Association Of Androgen And Natremia With Heart Function In Men With Chronic Heart Failure

Objective: To study the association of androgen and natremia with heart function in men with chronic heart failure.Methods: Total 71 hospitalized men with chronic heart failure(CHF) in line with heart failure diagnostic criteria of Framingham were chosen from Oct.2006 to Feb.2007, aged 63.58±10.46 years old, whose left ventricular ejection fraction was less than 50% and course of diease was more than six months. These patients were that 34 coronary artery disease, 16 dilated cardiomyopathy, 9 hypertensive heart disease and 12 valvular heart disease.71 patients with heart failure were categorized by the New York Heart Association classification as 23 classⅡ(symptomatic with moderate activity), 32 classⅢ(symptomatic with mild activity) and 16 classⅣ(symptomatic wat rest). 32 men in good health were allocated into control group, aged 60.28±5.26 years old. To measure natremia by automatic biochemistry analyzer; testosterone (T) by chemiluminescence; NT-proBNP by electrochemiluminescence; plasma renin activity (PRA), alosterone (ALD) by radioimmunity. To examinate left ventricular ejection fraction, fractional shortening, E, A, left ventricular end-diastolic dimension (LVEDD), interventricular septal thickness (IVST) and left ventricular posterior wall thickness (LVPWD) by echocardiography. To test 6 minutes walking distance of CHF patients of NYHA grade II, III.Results: 1. The serum testosterone in CHF patients is lower than that in control group (365.07±139.39 vs 521.37±110.47×10^-9g/ml, P<0.01). The level of testost- erone descends gradually in CHF patients classified by New York Heart Association (NYHA) gradeⅡ-Ⅳ: 466.58±109.39×10^-9g/ml, 361.88±118.02×10^-9 g/ml, 225.56±88.05×10^-9 g/ml.The difference among them is significant (P<0.01). 2. The level of testosterone in CHF patients is positive correlated with left ventri- cular ejection fraction, fractional shortening and 6 minutes walking distance (respecti- vely r = 0.515, P<0.01; r = 0.538, P<0.01; r = 0.317, P<0.05); negative correlated with E/A and NT-proBNP(respectively r =﹣0.307, P<0.05; r =﹣0.414, P<0.01 ). 3.To compare PRA, ALD, NT-proBNP and testosterone of CHF patients with hyponatremia to those of CHF patients with normal natremia: PRA 3.58±1.31 vs 2.42±0.84 ng/ml/h, P<0.01; ALD 57.15±16.38 vs 48.59±11.09×10-12 g/ml, P<0.05; NT-proBNP 4216.17±3743.28 vs 2471.88±2952.29 g/ml, P<0.05; T 404.14±150.16 vs 357.36±139.44×10^-9g/ml, P>0.05.4. To compare PRA, ALD, NT-proBNP and testosterone between correlated hyponatremia and hyponatremia: PRA 3.07±1.13 vs 3.58±1.31 ng/ml/h, P<0.01; ALD 53.80±16.49 vs 57.15±16.38×10-12 g/ml, P<0.01; NT-proBNP 3100.75±3341.54 vs 4216.17±3743.28g/ml, P<0.01; T 380.24±125.37 vs 404.14±150.16×10^-9 g/ml, P>0.05.Conclusion: 1.The level of serum testosterone is lower in CHF patients. Testosterone in CHF patients is negative correlated with heart function. The lower testosterone may play a pathophysiologic effect on heart failure.2. Hyponatremia may accelerate the excretion of PRA, ALD and NT-proBNP in CHF patients. Neuroendocrine activation in CHF patients with hyponatremia is higher than that of normal natremia group. Corrected hyponatremia attenuates the neuroendocrine activation.