Relation of serum parathyroid hormone level to severity of heart failure.

Increased parathyroid hormone (PTH) level is associated with all-cause mortality in patients with heart failure (HF). However its role for identifying advanced HF has not been previously studied. We aimed to investigate whether the assessment of serum PTH could enable clinicians to identify patients with advanced HF. One hundred fifty consecutive patients who visited our outpatient clinic with systolic HF were enrolled in the present study. Serum levels of PTH and brain natriuretic peptide (BNP) were measured across all New York Heart Association functional classes. Mean levels of PTH were 43 ± 19, 84 ± 56, 121 ± 47, and 161 ± 60 pg/ml in New York Heart Association functional classes I, II, III, and IV, respectively (p <0.001). In univariate analysis, body mass index, disease duration, PTH, BNP and hemoglobin levels, creatinine clearance, heart rate, systolic blood pressure, left ventricular ejection fraction, left ventricular diastolic diameter, left atrial size, presence of atrial fibrillation, and diuretic usage were found to be predictors of advanced HF. In multivariate logistic regression analysis, PTH level (hazard ratio 1.032, 95% confidence interval 1.003 to 1.062, p = 0.003) and body mass index (hazard ratio 0.542, 95% confidence interval 0.273 to 1.075, p = 0.079) were associated with advanced HF. Furthermore, serum PTH levels were correlated with BNP level and left ventricular ejection fraction (p <0.001 for the 2 comparisons). In receiver operator characteristics curve analysis, the optimal cut-off value of PTH to predict advanced HF was >96.4 pg/ml, with 93.3% sensitivity and 64.2% specificity. In conclusion, measurement of serum PTH could provide complementary information and a simple biomarker strategy to categorize patients with advanced HF based on increased PTH levels, allowing rapid risk stratification in these patients.