Abstract 18098: Elevated Parathyroid Hormone Predicts Mortality in Patients with Advanced Heart Failure and Preserved Renal Function and Normal Calcium Levels
Introduction: Elevated parathyroid hormone (PTH) had been shown to be associated with poor prognosis in heart failure. This was thought to be due to secondary hyperparathyroidism from low glomerular filtration rate (GFR) and calcium homeostasis. Vitamin D levels were also shown to be associated with heart failure mortality. We evaluated the prognostic role of PTH in stage D heart failure patients referred for cardiac transplant evaluation with normal calcium levels and preserved GFR.
Methods: We reviewed 269 consecutive patients with advanced heart failure undergoing transplant evaluation between 2007 and 2011. Patients with low GFR (<60 ml/m2) and hypocalcemia (calcium < 8.5 mg/dl) were excluded. Patients have been divided into tertiles and also into two groups based on the intact PTH levels using higher limit of lab normal (60 pg/ml). Patients with vitamin D levels lower than lab normal (31 ng/ml) were considered deficient. Survival (death or heart transplant) analysis was assessed by Kaplan-Meier curves and multivariate Cox proportional hazard regression.
Results: In our study cohort, median PTH level was 67 ± 62 pg/ml. Prevalence of vitamin D deficiency was not significantly different among patients with low and high PTH (77.6% vs. 80.8%, p=0.53). The mortality/transplant rate increased with increasing PTH tertiles (33%, 46%, 53%, respectively, p=0.17). Kaplan-Meier curves showed the worsening chance of survival with increasing PTH tertiles (Figure). Elevated PTH levels (adjusted HR 1.62, 95% CI, 1.04, 2.54) is an independent predictor of mortality in multivariate Cox regression model including age, gender, calcium, albumin, GFR, sodium, and uric acid.
Conclusions: Elevated PTH level is an independent predictor of mortality in patients with advanced heart failure, even in the setting of preserved renal function and normal calcium levels.
- © 2012 by American Heart Association, Inc.