PMID- 25578437
OWN - NLM
STAT- MEDLINE
DCOM- 20161213
LR  - 20191113
VI  - 125
IP  - 1-2
DP  - 2015
TI  - Abnormal serum calcium levels are associated with clinical response to 
      maximization of heart failure therapy.
PG  - 54-64
LID - AOP_15_005 [pii]
AB  - INTRODUCTION: Abnormal serum calcium levels are associated with adverse 
      cardiovascular effects. Therapy of heart failure (HF) may result in urinary 
      calcium excretion and calcium apposition to bones, and consequently, in calcemia. 
      OBJECTIVES: The aim of the study was to assess the prevalence of abnormal calcium 
      levels in the blood of patients receiving maximized HF therapy, to explore 
      clinical and laboratory determinants of abnormal serum calcium levels, and to 
      analyze the relation of abnormal calcium levels to prognosis. PATIENTS AND 
      METHODS: The study included 722 patients with HF classified as New York Heart 
      Association (NYHA) classes III-IV at baseline (age 53 +/-10 years, 13% of women), 
      who underwent HF therapy optimization to maximum tolerated doses. RESULTS: After 
      therapy maximization, the NYHA class improved in 66.7% of the patients, while it 
      did not change in 31.0% and worsened in 2.4%. Hypocalcemia occurred in 166 
      patients (22.9%) and was more prevalent in patients in whom the NYHA class 
      improved. Hypercalcemia was diagnosed in 63 patients (8.7%) and was more common 
      in patients with no functional improvement or worsening of the NYHA class. This 
      effect was independent of age, sex, etiology of HF, body mass index, kidney 
      function, or the use of thiazides. Hypercalcemia was associated with increased 
      catabolism, hemodynamic compromise, more intensive inflammation, and lower bone 
      mineral density. Lower albumin and higher phosphorus levels, were significant 
      predictors of hypercalcemia, independently of kidney function. Hypocalcemia was 
      associated with reduced catabolism, higher albumin and lower phosphorus levels, 
      use of thiazides, and smoking history. Neither hypocalcemia nor hypercalcemia was 
      associated with poor prognosis. CONCLUSIONS: Our study shows that abnormal serum 
      calcium levels are associated with a clinical response to treatment maximization 
      in patients with HF. Mild hypocalcemia after maximization of therapy is not 
      associated with poorer prognosis. Hypercalcemia is associated with lack of 
      response to treatment, and its prognostic value remains unclear.  
FAU - Rozentryt, Piotr
AU  - Rozentryt P
FAU - Niedziela, Jacek T
AU  - Niedziela JT
FAU - Hudzik, Bartosz
AU  - Hudzik B
FAU - Doehner, Wolfram
AU  - Doehner W
FAU - Jankowska, Ewa A
AU  - Jankowska EA
FAU - Nowak, Jolanta
AU  - Nowak J
FAU - von Haehling, Stephan
AU  - von Haehling S
FAU - Myrda, Krzysztof
AU  - Myrda K
FAU - Anker, Stefan D
AU  - Anker SD
FAU - Ponikowski, Piotr
AU  - Ponikowski P
FAU - Polonski, Lech
AU  - Polonski L
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20150112
PL  - Poland
TA  - Pol Arch Med Wewn
JT  - Polskie Archiwum Medycyny Wewnetrznej
JID - 0401225
RN  - 0 (Cardiotonic Agents)
RN  - 0 (Diuretics)
RN  - SY7Q814VUP (Calcium)
SB  - IM
MH  - Adult
MH  - Calcium/*blood
MH  - Cardiotonic Agents/*therapeutic use
MH  - Diuretics/*therapeutic use
MH  - Female
MH  - Heart Failure/*complications/*drug therapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
EDAT- 2015/01/13 06:00
MHDA- 2016/12/15 06:00
CRDT- 2015/01/13 06:00
PHST- 2015/01/13 06:00 [entrez]
PHST- 2015/01/13 06:00 [pubmed]
PHST- 2016/12/15 06:00 [medline]
AID - AOP_15_005 [pii]
AID - 10.20452/pamw.2646 [doi]
PST - ppublish
SO  - Pol Arch Med Wewn. 2015;125(1-2):54-64. doi: 10.20452/pamw.2646. Epub 2015 Jan 
      12.