title: Secondary hyperparathyroidism prevalence and prognostic role in elderly males with heart failure.
abstract: OBJECTIVE
  Evaluation 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.
  
  
  RESULTS
  SHPT 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].
  
  
  CONCLUSIONS
  SHPT 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.
authors.affiliation: Cardiology Department, Clinical Hospital Zvezdara, Dimitrija Tucovica 161, Belgrade, 11 000, Serbia. loncar_goran@yahoo.com.|Faculty of Medicine, University of Belgrade, Belgrade, Serbia. loncar_goran@yahoo.com.
authors.forename: G
authors.initials: G
authors.lastname: Loncar
authors.affiliation: Institute for Medical Research, Military Medical Academy, Belgrade, Serbia.|Institute for Physiology and Biochemistry, University of Belgrade, Belgrade, Serbia.
authors.forename: B
authors.initials: B
authors.lastname: Bozic
authors.affiliation: Cardiology Department, Clinical Hospital Zvezdara, Dimitrija Tucovica 161, Belgrade, 11 000, Serbia.
authors.forename: N
authors.initials: N
authors.lastname: Cvetinovic
authors.affiliation: Department of Cardiology, Campus Virchow, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: H-D
authors.initials: HD
authors.lastname: Dungen
authors.affiliation: Departments of Cardiology and Research and Education, General Hospital Celje, Celje, Slovenia.|Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
authors.forename: M
authors.initials: M
authors.lastname: Lainscak
authors.affiliation: Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Medicine Göttingen, Göttingen, Germany.|Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Campus Virchow-Klinikum, Berlin, Germany.
authors.forename: S
authors.initials: S
authors.lastname: von Haehling
authors.affiliation: Center for Stroke Research Berlin, Charite University Medical School, Berlin, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Doehner
authors.affiliation: Institute for Statistics, Faculty of Organizational Sciences, University of Belgrade, Belgrade, Serbia.
authors.forename: Z
authors.initials: Z
authors.lastname: Radojicic
authors.affiliation: Faculty of Medicine, University of Belgrade, Belgrade, Serbia.|Cardiology Department, Clinical Hospital Center Zemun, Belgrade, Serbia.
authors.forename: B
authors.initials: B
authors.lastname: Putnikovic
authors.affiliation: Department of Cardiology, Campus Virchow, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Trippel
authors.affiliation: Faculty of Medicine, University of Belgrade, Belgrade, Serbia.|Institute of Endocrinology, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: V
authors.initials: V
authors.lastname: Popovic
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000175:diagnosis / Q000453:epidemiology* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011788:Quality of Life; D012372:ROC Curve; D055771:Serbia / Q000453:epidemiology; D015996:Survival Rate
chemical_list: D015415:Biomarkers
keywords: Heart failure; Hyperparathyroidism; Mortality; PTH