Author + information
- Received February 10, 2009
- Revision received April 8, 2009
- Accepted April 29, 2009
- Published online September 1, 2009.
- Giuseppe Caminiti, MD⁎,
- Maurizio Volterrani, MD⁎,
- Ferdinando Iellamo, MD⁎,†,⁎ (, )
- Giuseppe Marazzi, MD⁎,
- Rosalba Massaro, MD⁎,
- Marco Miceli, MD⁎,
- Caterina Mammi, MD⁎,
- Massimo Piepoli, MD‡,
- Massimo Fini, MD⁎ and
- Giuseppe M.C. Rosano, MD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Ferdinando Iellamo, Dipartimento di Medicina Interna, IRCCS San Raffaele Pisana, Università di Roma “Tor Vergata,” Via O. Raimondo, 8 00173 Rome, Italy
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 VO2significantly 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 VO2and 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.
This study was supported by the Italian Ministry of Health, as a part of Finalized Research 2005 Grant. This study was also supported, in part, by Agenzia Spaziale Italiana, Grant ASI I/006/06/0 to Dr. Iellamo.
- Received February 10, 2009.
- Revision received April 8, 2009.
- Accepted April 29, 2009.
- American College of Cardiology Foundation