Effect of long-acting testosterone treatment on functional exercise capacity, skeletal muscle performance, insulin resistance, and baroreflex sensitivity in elderly patients with chronic heart failure a double-blind, placebo-controlled, randomized study.
OBJECTIVE
This study investigated the effect of a 12-week long-acting testosterone administration on maximal exercise capacity, ventilatory efficiency, muscle strength, insulin resistance, and baroreflex sensitivity (BRS) in elderly patients with chronic heart failure (CHF).


BACKGROUND
CHF is characterized by a metabolic shift favoring catabolism and impairment in skeletal muscle bulk and function that could be involved in the pathophysiology of heart failure.


METHODS
Seventy elderly patients with stable CHF-median age 70 years, ejection fraction 31.8 +/- 7%-were randomly assigned to receive testosterone (n = 35, intramuscular injection every 6 weeks) or placebo (n = 35), both on top of optimal medical therapy. At baseline and at the end of the study, all patients underwent echocardiogram, cardiopulmonary exercise test, 6-min walk test (6MWT), quadriceps maximal voluntary contraction (MVC), and isokinetic strength (peak torque) and BRS assessment (sequences technique).


RESULTS
Baseline peak oxygen consumption (VO(2)) and quadriceps isometric strength showed a direct relation with serum testosterone concentration. Peak VO(2) significantly improved in testosterone but was unchanged in placebo. Insulin sensitivity was significantly improved in testosterone. The MVC and peak torque significantly increased in testosterone but not in placebo. The BRS significantly improved in testosterone but not in placebo. Increase in testosterone levels was significantly related to improvement in peak VO(2) and MVC. There were no significant changes in left ventricular function either in testosterone or placebo.


CONCLUSIONS
These results suggest that long-acting testosterone therapy improves exercise capacity, muscle strength, glucose metabolism, and BRS in men with moderately severe CHF. Testosterone benefits seem to be mediated by metabolic and peripheral effects.
Caminiti
Giuseppe
G
Centre for Clinical and Basic Research, Cardiovascular Research Unit, Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy.
Volterrani
Maurizio
M
Iellamo
Ferdinando
F
Marazzi
Giuseppe
G
Massaro
Rosalba
R
Miceli
Marco
M
Mammi
Caterina
C
Piepoli
Massimo
M
Fini
Massimo
M
Rosano
Giuseppe M C
GM
D000368:Aged; D017704:Baroreflex / Q000187:drug effects*; D001786:Blood Glucose / Q000032:analysis; D002908:Chronic Disease; D004311:Double-Blind Method; D004452:Echocardiography; D005080:Exercise Test; D017079:Exercise Tolerance / Q000187:drug effects*; D006333:Heart Failure / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D007273:Injections, Intramuscular; D007333:Insulin Resistance; D007866:Leg; D008297:Male; D053580:Muscle Strength / Q000187:drug effects; D018482:Muscle, Skeletal / Q000187:drug effects* / Q000503:physiopathology; D010101:Oxygen Consumption / Q000187:drug effects; D013739:Testosterone / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000097:blood; D045165:Testosterone Congeners / Q000008:administration & dosage*; D016277:Ventricular Function, Left / Q000187:drug effects
D001786:Blood Glucose; D045165:Testosterone Congeners; D013739:Testosterone; C010792:testosterone undecanoate