Left ventricular functions in children with newly diagnosed Graves' disease. A single-center study from Upper Egypt

Artificial intelligence-enabled electrocardiography contributes to hyperthyroidism detection and outcome prediction

BACKGROUND

Hyperthyroidism is frequently under-recognized and leads to heart failure and mortality. Timely identification of high-risk patients is a prerequisite to effective antithyroid therapy. Since the heart is very sensitive to hyperthyroidism and its electrical signature can be demonstrated by electrocardiography, we developed an artificial intelligence model to detect hyperthyroidism by electrocardiography and examined its potential for outcome prediction.

METHODS

The deep learning model was trained using a large dataset of 47,245 electrocardiograms from 33,246 patients at an academic medical center. Patients were included if electrocardiograms and measurements of serum thyroid-stimulating hormone were available that had been obtained within a three day period. Serum thyroid-stimulating hormone and free thyroxine were used to define overt and subclinical hyperthyroidism. We tested the model internally using 14,420 patients and externally using two additional test sets comprising 11,498 and 596 patients, respectively.

RESULTS

The performance of the deep learning model achieves areas under the receiver operating characteristic curves (AUCs) of 0.725-0.761 for hyperthyroidism detection, AUCs of 0.867-0.876 for overt hyperthyroidism, and AUC of 0.631-0.701 for subclinical hyperthyroidism, superior to a traditional features-based machine learning model. Patients identified as hyperthyroidism-positive by the deep learning model have a significantly higher risk (1.97-2.94 fold) of all-cause mortality and new-onset heart failure compared to hyperthyroidism-negative patients. This cardiovascular disease stratification is particularly pronounced in subclinical hyperthyroidism, surpassing that observed in overt hyperthyroidism.

CONCLUSIONS

An innovative algorithm effectively identifies overt and subclinical hyperthyroidism and contributes to cardiovascular risk assessment.

Graves' Disease in Children: An Update

Graves' disease (GD) is the most common cause of hyperthyroidism in children. A common GD symptom is a goiter. The usual biochemical profile in children with GD is a decreased thyroid hormone stimulating hormone (TSH) level and high free thyroxine (FT4) and free triiodothyronine (FT3) concentrations. The presence of thyroid receptor antibodies (TRAb) is the most important specific immunological sign for diagnosing GD. The treatment choices for pediatric GD are anti-thyroid drugs (ATDs), radioiodine, and thyroidectomy, but the risks and benefits of each modality are different. Management recommendations include the first-line use of a prolonged course of ATDs for at least 3 years and potentially 5 years or more. Rituximab and Teprotumumab are new novel alternative medications for the treatment of adult patients with GD and Graves' orbitopathy respectively, but evidence of the efficacy and safety of these drugs in pediatric patients with GD is lacking.

Changes in left ventricular function and contractile homogeneity in young adults with newly diagnosed hyperthyroidism due to Graves' disease

PURPOSE

The aim of this study was to investigate myocardial dysfunction and mechanical abnormalities in young patients with Graves' disease before therapy, using two-dimensional speckle tracking echocardiography.

METHODS

We performed a comprehensive transthoracic echocardiographic examination, including segmental and global radial strain, and time-to-peak radial strain, in 47 young patients with hyperthyroidism and 34 healthy adults. The time-to-peak radial strain was corrected by RR interval. The variables derived from radial myocardial deformation by the six-basal, six-mid, and six-apical segmental model were compared to investigate the difference of the myocardial function between the two groups.

RESULTS

Early diastolic mitral inflow velocity, E/A ratio, early diastolic mitral annular velocity, and e'/a' ratio were lower in patients with Graves' disease than in controls. The left ventricular end-diastolic volume, left ventricular end-systolic volume, stroke volume, cardiac output, heart rate, late diastolic mitral inflow velocity, and late diastolic mitral annular velocity were slightly higher in patients than in controls. Radial strain, global radial strain, and corrected time-to-peak radial strain were lower in the patient group.

CONCLUSIONS

The decreased radial strain, global radial strain, and corrected time-to-peak radial strain in young patients with newly diagnosed hyperthyroidism due to Graves' disease could serve as an early sign of subclinical cardiac involvement.