A deficiency of anabolic hormones in patients with idiopathic pulmonary arterial hypertension (PAH) transcribes to lower exercise capacity, impaired pulmonary hemodynamics, and reduced right ventricular size, according to a new study published in the journal Heart Failure Clinics.

The study design used a retrospective analysis of 30 patients with idiopathic PAH who had undergone a 6-minute walk test, cardiac magnetic resonance imaging (MRI), and functional class assessment according to World Health Organization criteria. The selected hormones of interest included testosterone, dehydroepiandrostenedione, insulin-like growth factor 1, insulin and blood glucose, and thyroid hormones.

In the study, the presence of 1 hormonal deficit was regarded as a mild hormonal deficiency, 2 as a moderate hormonal deficiency, and 3 or more as a severe hormonal deficiency. 


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Patients with moderate and severe hormonal deficiencies had worse World Health Organization class and impaired pulmonary hemodynamics in terms of mean and diastolic pressures, higher pulmonary vascular resistance, and a reduced cardiac index compared with the PAH patients who presented with 1 or no hormonal deficiencies. Moreover, MRI examination indicated increased right ventricular volumes, slightly reduced pump function, and a greater degree of right ventricular hypertrophy in the multiple hormonal deficits patient group. 

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The authors also noted a significant difference between those with mild, moderate, and severe hormonal deficiencies in the distance covered in the 6-minute walk test as well as the MRI results or pulmonary vascular resistance, end-diastolic and end-systolic volumes, and right ventricular ejection fraction.

“The presence of increased pulmonary vascular resistance is undoubtedly of considerable importance, considering that it is the strongest independent predictor of mortality according to the data from the American REVEAL registry, the registry with the largest number of patients in the world,“ Marra and colleagues wrote. 

Pulmonary hypertension is a clinical condition that often leads to an increase in right ventricular afterload and subsequent right heart failure. 

Reference

Marra AM, D’Agostino A, Salzano A, et al. Impact of hormonal-anabolic deficiencies in idiopathic pulmonary arterial hypertension. Heart Fail Clin. January 2023. doi:10.1016/j.hfc.2022.09.001