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Brenner R, Drescher T, Locher R, Bilz S, Rickli H, Brändle M, Nobel D, Weilenmann D, Ammann P, Maeder MT. Pulmonary and Systemic Hemodynamics in Patients with Hyperthyroidism. Am J Med 2024; 137:350-357. [PMID: 38104644 DOI: 10.1016/j.amjmed.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND There is an association between hyperthyroidism and pulmonary hypertension. However, the prevalence of pulmonary hypertension in hyperthyroidism and the underlying mechanisms are incompletely defined. METHODS Consecutive patients with severe hyperthyroidism, mostly due to Graves disease, were included in this single-center study. Echocardiographic assessment of pulmonary hemodynamics was performed at the time of hyperthyroidism diagnosis (baseline) and after normalization of thyroid hormones (follow-up; median 11 months). In a subset of patients, right heart catheterization and noninvasive assessment of central hemodynamics was performed. RESULTS Among all 99 patients, 31% had pulmonary hypertension at baseline. The estimated systolic pulmonary artery pressure correlated significantly with the estimated left ventricular filling pressure (E/e'). The invasively measured systolic pulmonary artery pressure correlated well with the estimated systolic pulmonary artery pressure. Cardiac output, E/e', left and right ventricular dimensions were significantly reduced from baseline to follow-up, whereas the estimated pulmonary vascular resistance did not differ. Diastolic blood pressure was significantly higher at follow-up, with no change in systolic blood pressure. The central systolic blood pressure, however, exhibited a trend for a reduction at follow-up, while the pulse wave velocity was significantly lower at follow-up. CONCLUSIONS Approximately one-third of patients with hyperthyroidism have evidence of pulmonary hypertension. Our data suggest that an increased cardiac output and left ventricular filling pressure are the main mechanisms underlying the elevated systolic pulmonary artery pressure in hyperthyroidism, whereas there is no evidence of significant pulmonary vascular disease.
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Affiliation(s)
| | - Tilman Drescher
- Department of Endocrinology, Kantonsspital, St.Gallen, Switzerland
| | - Rebecca Locher
- Department of Endocrinology, Kantonsspital Graubünden, Chur, Switzerland
| | - Stefan Bilz
- Department of Endocrinology, Kantonsspital, St.Gallen, Switzerland
| | | | - Michael Brändle
- Department of Endocrinology, Kantonsspital, St.Gallen, Switzerland
| | - Daniel Nobel
- Department of Internal Medicine, Spital Wil, Switzerland
| | | | | | - Micha T Maeder
- Department of Cardiology; University of Basel, Switzerland
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Liu Z, Liu G, Wang Y, Zheng C, Guo Y. Association between skeletal muscle and left ventricular mass in patients with hyperthyroidism. Front Endocrinol (Lausanne) 2024; 15:1301529. [PMID: 38356960 PMCID: PMC10864587 DOI: 10.3389/fendo.2024.1301529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/08/2024] [Indexed: 02/16/2024] Open
Abstract
Objective This study aims to investigate the relationship between skeletal muscle and left ventricular mass (LVM) in patients with hyperthyroidism, providing theoretical and data-based foundations for further research on the interaction between secondary muscle atrophy and cardiac remodeling. Methods A retrospective data collection was conducted, including 136 patients with hyperthyroidism (Study group) and 50 healthy participants (control group). The Study group was further divided into Group A (high LVM) and Group B (low LVM) based on LVM size. Multiple linear regression analysis was performed to examine the correlation between skeletal muscle and LVM, with model evaluation. Based on the results, further nonlinear regression analysis was conducted to explore the detailed relationship between skeletal muscle and LVM. Results Compared to the control group, the Study group exhibited significantly lower LVM, skeletal muscle mass index (SMI), and skeletal muscle mass (SMM) (P<0.05). Within the subgroups, Group A had significantly higher SMI, SMM, and hand grip strength compared to Group B (P<0.05). The results of the multiple linear regression showed a certain correlation between SMI (β=0.60, P=0.042, 95% CI=0.02~1.17) and hand grip strength (β=0.34, P=0.045, 95% CI=0.01~0.67) with LVM. However, the residuals of the multiple regression did not follow a normal distribution (K-S=2.50, P<0.01). Further results from a generalized linear model and structural equation modeling regression also demonstrated a correlation between SMI (β=0.60, P=0.040, 95% CI=0.03~1.17) (β=0.60, P=0.042, 95% CI=0.02~1.17) and hand grip strength (β=0.34, P=0.043, 95% CI=0.01~0.67) (β=0.34, P=0.045, 95% CI=0.01~0.67) with LVM. Conclusion Patients with hyperthyroidism may exhibit simultaneous decreases in LVM, SMM, and SMI. The LVM in patients is correlated with SMM and hand grip strength, highlighting the need for further exploration of the causal relationship and underlying mechanisms. These findings provide a basis for the prevention and treatment of secondary sarcopenia and cardiac pathology in patients with hyperthyroidism.
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Affiliation(s)
- Zhenchao Liu
- Institute of Integrative Medicine, Qingdao University, Qingdao, Shandong, China
| | - Guang Liu
- Shandong Provincial Sports Center, Shandong Administration of Sports, Jinan, Shandong, China
| | - Yanzhi Wang
- Academic Affairs Office, Binzhou Medical University, Yantai, Shandong, China
| | - Chongwen Zheng
- Department of Neurology, The 2nd Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Yunliang Guo
- Institute of Integrative Medicine, Qingdao University, Qingdao, Shandong, China
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Chen S, Wohlford GF, Vecchie’ A, Carbone S, Yavuz S, Van Tassell B, Abbate A, Celi FS. Acute Effects of Liothyronine Administration on Cardiovascular System and Energy Metabolism in Healthy Volunteers. Front Endocrinol (Lausanne) 2022; 13:843539. [PMID: 35295986 PMCID: PMC8919711 DOI: 10.3389/fendo.2022.843539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/02/2022] [Indexed: 11/26/2022] Open
Abstract
CONTEXT The pharmacokinetics of liothyronine causes concerns for cardiovascular toxicity. While the effects of sustained increase in serum T3 concentrations are well described, little is known on the effects of acute changes in T3 concentrations due to rapid action of thyroid hormone. OBJECTIVE To assess the clinical relevance of transient increase of T3 levels on cardiovascular system and energy metabolism. SETTING Double-blind, three arms, placebo controlled, cross-over study (ClinicalTrials.gov Identifier: NCT03098433). STUDY PARTICIPANTS Twelve volunteers (3 females, 9 males), age 27.7 ± 5.1 years. INTERVENTION Oral administration of liothyronine 0.7 mcg/kg, equimolar dose of levothyroxine (0.86 mcg/kg), or placebo in three identical study visits. Blood samples for total T3, free T4 were collected at times 0', 60' 120' 180' 240'. Continuous recording of heart rate, blood pressure, and hemodynamic data was performed using the volume clamp method. Resting energy expenditure was measured by indirect calorimetry. An echocardiogram was performed on each study visit at baseline and after the last blood sampling. MAIN OUTCOME MEASURES Changes in cardiovascular function and energy expenditure. RESULTS Following the administration of liothyronine, serum T3 reached a Cmax of 421 ± 57 ng/dL with an estimated Tmax of 120 ± 26 minutes. No differences between study arms were observed in heart rate, blood pressure, hemodynamics parameters, energy expenditure, and in echocardiogram parameters. CONCLUSIONS The absence of measurable rapid effects on the cardiovascular system following a high dose of liothyronine supports the rationale to perform long-term studies to assess its safety and effectiveness in patients affected by hypothyroidism.
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Affiliation(s)
- Shanshan Chen
- Division of Endocrinology Diabetes and Metabolism, Virginia Commonwealth University, Richmond, VA, United States
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, United States
| | - George F. Wohlford
- Department of Pharmacotherapy and Outcomes Sciences, Virginia Commonwealth University, Richmond, VA, United States
| | - Alessandra Vecchie’
- Division of Cardiology, Virginia Commonwealth University, Richmond, VA, United States
- Department of Internal Medicine, ASST Sette Laghi, Varese, Italy
| | - Salvatore Carbone
- Department of Kinesiology and Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA, United States
| | - Sahzene Yavuz
- Division of Endocrinology Diabetes and Metabolism, Virginia Commonwealth University, Richmond, VA, United States
| | - Benjamin Van Tassell
- Department of Pharmacotherapy and Outcomes Sciences, Virginia Commonwealth University, Richmond, VA, United States
| | - Antonio Abbate
- Division of Cardiology, Virginia Commonwealth University, Richmond, VA, United States
| | - Francesco S. Celi
- Division of Endocrinology Diabetes and Metabolism, Virginia Commonwealth University, Richmond, VA, United States
- *Correspondence: Francesco S. Celi,
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Li B, Li Z, Huang Y. Investigating Changes in Cardiac Function and Structure of Left Ventricle by Speckle-Tracking Echocardiography in Patients With Hyperthyroidism and Graves' Disease. Front Cardiovasc Med 2021; 8:695736. [PMID: 34778388 PMCID: PMC8578409 DOI: 10.3389/fcvm.2021.695736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
Subclinical hyperthyroidism is a common thyroid dysfunction that can lead to cardiovascular complications. It is necessary to understand the treatment strategy in clinical practice. This study aimed to investigate the changes in cardiac function and left ventricular (LV) structure by speckle-tracking echocardiography in patients with hyperthyroidism and Graves' disease. PubMed, Medline, Cochrane Library, Embase, and SinoMed were searched for targeted articles, from inception till November 26, 2020, without any language restriction. All studies that evaluated changes in cardiac function and LV structure by speckle-tracking echocardiography in patients with hyperthyroidism and Graves' disease were screened. Included studies met the following inclusion criteria: (1) study population diagnosed with hyperthyroidism or Graves' disease; (2) patients without treatment and are undergoing speckle-tracking echocardiography; (3) necessary data could be extracted from original studies; (4) studies published in English or Chinese; and (5) if the study population was duplicated, only one study from the same institution that provided detailed information or newly published article was selected. All relevant articles from the above databases were screened and assessed according to the inclusion criteria by two reviews independently. Inverse variance methods with random-effects were employed to pool the mean differences (MDs) and the corresponding 95% confidence intervals (CIs). Ten studies with 483 patients and 434 healthy controls were included for data extraction and meta-analysis. On comparing patients with healthy controls, two-dimensional echocardiography revealed significant differences in several parameters including interventricular septal thickness (IVST) [mean difference (MD): 0.43, 95% CI = 0.12–0.73, P < 0.05] and left ventricular end systolic diameter (LVESD) (MD: 1.42, 95% CI = 0.33–2.52, P < 0.05). Moreover, there were significant differences in left ventricular ejection fraction (LVEF) (P < 0.05), global longitudinal strain (P < 0.05), and global circumferential strain (P < 0.05) demonstrated by three-dimensional echocardiography. These findings suggested that left ventricle (LV) function evaluated by speckle-tracking echocardiography showed significant impairment in patients with hyperthyroidism. However, additional original studies and meta-analyses are warranted for an in-depth investigation.
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Affiliation(s)
- Binyi Li
- Department of Ultrasound, The People's Hospital of Danyang, Danyang Hospital of Nantong University, Danyang, China
| | - Zheng Li
- Department of Ultrasound, The People's Hospital of Danyang, Danyang Hospital of Nantong University, Danyang, China
| | - Yong Huang
- Department of Endocrinology, The People's Hospital of Danyang, Danyang Hospital of Nantong University, Danyang, China
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Duzen IV, Tabur S, Ozturk S, Savcilioglu MD, Alıc E, Yetisen M, Sanli S, Goksuluk H, Vuruskan E, Altunbas G, Coskun FY, Kaplan M, Taysi S, Sucu M. Assessment of subclinical left ventricular dysfunction with speckle-tracking echocardiography in hyperthyroid and euthyroid Graves' disease and its correlation with serum TIMP-1. Acta Cardiol 2021; 76:177-184. [PMID: 31910731 DOI: 10.1080/00015385.2019.1708598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Graves' disease has a multitude of effects on the cardiovascular system. In the detection of subclinical left ventricular dysfunction, speckle-tracking echocardiography is more useful than conventional echocardiography. The aim of the present study was to compare the longitudinal global strain values and venous blood concentration of (tissue inhibitor of metalloproteinase-1) TIMP-1, a regulator of the extracellular matrix, among hyperthyroid patients with Graves' disease, euthyroid patients with Graves' disease and healthy control subjects. MATERIALS AND METHODS The study enrolled 40 hyperthyroid patients with newly diagnosed Graves' disease, 40 patients with Graves' disease who were euthyroid for at least 6 months and 40 control subjects with normal thyroid function. Participants underwent conventional echocardiography and speckle-tracking echocardiography to obtain segmental and global longitudinal strain values. In addition, the serum TIMP-1 value was assessed in the venous blood samples of the participants. RESULTS The hyperthyroid Graves' patients showed greater serum TIMP-1 levels versus the control group and the euthyroid Graves' group. Compared to the control group, the TIMP-1 level was also significantly higher in the euthyroid Graves' group. Lower GLS (global longitudinal strain) average and GLS2C, GLS3C, GLS4C values were observed in both the hyperthyroid and euthyroid Graves' patients compared to the control group. The euthyroid Graves' patients and hyperthyroid Graves' patients had similar GLS values. The serum TIMP-1 level was negatively correlated with global strain values. CONCLUSION Graves' disease coexists with impaired segmental and global longitudinal strain and increased TIMP-1 levels. This coexistence seems to be independent of serum thyroid hormone levels.
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Affiliation(s)
- Irfan Veysel Duzen
- Department of Cardiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Suzan Tabur
- Department of Endocrinology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Sadettin Ozturk
- Department of Endocrinology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | | | - Enes Alıc
- Department of Cardiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Mustafa Yetisen
- Department of Cardiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Sıddık Sanli
- Department of Cardiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | | | - Ertan Vuruskan
- Department of Cardiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Gokhan Altunbas
- Department of Cardiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Fatma Yılmaz Coskun
- Department of Cardiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Mehmet Kaplan
- Adana City Training and Research Hospital, Adana, Turkey
| | - Seyithan Taysi
- Department of Biochemistry, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Murat Sucu
- Department of Cardiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
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Grove-Laugesen D, Malmstroem S, Ebbehoj E, Riis AL, Watt T, Rejnmark L, Würgler Hansen K. Arterial Stiffness and Blood Pressure in Patients Newly Diagnosed with Graves' Disease Compared with Euthyroid Controls. Eur Thyroid J 2020; 9:148-156. [PMID: 32523891 PMCID: PMC7265727 DOI: 10.1159/000505873] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/11/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE The excess cardiovascular morbidity and mortality in hyperthyroidism and Graves' disease (GD) is inadequately understood. We aimed to elucidate whether well-established cardiovascular risk factors such as arterial stiffness in terms of pulse wave velocity (PWV) and blood pressure differ in GD and controls. METHODS This was a cross-sectional study comparing 55 hyperthyroid patients with newly diagnosed GD and 55 euthyroid, population-based controls matched for age, sex and menopausal status. PWV and blood pressure were measured in office (SphygmoCor Xcel) and 24-h ambulatory settings (Arteriograph). Differences between groups were assessed using adjusted linear regression analysis. RESULTS Compared to controls, GD patients showed higher PWV in the 24-h but not in the office setting with an adjusted 24-h PWV difference of 1.0 (95% CI: 0.6-1.5) m/s. PWV was higher in GD at both day and night, and nightly PWV dipping was lower (-5.5, 95% CI: -10.4 to -0.6%). Furthermore, central and brachial pulse pressure was significantly higher in both the office and 24-h setting, whereas nightly central pulse pressure dipping was significantly lower in GD (-5.4, 95% CI: -10.5 to -0.2%). Mean arterial pressure did not differ between the groups. CONCLUSIONS Despite comparable blood pressure, GD is associated with a higher 24-h PWV that was not detected in the office setting. Pulse pressure was higher in GD, whereas mean arterial pressure did not differ between the groups. Longitudinal studies should pursue whether higher PWV might be a piece to the puzzle of understanding the increased risk of cardiovascular disease in hyperthyroidism and GD.
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Affiliation(s)
- Diana Grove-Laugesen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- *Diana Grove-Laugesen, Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK–8200 Aarhus N (Denmark),
| | - Sofie Malmstroem
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Eva Ebbehoj
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Lene Riis
- Medical Department, Regional Hospital Horsens, Horsens, Denmark
| | - Torquil Watt
- Department of Internal Medicine, Gentofte and Herlev Hospital, Hellerup, Denmark
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
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Zhou M, Tan J, Liu J, Yin LX, Wang SJ, Xie L, Guo ZY, Zhang WJ. Changes in left ventricular function and contractile homogeneity in young adults with newly diagnosed hyperthyroidism due to Graves' disease. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:216-221. [PMID: 31833078 DOI: 10.1002/jcu.22802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 10/20/2019] [Accepted: 12/01/2019] [Indexed: 06/10/2023]
Abstract
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.
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Affiliation(s)
- Mi Zhou
- Department of Ultrasound in Medicine, Sichuan Provincial People's Hospital Affiliate Wenjiang Hospital, Chengdu, Sichuan, China
| | - Jing Tan
- Department of Ultrasound in Medicine, Sichuan Provincial People's Hospital Affiliate Wenjiang Hospital, Chengdu, Sichuan, China
| | - Jun Liu
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Li-Xue Yin
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Si-Jia Wang
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Ling Xie
- Department of Ultrasound in Medicine, Meishan Second People's Hospital, Chengdu, Sichuan, China
| | - Zhi-Yu Guo
- GE Healthcare Cardiac and Vascular Ultrasound Clinic Education Team, Chengdu, Sichuan, China
| | - Wen-Jun Zhang
- Department of Ultrasound in Medicine, Sichuan Provincial People's Hospital Affiliate Wenjiang Hospital, Chengdu, Sichuan, China
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Li H, Zeng R, Liao Y, Fu M, Zhang H, Wang L, Li Y. Prevalence and Risk Factors of Left Ventricular Diastolic Dysfunction in Patients With Hyperthyroidism. Front Endocrinol (Lausanne) 2020; 11:605712. [PMID: 33488520 PMCID: PMC7821907 DOI: 10.3389/fendo.2020.605712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 11/23/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Left ventricular (LV) diastolic dysfunction has been demonstrated to be an independent predictor of the future heart failure. Heart failure is one of the severe complications caused by overt hyperthyroidism. However, the effects of overt hyperthyroidism on diastolic dysfunction are conflicting, and little is known about the prevalence and risk factors of the diastolic dysfunction in patients with overt hyperthyroidism. METHODS A total of 388 patients with overt hyperthyroidism were included and compared with 388 age- and gender- matched euthyroid control subjects. LV diastolic function was evaluated by traditional and tissue-Doppler echocardiography. Routine clinical medical data and echocardiographic parameters were recorded for analysis. RESULTS The prevalence of LV diastolic dysfunction was 35.1% among hyperthyroid patients and significantly higher than control subjects whose prevalence was 25.5% (P = 0.003), and it increased with age and body mass index (BMI) in patients with overt hyperthyroidism. The possible risk factors for LV diastolic dysfunction, such as hypertension, diabetes, decreased estimated glomerular filtration rate (eGFR), and increased level of thyroid hormones weren't associated with LV diastolic dysfunction. However, overweight or obese were significantly associated with LV diastolic dysfunction (OR = 3.024, 95% CI = 1.517-6.027, P = 0.002) compared with normal BMI. When compared with age <40 years old group, 40-50 years old group, 50-60 years old group and age ≥60 years old group were significantly associated with LV diastolic dysfunction, with ORs of 2.976 (95% CI = 1.744-5.019), 12.424 (95% CI = 4.934-31.283), 24.966 (95% CI = 5.975-104.321), respectively. CONCLUSION LV diastolic dysfunction was very common, in particular, in older and overweight or obese patients with overt hyperthyroidism. Additionally, age and BMI were independent risk factors for LV diastolic dysfunction, while the level of thyroid hormones was not. Therefore, besides the LV systolic function, we also need focus on the diastolic function in patients with overt hyperthyroidism in clinical work, especially the older and overweight or obese patients.
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Affiliation(s)
- Huan Li
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Renli Zeng
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Yunfei Liao
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Mengfei Fu
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Huan Zhang
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Linfang Wang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Yuming Li, ; Linfang Wang,
| | - Yuming Li
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
- *Correspondence: Yuming Li, ; Linfang Wang,
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Gazzana ML, Souza JJ, Okoshi MP, Okoshi K. Prospective Echocardiographic Evaluation of the Right Ventricle and Pulmonary Arterial Pressure in Hyperthyroid Patients. Heart Lung Circ 2018; 28:1190-1196. [PMID: 30262155 DOI: 10.1016/j.hlc.2018.06.1055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/11/2018] [Accepted: 06/20/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) occurs in 35% to 65% of hyperthyroid patients. Despite this high frequency, only a few authors have examined the effects of hyperthyroidism treatment on PAH and the right ventricle. We evaluated the effects of hyperthyroidism and its reversal on cardiovascular structure and function using Doppler echocardiography. METHODS We prospectively evaluated 32 patients (42.5±11.9years old) with thyrotoxicosis. Exclusion criteria included previous cardiovascular disease. An echocardiogram was performed at the time of hyperthyroidism diagnosis and after normalisation of free thyroxine (T4) levels. Patients were divided into two groups according to the presence or absence of PAH at the diagnosis, or at two moments, before and after T4 normalisation. RESULTS Graves' disease was the most frequent aetiology (75%) of hyperthyroidism. Pulmonary arterial hypertension was observed in 43.8% of patients. Free T4 concentration was higher in PAH than non-PAH patients. Free T4 normalised after 5 (2.0-10.5; median and percentiles) months of treatment. Cardiac chamber sizes and cardiac output were higher in PAH. Right ventricular (RV) systolic function was impaired in PAH. Cardiac output and free T4 (r=0.42; p<0.05) correlated with pulmonary artery systolic pressure (PASP). Cardiac chamber size, cardiac output, left ventricular ejection fraction, and PASP (34.0±8.6 to 21.7±4.5mmHg) reduced after treatment. Right ventricular myocardial performance index and fractional area change improved after T4 normalisation. CONCLUSIONS Pulmonary arterial hypertension is highly prevalent in hyperthyroid patients and is combined with increased cardiac chambers size and cardiac output, and impaired RV function. Cardiovascular changes are reversible after T4 normalisation in patients without cardiovascular disease.
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Affiliation(s)
- M L Gazzana
- Superior School of Health Sciences, Amazonas State University - UEA, Manaus, Amazonas, Brazil
| | - J J Souza
- Medical School, Amazonas Federal University - UFAM, and Medical School, Nilton Lins University - UNL, Manaus, Amazonas, Brazil
| | - M P Okoshi
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, Sao Paulo, Brazil
| | - K Okoshi
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, Sao Paulo, Brazil.
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Muthukumar S, Ravikumar K, Dhalapathy S, Gomathy T, Umadevi S, Maruthupandian D. A Prospective Comparative Study on Improvement of Hyperthyroid Cardiovascular Dysfunction in Patients Undergoing Total Thyroidectomy Versus Medical Management. World J Surg 2018. [DOI: 10.1007/s00268-018-4571-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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