Background: Progression of heart failure is associated with activation of the hypothalamic-pituitary-adrenal axis and secretion of cortisol from the adrenal cortex. We have developed a method to measure cortisol in scalp hair, allowing longitudinal assessment of cortisol levels. We aimed to evaluate whether hair cortisol levels correlate with heart failure severity.
Methods and results: A prospective study on ambulatory male patients with a left ventricular ejection fraction (LVEF) ≤40%. An enzyme immunoassay technique was used to measure cortisol in the most proximal 2 cm of hair, considered to represent the most recent 2 months of exposure. Primary endpoints included the correlation of hair cortisol levels with New York Heart Association (NYHA) class, LVEF, exercise capacity and NT-proBNP. Median (range) hair level of cortisol for the 44 CHF patients was 207 ng/g (117.7 - 1277.3). Hair cortisol concentrations correlated positively with NYHA class (r = 0.48, p = 0.001) and negatively with treadmill stress test performance, (r = -0.37, p < 0.05). No correlations were found between hair cortisol concentrations and LVEF (r = 0.14, p = 0.37) and NT-proBNP (r = 0.19, p = 0.22). During a 1-year follow-up, 25 patients had a CHF-related hospitalization with a trend toward higher hair cortisol levels in the hospitalized patients (p = 0.08).
Conclusion: Hair cortisol levels correlate with heart failure severity as assessed by the NYHA class and exercise capacity. Further studies are needed to assess whether this novel technique should become part of the routine evaluation of patients with heart failure.
