A total of 41 (56 %) patients died within 6 years of follow-up. Kaplan–Meier survival analysis showed impaired long-term survival in patients with SHPT versus patients with normal PTH (p = 0.009). The rate of death was highest (75 %) in the group of patients with SHPT and NT-proBNP levels above median value (p = 0.003). Cox regression analysis demonstrated that NT-proBNP was the single independent predictor of all-cause mortality at 6-year follow-up [HR 3.698 (1.927–7.095), p < 0.0001]. ConclusionSHPT was highly prevalent in elderly males with HF and was associated with impaired survival. HF patients with SHPT had more severe disease compared to the patients with normal serum PTH. Determination of serum PTH levels provided additional value to NT-proBNP for risk stratification in these patients.
... The parathyroid hormone (PTH) is a linear peptide comprising 84 amino acids secreted by parathyroid lord cells, which are mainly implicated in the regulation of calcium phosphorus metabolism. Previous studies have shown that PTH induces high blood pressure and myocardial hypertrophy, is closely associated with heart failure and can even predict the occurrence of coronary heart disease (3)(4)(5)(6). In recent years, the association between PTH and CAC has become a research hotspot. ...
The aim of the present study was to investigate the correlation between serum parathyroid hormone (PTH) levels and coronary artery calcification (CAC) in patients without renal failure, as well as to determine independent risk factors of CAC score (CACS). A total of 157 patients who underwent coronary computed tomography angiographic examination at the 101th Hospital of the People's Liberation Army between December 2013 and February 2015 were retrospectively evaluated. The correlation between PTH levels and CACS was determined using a Pearson correlation analysis. A receiver operating characteristic (ROC) curve was drawn to determine the best cutoff PTH level for prediction of CAC. The independent association between serum PTH levels and CAC was analyzed by using a logistic regression analysis model with the response variable Be binary class. The results revealed that PTH levels in patients in the CAC group were significantly higher than those of patients in the non-calcification group. PTH levels were positively correlated with CACS (r=0.288, P<0.001). The ROC curve suggested that a PTH level of ≥31.05 pg/ml was the best cut-off point for the prediction of CAC, with a sensitivity of 80.88%, specificity of 60.67% and an area under the curve of 0.761. After including predictive factors for CAC (gender, age, smoking status, diabetes, hypertension, hyperlipidemia, body mass index, glomerular filtration rate and calcium, phosphorus, calcium-phosphorus product, magnesium, PTH, total cholesterol, low-density lipoprotein cholesterol, triglyceride, high-density lipoprotein cholesterol and C-reactive protein levels), the odds ratio of the serum PTH levels regarding the prediction of CAC was 1.050 (95% confidence interval, 1.027-1.074; P<0.001). In conclusion, the present study suggested that serum PTH levels are correlated with CAC in patients without renal failure and may thus be used as a reliable predictor of CAC.
... In recent years, it has been proven that parathyroid hormone (PTH) also plays an important role in cardiovascular diseases, including hypertension, left ventricular hypertrophy, arteriosclerosis, and valvular calcification, among others (Cha et al., 2010;Klarić et al., 2011;Bosworth et al., 2013;Demir et al., 2013), and it is particularly associated with HF (Sugimoto et al., 2013). In addition, PTH is well correlated with either HF with normal ejection fraction (EF) or with progressive HF (Altay et al., 2012(Altay et al., , 2013. ...
Aims:
Parathyroid hormone (PTH) levels are useful as a prognostic factor of chronic heart failure (HF) and can predict hospitalization for HF. It is unknown whether serum PTH levels in hospitalized patients with HF can predict discharge and if admission, discharge, or change from admission to discharge PTH measure is the most important predictor of readmission and/or death.
Methods:
A total of 125 consecutive hospitalized patients with HF were enrolled into this study. The receiver operating characteristic (ROC) curves indicated the predicted values of PTH for readmission due to HF and the optimal cutoff points of PTH levels for discharge. The binary logistic regression model indicated an association between PTH levels and readmission due to HF.
Results:
The PTH level on admission was positively correlated with the New York Heart Association class and N-terminal pro-B-type natriuretic peptide level. The ROC curves showed that the PTH level at discharge (PTHdis) was of predictive value for readmission within 1 year due to HF. A PTHdis level <45.2 pg/mL was the best cutoff point for discharge, with a sensitivity of 72.1%, specificity of 61.5%, and area under the ROC curve of 0.693 (95% confidence interval [CI] 0.598-0.788). The results of logistic regression analysis showed that PTHdis had an odds ratio of 1.035 for readmission due to HF (95% CI 1.005-1.067).
Conclusion:
Serum PTH levels in hospitalized patients with HF were shown to be an independent predictor of discharge and PTHdis was the best predictor of readmission and/or death within 1 year due to HF.
... Additionally, PTH levels were associated with worse hemodynamic, echocardiographic, and laboratory parameters [7,35]. Another study done by Sugimoto et al. [36] showed the association between PTH levels and hemodynamic state in HF patients. PTH levels were positively correlated with pulmonary capillary wedge pressure and inversely related with stroke volume index even after adjustment for confounding factors. ...
