P420 PLASMA LEVELS OF PARATHYROID HORMONE IN HEART FAILURE: CLINICAL CORRELATIONS AND PROGNOSTIC ROLE

Abstract

Abstract Background Circulating concentrations of parathyroid hormone (PTH) increase in heart failure (HF) patients. Plasma concentrations in PTH are related to HF severity, thus considering PTH as biomarkers of HF worsening. The aim of our study was to evaluate clinical correlations and prognostic role of PTH in patients with HF. Methods We evaluated 229 HF patients (42% acute and 58% chronic HF). Patients underwent evaluation of NYHA functional class, measurements of bioactive PTH (1–84), B–type natriuretic peptide (BNP), creatinine cleareance, and hydration status (by means of bioimpedance analysis) and all–cause mortality during follow–up. Results PTH levels were higher in acute HF as compared to chronic HF (248±180 pg/ml vs 153±133 pg/ml, p < 0.001), and significantly correlates with NYHA class, BNP levels (r = 0.4), creatinine clearance (r=–0.3), and hydration status (r = 0.4). Fifty patients died after a median follow–up of 408 days (IQR: 283–573). The cumulative mortality rate was 22%. At univariate Cox regression analysis, we found a strong and significant association of PTH plasma values at admission to mortality (HR 1.003). The optimal cut–off for death occurrence was: PTH > 249 (AUC=0.65; sensibility 50% and specificity 82% ). At multivariate Cox regression analysis PTH level was no longer associated with death, while BNP, hydration status, and renal function maintained an independent predictive value for mortality (HR 1.0004, HR 1.06, and HR 0.98, respectively). Conclusions Our study demonstrated that circulating concentrations of bioactive PTH are related to other biomarkers of HF worsening, i.e. creatinine clearance and hydration status. Although PTH acted as a prognostic determinants of mortality in HF, it was not an independent prognostic biomarkers at multivariate regression analysis.