Effect of Long-Acting Testosterone Treatment on Functional Exercise Capacity, Skeletal Muscle Performance, Insulin Resistance, and Baroreflex Sensitivity in Elderly Patients With Chronic Heart Failure A Double-Blind, Placebo-Controlled, Randomized Study
Effect of Long-Acting Testosterone Treatment on Functional Exercise Capacity, Skeletal Muscle Performance, Insulin Resistance, and Baroreflex Sensitivity in Elderly Patients With Chronic Heart Failure A Double-Blind, Placebo-Controlled, Randomized Study
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DOI：
10.1016/j.jacc.2009.04.078
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发表时间：
2009-09-01
影响因子：
24
通讯作者：
Rosano, Giuseppe M. C.
中科院分区：
文献类型：
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作者：
Caminiti, Giuseppe;Volterrani, Maurizio;Rosano, Giuseppe M. C.
目的研究长效睾酮治疗12周对最大运动能力、运动效率、肌肉力量、胰岛素抵抗老年慢性心力衰竭患者压力感受性反射敏感性的研究背景CHF是一种以代谢紊乱、骨骼肌体积和功能受损为特征的疾病，可能与心脏的病理生理有关。方法70例稳定CHF的老年患者-中位年龄70岁，射血分数31.8 +/-7%-被随机分配接受睾酮（n = 35，每6周肌肉注射一次）或安慰剂（n = 35），两者均在最佳药物治疗的基础上。分别于基线及研究结束时进行超声心动图、心肺运动试验、6 min步行试验（6 MWT）、股四头肌最大随意收缩（MVC）、等速肌力（峰值扭矩）及BRS评定（序列技术）。睾酮组的峰值VO 2显著改善，但安慰剂组无变化。睾酮组胰岛素敏感性显著改善。睾酮组的MVC和峰值扭矩显著增加，但安慰剂组没有。BRS在睾酮组中显著改善，但在安慰剂组中没有改善。睾酮水平的增加与峰值VO 2和MVC的改善显著相关。左心室功能无论是在睾酮或placebo.Conclusions这些结果表明，长效睾酮治疗改善运动能力，肌肉力量，葡萄糖代谢，和BRS中重度CHF的男性没有显着的变化。替吉奥的益处似乎是由代谢和外周效应介导的。（美国科尔心脏病学杂志2009; 54：919-27）（C）2009年美国心脏病学会基金会
Objectives This study investigated the effect of a 12-week long-acting testosterone administration on maximal exercise capacity, ventilatory efficiency, muscle strength, insulin resistance, and baroreflex sensitivity (BRS) in elderly patients with chronic heart failure (CHF).Background CHF is characterized by a metabolic shift favoring catabolism and impairment in skeletal muscle bulk and function that could be involved in the pathophysiology of heart failure.Methods Seventy elderly patients with stable CHF-median age 70 years, ejection fraction 31.8 +/- 7%-were randomly assigned to receive testosterone (n = 35, intramuscular injection every 6 weeks) or placebo (n = 35), both on top of optimal medical therapy. At baseline and at the end of the study, all patients underwent echocardiogram, cardiopulmonary exercise test, 6-min walk test (6MWT), quadriceps maximal voluntary contraction (MVC), and isokinetic strength (peak torque) and BRS assessment (sequences technique).Results Baseline peak oxygen consumption (VO2) and quadriceps isometric strength showed a direct relation with serum testosterone concentration. Peak VO2 significantly improved in testosterone but was unchanged in placebo. Insulin sensitivity was significantly improved in testosterone. The MVC and peak torque significantly increased in testosterone but not in placebo. The BRS significantly improved in testosterone but not in placebo. Increase in testosterone levels was significantly related to improvement in peak VO2 and MVC. There were no significant changes in left ventricular function either in testosterone or placebo.Conclusions These results suggest that long-acting testosterone therapy improves exercise capacity, muscle strength, glucose metabolism, and BRS in men with moderately severe CHF. Testosterone benefits seem to be mediated by metabolic and peripheral effects. (J Am Coll Cardiol 2009; 54: 919-27) (C) 2009 by the American College of Cardiology Foundation