Abstract
Background: The effect of testosterone supplementation in patients with chronic heart failure (CHF) remains uncertain.Methods: A meta-analysis of randomized controlled trials (RCTs) was performed. RCTs that evaluate the chronic effect of testosterone supplementation on exercise capacity and cardiac function in CHF were identified via searching of PubMed, Embase, and the Cochrane's Library databases. Heterogeneity was evaluated by the Cochrane's Q test and I2 statistics. A fixed-effect model was used if the heterogeneity was not significant (I2 < 50%); otherwise, a random-effect model was applied.Results: Eight studies including 170 patients in the testosterone supplementation group and 162 in the control group were included. Overall, testosterone supplementation was not associated with an improved exercise capacity (walking test: standardized mean difference [SMD] = 0.36, p = 0.07). Sensitivity analyses limited to male patients showed similar results (SMD = 0.21, p = 0.15), and subgroup analyses also showed similar results in male HF patients with baseline total testosterone (TT) ≥ or < 10 nmol/L. However, patients with TT at endpoint ≥ 25 nmol/L was associated with improved exercise capacity (SMD = 1.12, p = 0.02), but not for those with TT at endpoint < 25 nmol/L (SMD = 0.24, p = 0.12). In addition, VO2max (weight mean difference [WMD] = 0.85, p = 0.43), the functional classification (the New York Heart Association classification: WMD = −0.08, p = 0.16) and quality of life (Minnesota Living with Heart Failure [MLHF] questionnaire: WMD = −6.03, p = 0.12) were not significantly affected. Moreover, testosterone supplementation did not significantly affect left ventricular ejection fraction (WMD: −1.52%, p = 0.37), serum B-type natriuretic peptide (SMD: −0.19, p = 0.23), or a composite outcome of death or HF hospitalization (risk ratio [RR]: 1.02, p = 0.96). Although testosterone supplementation increased systolic blood pressure (BP) in CHF patients (WMD: 5.68 mmHg, p < 0.001), diastolic BP or heart rate was not significantly changed as compared to control.Conclusions: Testosterone supplementation within a physiological range is not associated with significantly improved exercise capacity, cardiac function, quality of life, or clinical outcome in CHF patients.
Highlights
Chronic heart failure (CHF) is a severe clinical syndrome that occurs as a late stage of various cardiovascular diseases (1)
randomized controlled trials (RCTs) that evaluate the chronic effect of testosterone supplementation on exercise capacity and cardiac function in CHF were identified via searching of PubMed, Embase, and the Cochrane’s Library databases
VO2max, the functional classification and quality of life (Minnesota Living with Heart Failure [MLHF] questionnaire: weighted mean difference (WMD) = −6.03, p = 0.12) were not significantly affected
Summary
Chronic heart failure (CHF) is a severe clinical syndrome that occurs as a late stage of various cardiovascular diseases (1). Testosterone deficiency has been related with the severity of cardiac dysfunction and poor prognosis in CHF patients (10, 11). Randomized controlled trials (RCTs) have been performed to evaluate the efficacy of testosterone supplementation in CHF patients (11–13). A previously published meta-analysis have systematically evaluated the efficacy of testosterone supplementation in CHF patients (22), only four RCTs (14–17) were included and many outcomes such as the influences of testosterone supplementation on cardiac functional classification, quality of life, blood pressure (BP) and resting heart rate (HR), were not quantitatively evaluated since limited RCTs were available. In this study we aimed to perform an updated meta-analysis to systematically evaluate the efficacy of testosterone supplementation in patients with CHF. The effect of testosterone supplementation in patients with chronic heart failure (CHF) remains uncertain
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