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Multiple hormonal and metabolic deficiency syndrome predicts outcome in heart failure: the T.O.S.CA. registry

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journal contribution
posted on 16.03.2021, 14:55 by Antonio Cittadini, Andrea Salzano, Massimo Iacoviello, Vincenzo Triggiani, Giuseppe Rengo, Francesco Cacciatore, Ciro Maiello, Giuseppe Limongelli, Daniele Masarone, Francesco Perticone, Antonio Cimellaro, Pasquale Perrone Filardi, Stefania Paolillo, Antonio Mancini, Maurizio Volterrani, Olga Vriz, Roberto Castello, Andrea Passantino, Michela Campo, Pietro A Modesti, Alfredo De Giorgi, Ines P Monte, Alfonso Puzzo, Andrea Ballotta, Roberta D'Assante, Michele Arcopinto, Paola Gargiulo, Angela Sciacqua, Dario Bruzzese, Annamaria Colao, Raffaele Napoli, Toru Suzuki, Kim A Eagle, Hector O Ventura, Alberto M Marra, Eduardo Bossone, T.O.S.CA. Investigators, Liam HeaneyLiam Heaney
Aims Recent evidence supports the occurrence of multiple hormonal and metabolic deficiency syndrome (MHDS) in chronic heart failure (CHF). However, no large observational study has unequivocally demonstrated its impact on CHF progression and outcome. The T.O.S.CA. (Trattamento Ormonale nello Scompenso CArdiaco; Hormone Treatment in Heart Failure) Registry has been specifically designed to test the hypothesis that MHDS affects morbidity and mortality in CHF patients.
Methods and Results The T.O.S.CA. Registry is a prospective, multicentre, observational study involving 19 Italian centres. Thyroid hormones, insulin-like growth factor-1, total testosterone, dehydropianoandrosterone sulfate, insulin resistance, and the presence of diabetes were evaluated. A MHDS was defined as the presence of >_2 hormone deficiencies (HDs). Primary endpoint was a composite of all-cause mortality and cardiovascular hospitalizations. Four hundred and eighty heart failure patients with ejection fraction <_45% were enrolled. MHDS or diabetes was diagnosed in 372 patients (77.5%). A total of 271 events (97 deaths and 174 cardiovascular hospitalizations) were recorded, 41% in NO-MHDS and 62% in MHDS (P < 0.001). Median follow-up was of 36 months. MHDS was independently associated with the occurrence of the primary endpoint [hazard ratio 95% (confidence interval), 1.93 (1.37–2.73), P < 0.001] and identified a group of patients with a higher mortality [2.2 (1.28–3.83), P = 0.01], with a graded relation between HDs and cumulative events (P < 0.01).
Conclusion MHDS is common in CHF and independently associated with increased all-cause mortality and cardiovascular hospitalization, representing a promising therapeutic target.


The work was supported by unrestricted grant from Merck Serono Italy



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European Journal of Preventive Cardiology




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This is an Open Access Article. It is published by OUP under the Creative Commons Attribution-NonCommercial 4.0 International Licence (CC BY-NC). Full details of this licence are available at: https://creativecommons.org/licenses/by-nc/4.0/

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Dr Liam Heaney. Deposit date: 15 March 2021