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Han X, Wang X. Does subclinical hypothyroidism affect the prognosis of patients with chronic systolic heart failure: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e38410. [PMID: 38847701 PMCID: PMC11155587 DOI: 10.1097/md.0000000000038410] [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: 01/09/2024] [Accepted: 05/09/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Chronic systolic heart failure (CSHF) is a significant health burden with high morbidity and mortality. The role of subclinical hypothyroidism (SCH) in the prognosis of CSHF patients remains a critical area of inquiry. This systematic review and meta-analysis aim to elucidate the impact of SCH on the prognosis of patients with CSHF. METHODS Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, this meta-analysis employed a comprehensive search strategy across major databases including PubMed, Embase, Web of Science, and the Cochrane Library. The Patient, Intervention, Comparison, Outcome framework guided the inclusion of studies focusing on patients with CSHF, comparing those with and without SCH. Quality assessment was performed using the Newcastle-Ottawa scale. Statistical analyses assessed heterogeneity and publication bias, employing fixed-effect or random-effects models based on heterogeneity levels. RESULTS From an initial pool of 1439 articles, 8 studies met the stringent inclusion criteria. These studies, conducted across diverse geographical regions, highlighted the relationship between SCH and all-cause mortality, cardiac events, and subgroup differences in CSHF patients. The meta-analysis revealed SCH as a significant risk factor for all-cause mortality (HR = 1.42) and cardiac events (HR = 1.46). Subgroup analysis indicated variability in risk based on region, sample size, age, and follow-up duration. Sensitivity analysis confirmed the stability of these findings, and publication bias assessment indicated symmetric funnel plot and nonsignificant Egger test results. CONCLUSIONS SCH emerges as a predictive factor for all-cause mortality, cardiovascular events, and rehospitalization in CSHF patients. This finding underscores the importance of screening for SCH in CSHF patients, highlighting its potential role in improving patient prognosis.
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Affiliation(s)
- Xiao Han
- Department of Endocrinology and Metabolism, Changchun University of Traditional Chinese Medicine, Changchun, Jilin Province, China
- Department of Endocrinology and Metabolism, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin Province, China
| | - Xiuge Wang
- Department of Endocrinology and Metabolism, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin Province, China
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2
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Frankel M, Bayya F, Munter G, Wolak A, Tolkin L, Barenhoz-Goultschin O, Asher E, Glikson M. Thyroid dysfunction and mortality in cardiovascular hospitalized patients. Cardiovasc Endocrinol Metab 2024; 13:e0299. [PMID: 38193023 PMCID: PMC10773777 DOI: 10.1097/xce.0000000000000299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 11/29/2023] [Indexed: 01/10/2024]
Abstract
Background Thyroid dysfunction (TD) is associated with increased cardiovascular morbidity and mortality. Early detection may influence the clinical management. Objective To determine the prevalence, predictors, and prognostic value of TD among hospitalized cardiac patients. Methods A retrospective analysis of a 12-year database consisting of nonselectively adult patients admitted to a Cardiology Department and who were all screened for serum thyroid-stimulation-hormone (TSH) levels . Statistical analysis of demographic and clinical characteristics, mortality and length of hospital stay (LOS) was performed. Results A total of 14369 patients were included in the study; mean age was 67 years, 38.3% females. 1465 patients (10.2%) had TD. The most frequent type of TD was mildly elevated TSH (5.4%) followed by mildly reduced TSH (2.1%), markedly elevated TSH (1.5%), and markedly reduced TSH (1.2%). Female gender, history of hypothyroidism, heart failure, atrial fibrillation, renal failure and amiodarone use were significantly associated with TD. During follow-up 2975 (20.7%) patients died. There was increased mortality in the mildly reduced TSH subgroup (hazard ratio [HR] =1.44), markedly elevated TSH subgroup (HR=1.40) and mildly elevated TSH subgroup (HR=1.27). LOS was longer for patients with TD; the longest stay was observed in the markedly elevated TSH subgroup (odds ratio=1.69). Conclusion The prevalence of TD in hospitalized cardiac patients is 10.2%. TD is associated with an increased mortality rate and LOS. Consequently, routine screening for thyroid function in this population is advisable, particularly for selected high-risk subgroups. Future studies are needed to determine whether optimizing thyroid function can improve survival in these patients.
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Affiliation(s)
- Meir Frankel
- Endocrinology Unit, Shaare Zedek Medical Center
- Hebrew University Medical School, Jerusalem, Israel
| | - Feras Bayya
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center
- Hebrew University Medical School, Jerusalem, Israel
| | - Gabriel Munter
- Endocrinology Unit, Shaare Zedek Medical Center
- Hebrew University Medical School, Jerusalem, Israel
| | - Arik Wolak
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center
- Hebrew University Medical School, Jerusalem, Israel
| | - Lior Tolkin
- Endocrinology Unit, Shaare Zedek Medical Center
- Hebrew University Medical School, Jerusalem, Israel
| | - Orit Barenhoz-Goultschin
- Endocrinology Unit, Shaare Zedek Medical Center
- Hebrew University Medical School, Jerusalem, Israel
| | - Elad Asher
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center
- Hebrew University Medical School, Jerusalem, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center
- Hebrew University Medical School, Jerusalem, Israel
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3
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Zhang H, Li X, Zhang N, Tian L. Effect of thyroid dysfunction on N-terminal pro-B-type natriuretic peptide levels: A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1083171. [PMID: 36777339 PMCID: PMC9909547 DOI: 10.3389/fendo.2023.1083171] [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: 10/28/2022] [Accepted: 01/10/2023] [Indexed: 01/27/2023] Open
Abstract
PURPOSE Thyroid hormones (THs) significantly affect the cardiovascular system. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a useful biomarker for diagnosing, evaluating, and predicting outcomes in heart failure (HF). This comprehensive review and meta-analysis aimed to investigate the effects of thyroid dysfunction (hypothyroidism and hyperthyroidism) on NT-proBNP levels. METHODS Two investigators independently searched PubMed, Embase, Cochrane Library, and Web of Science databases for studies published from inception to July 31, 2022, without any restrictions on language. RESULTS 21 studies were included. In participants without HF, NT-proBNP levels may be elevated in those with overt hyperthyroidism (standardized mean difference [SMD] 2.38, 95% confidence interval [CI]:1.0-3.76). Notably, among patients with preexisting HF, significantly higher NT-proBNP levels were found in patients with overt hyperthyroidism, overt hypothyroidism, or subclinical hypothyroidism than in euthyroid subjects (SMD [95%CI] = 0.31[0.01, 0.62], 0.32[0.08, 0.56], and 0.33[0.21, 0.46], respectively). Seven trials compared NT-proBNP levels in patients with thyroid dysfunction before and after therapy, and significant drops in NT-proBNP levels were observed in patients with hyperthyroidism (SMD [95%CI] = -1.53[-2.50, -0.55]) upon achieving a euthyroid state. In contrast, increased NT-proBNP levels were observed in hypothyroid patients after treatment (SMD [95%CI] = 1.07[0.28, 1.85]). CONCLUSION Thyroid dysfunction can significantly affect NT-proBNP levels, which may change upon achieving a euthyroid state. Notably, the effect of thyroid dysfunction on cardiac function may depend on the underlying cardiac status. Thus, timely recognition and effective treatment of cardiac symptoms in patients with thyroid dysfunction are mandatory because the prognosis of HF may be improved with appropriate treatment of thyroid dysfunction. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero, identifier CRD42022353700.
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Affiliation(s)
- Hongling Zhang
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, China
| | - Xiaotao Li
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, China
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Nawen Zhang
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, China
| | - Limin Tian
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, China
- Clinical Research Center for Metabolic Diseases, Lanzhou, Gansu, China
- *Correspondence: Limin Tian,
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4
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Wei J, Zhou Y. Association of Thyroid-Stimulating Hormone (TSH) Levels With the Prognosis of Patients Undergoing Heart Transplantation: A Retrospective Study. Front Cardiovasc Med 2021; 8:720922. [PMID: 34778392 PMCID: PMC8578266 DOI: 10.3389/fcvm.2021.720922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 10/05/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To investigate the impact of TSH levels using a more stringent cutoff of subclinical hypothyroidism (i.e., TSH > 2.5 mIU/L) on the short-term complications and long-term prognosis in patients who underwent heart transplantation (HTx). Methods: This is a retrospective study of consecutive patients with end-stage heart failure (HF) who underwent HTx. They were divided into three groups: thyroid-stimulating hormone (TSH) ≤ 2.50 mIU/L (L-TSH), 2.50 < TSH ≤ 4.91 mIU/L (M-TSH), and TSH > 4.91 mIU/L (H-TSH). The outcomes are all-cause death and cardiogenic death. Results: There are 63 (70%) males and 27 (30%) females. Nine (10%) patients died within 1 month after surgery, including five cardiogenic deaths. By 1 year, a total of 19 patients total were dead. The survival rate in the M-TSH group was significantly higher than that of the L-TSH group (P = 0.017). After adjusted by variables of sex, age, BMI, diabetes history, hypertension history, the multivariable Cox analysis showed that body mass index (HR = 0.804, 95%CI: 0.680-0.951, P = 0.011), and L-TSH (HR = 8.757, 95%CI: 1.786-42.948, P = 0.007 vs. M-TSH), and H-TSH (HR = 6.427, 95%CI: 1.137-36.327, P = 0.035 vs. M-TSH) were independently associated with all-cause death. The multivariable Cox analysis showed that body mass index (HR = 0.703, 95%CI: 0.564-0.878, P = 0.002), and L-TSH (HR = 17.717, 95%CI: 1.907-164.607, P = 0.011 vs. M-TSH) were independently associated with cardiogenic death. Conclusion: For patients with end-stage HF undergoing HTx, low and high baseline TSH levels are independently associated with 1-year all-cause death and low baseline TSH levels with cardiogenic death.
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Affiliation(s)
- Jiajie Wei
- Department of Endocrinology and Metabolism, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yingsheng Zhou
- Department of Endocrinology and Metabolism, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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5
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Zawadzka K, Dziedzic R, Surdacki A, Chyrchel B. Thyroid Hormones-An Underestimated Player in Dilated Cardiomyopathy? J Clin Med 2021; 10:jcm10163618. [PMID: 34441915 PMCID: PMC8397026 DOI: 10.3390/jcm10163618] [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: 05/05/2021] [Revised: 08/03/2021] [Accepted: 08/13/2021] [Indexed: 01/01/2023] Open
Abstract
Dilated cardiomyopathy (DCM) is the most prevalent cardiomyopathy, typified by left ventricular dilation and systolic dysfunction. Many patients with DCM have altered thyroid status, especially lower levels of free triiodothyronine (T3) and elevated levels of thyroid-stimulating hormone. Moreover, growing evidence indicates that even subtle changes in thyroid status (especially low T3) are linked with a worse long-term prognosis and a higher risk of mortality. Notably, recent discoveries have shown that not only local myocardial thyroid hormones (THs) bioavailability could be diminished due to impaired expression of the activating deiodinase, but virtually all genes involved in TH biosynthesis are also expressed in the myocardium of DCM patients. Importantly, some studies have suggested beneficial effects of TH therapy in patients suffering from DCM. Our aim was to discuss new insights into the association between TH status and prognosis in DCM, abnormal expression of genes involved in the myocardial synthesis of TH in DCM, and the potential for TH use in the future treatment of DCM.
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Affiliation(s)
- Karolina Zawadzka
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (K.Z.); (R.D.)
| | - Radosław Dziedzic
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (K.Z.); (R.D.)
| | - Andrzej Surdacki
- Second Department of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland;
| | - Bernadeta Chyrchel
- Second Department of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland;
- Correspondence: ; Tel.: +48-12-400-2250
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6
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Aguilar M, Rose RA, Takawale A, Nattel S, Reilly S. New aspects of endocrine control of atrial fibrillation and possibilities for clinical translation. Cardiovasc Res 2021; 117:1645-1661. [PMID: 33723575 PMCID: PMC8208746 DOI: 10.1093/cvr/cvab080] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/25/2021] [Accepted: 03/11/2021] [Indexed: 12/20/2022] Open
Abstract
Hormones are potent endo-, para-, and autocrine endogenous regulators of the function of multiple organs, including the heart. Endocrine dysfunction promotes a number of cardiovascular diseases, including atrial fibrillation (AF). While the heart is a target for endocrine regulation, it is also an active endocrine organ itself, secreting a number of important bioactive hormones that convey significant endocrine effects, but also through para-/autocrine actions, actively participate in cardiac self-regulation. The hormones regulating heart-function work in concert to support myocardial performance. AF is a serious clinical problem associated with increased morbidity and mortality, mainly due to stroke and heart failure. Current therapies for AF remain inadequate. AF is characterized by altered atrial function and structure, including electrical and profibrotic remodelling in the atria and ventricles, which facilitates AF progression and hampers its treatment. Although features of this remodelling are well-established and its mechanisms are partly understood, important pathways pertinent to AF arrhythmogenesis are still unidentified. The discovery of these missing pathways has the potential to lead to therapeutic breakthroughs. Endocrine dysfunction is well-recognized to lead to AF. In this review, we discuss endocrine and cardiocrine signalling systems that directly, or as a consequence of an underlying cardiac pathology, contribute to AF pathogenesis. More specifically, we consider the roles of products from the hypothalamic-pituitary axis, the adrenal glands, adipose tissue, the renin–angiotensin system, atrial cardiomyocytes, and the thyroid gland in controlling atrial electrical and structural properties. The influence of endocrine/paracrine dysfunction on AF risk and mechanisms is evaluated and discussed. We focus on the most recent findings and reflect on the potential of translating them into clinical application.
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Affiliation(s)
- Martin Aguilar
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, QC, Canada.,Department of Pharmacology and Physiology/Institute of Biomedical Engineering, Université de Montréal, Montréal, QC, Canada
| | - Robert A Rose
- Department of Cardiac Sciences, Department of Physiology and Pharmacology, Libin Cardiovascular Institute, Cumming School of Medicine, Health Research Innovation Center, University of Calgary, AB, Canada
| | - Abhijit Takawale
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, QC, Canada.,Department of Pharmacology and Physiology/Institute of Biomedical Engineering, Université de Montréal, Montréal, QC, Canada.,Department of Pharmacology and Therapeutics, McGill University, Montreal, QC, Canada
| | - Stanley Nattel
- Department of Pharmacology and Therapeutics, McGill University, Montreal, QC, Canada.,Faculty of Medicine, Department of Pharmacology and Physiology, and Research Centre, Montreal Heart Institute and University of Montreal, Montreal, QC, Canada.,Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Germany.,IHU LIRYC and Fondation Bordeaux Université, Bordeaux, France
| | - Svetlana Reilly
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, John Radcliffe Hospital, Oxford, UK
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7
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Yamazaki Y, Shoji T, Miyashima M, Nagata Y, Kakutani Y, Ochi A, Morioka T, Nakatani S, Mori K, Tsujimoto Y, Emoto M. Low Free Triiodothyronine Level as a Predictor of Cardiovascular Events and All-Cause Mortality in Patients Undergoing Hemodialysis: The DREAM Cohort. J Atheroscler Thromb 2020; 28:1071-1082. [PMID: 33361647 PMCID: PMC8560844 DOI: 10.5551/jat.60624] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Low T3 syndrome is characterized by low serum triiodothyronine (T3) levels without elevation of thyroid-stimulating hormone (TSH) in patients without apparent thyroid disease, which is known to be associated with worse clinical outcomes in various populations including those with kidney failure. In this study, we examined whether low free T3 (FT3) levels are independent predictor of cardiovascular disease (CVD) events in patients undergoing hemodialysis. METHODS This was a prospective cohort study of patients with chronic kidney disease undergoing hemodialysis. From the total of 518 patients, we excluded patients with treated or untreated hyperthyroidism or hypothyroidism and those treated with corticosteroids. RESULTS We analyzed data from 438 eligible patients. During the 5-year follow-up, 154 new CVD events and 86 all-cause deaths were recorded. Kaplan-Meier analysis showed that lower FT3 levels were associated with higher risks for new cardiovascular events and all-cause death. This inverse association of FT3 and new CVD events remained significant after adjustment for age, sex, duration of hemodialysis, diabetic kidney disease, hypertension, dyslipidemia, and smoking; however, it was no longer significant after further adjustment for prior CVD or N-terminal fragment of probrain natriuretic peptide (NT-proBNP). FT3 did not show an independent association with all-cause mortality. CONCLUSIONS Our results indicate that low FT3 status is not an independent predictor of new CVD events and that the following factors are closely associated: prior CVD, low FT3 and high NT-proBNP levels at present, and future risk of new CVD events in hemodialysis patients.
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Affiliation(s)
- Yuko Yamazaki
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine
| | - Tetsuo Shoji
- Department of Vascular Medicine, Osaka City University Graduate School of Medicine.,Vascular Science Center for Translational Research, Osaka City University Graduate School of Medicine
| | - Masako Miyashima
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine
| | - Yuki Nagata
- Department of Vascular Medicine, Osaka City University Graduate School of Medicine.,Vascular Science Center for Translational Research, Osaka City University Graduate School of Medicine
| | - Yoshinori Kakutani
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine
| | - Akinobu Ochi
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine
| | - Tomoaki Morioka
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine
| | - Shinya Nakatani
- Department of Nephrology, Osaka City University Graduate School of Medicine
| | - Katsuhito Mori
- Department of Nephrology, Osaka City University Graduate School of Medicine
| | | | - Masanori Emoto
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine.,Vascular Science Center for Translational Research, Osaka City University Graduate School of Medicine.,Department of Nephrology, Osaka City University Graduate School of Medicine
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8
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Isaksen JL, Skov MW, Graff C, Ellervik C, Kanters JK. Electrocardiography in euthyroid individuals: a Danish general population study. Minerva Endocrinol (Torino) 2020; 47:103-110. [PMID: 32720496 DOI: 10.23736/s2724-6507.20.03170-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Thyroid hormones within the euthyroid range have been linked to mortality and differences in heart rate. However, some relations between thyroid hormone concentration and various electrocardiographic measurements remain unassessed. We aimed to investigate the association between thyroid hormone concentrations within the euthyroid range and different electrocardiographic markers in people free of thyroid disease. METHODS We obtained electrocardiograms (ECG) and blood samples of free T4, total T3, and thyrotropin (TSH) in 20,852 subjects from the general population (the GESUS study). Relations between concentrations of TSH, free T4, and total T3 and heart rate, QTc, QRS duration, PR interval, P-wave duration and T-wave morphology were assessed in a multivariate adjusted linear model stratified by sex. RESULTS Roughly half of the 18,046 included participants with thyroid hormone measurements within euthyroid range were men, and the average age was 56 years. Heart rate increased with concentrations of T3 (6.4 bpm/nM, P<0.001 in women and 5.3 bpm/nM, P<0.001 in men) and T4 (3.7 bpm/10pM, P<0.001 in women and 3.1 bpm/10pM, P<0.001 in men). We found no relation between TSH and heart rate. PR interval and QRS duration decreased with higher concentrations of T3 (all P<0.01). QTc increased with higher concentrations of T4 in men (5 ms/10pM), and T waves were flatter, more asymmetric, and more often had notches with higher concentrations of T4 (all P≤0.01). CONCLUSIONS Thyroid hormone concentrations within the euthyroid range in people free of thyroid disease were associated with changes in the electrocardiogram in a general population.
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Affiliation(s)
- Jonas L Isaksen
- Department of Biomedical Sciences, Laboratory of Experimental Cardiology, University of Copenhagen, Copenhagen, Denmark
| | - Morten W Skov
- Department of Cardiology, Laboratory for Molecular Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Claus Graff
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Christina Ellervik
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Laboratory Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Production, Research and Innovation, Region Zealand, Sorø, Denmark
| | - Jørgen K Kanters
- Department of Biomedical Sciences, Laboratory of Experimental Cardiology, University of Copenhagen, Copenhagen, Denmark -
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9
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Manolis AA, Manolis TA, Melita H, Manolis AS. Subclinical thyroid dysfunction and cardiovascular consequences: An alarming wake-up call? Trends Cardiovasc Med 2020; 30:57-69. [DOI: 10.1016/j.tcm.2019.02.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/14/2019] [Accepted: 02/25/2019] [Indexed: 12/12/2022]
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10
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Zhai T, Cai Z, Zheng J, Ling Y. Impact of Hypothyroidism on Echocardiographic Characteristics of Patients With Heart Valve Disease: A Single-Center Propensity Score-Based Study. Front Endocrinol (Lausanne) 2020; 11:554762. [PMID: 33071970 PMCID: PMC7542235 DOI: 10.3389/fendo.2020.554762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/21/2020] [Indexed: 11/27/2022] Open
Abstract
Background: Hypothyroidism is known to be correlated with multiple heart diseases. However, the influence of hypothyroidism on the patients with heart valve disease (HVD) is still unclear. The purpose of our study was to investigate the impact of hypothyroidism on echocardiographic characteristics of patients with heart valve disease. Methods: We conducted a retrospective cohort study which included 2,128 patients with HVD, and they were divided into euthyroid, subclinical hypothyroidism (SCHypoT), and overt hypothyroidism (OHypoT) group. Echocardiographic characteristics before and after valve surgery between groups were compared by using propensity score (PS) analysis. Kaplan-Meier analysis was used to compare the percent of recovery of left atrial (LA) enlargement between groups. Results: Overall, 463 patients had hypothyroidism (404 SCHypoT patients and 59 OHypoT patients), and 1,665 patients were euthyroid. At baseline, hypothyroidism was associated with significantly higher left atrial diameter (LAD), interventricular septum thickness, left ventricular posterior wall thickness, pulmonary artery systolic pressure, and lower left ventricular ejection fraction. After valve surgery, only LAD remained significantly higher in the patients with hypothyroidism. Additionally, patients with hypothyroidism had a significantly lower recovery rate of LA enlargement after valve surgery compared with euthyroid patients. Conclusion: Hypothyroidism was associated with a larger LAD in patients with HVD before and after surgery, which may suggest that hypothyroidism is a risk factor of LA enlargement of HVD. Besides, hypothyroidism was associated with a significantly lower recovery rate of LA enlargement after valve surgery.
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Affiliation(s)
- Tianyu Zhai
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhenqin Cai
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiayu Zheng
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Jiayu Zheng
| | - Yan Ling
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
- Yan Ling
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11
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Kannan L, Shaw PA, Morley MP, Brandimarto J, Fang JC, Sweitzer NK, Cappola TP, Cappola AR. Thyroid Dysfunction in Heart Failure and Cardiovascular Outcomes. Circ Heart Fail 2019; 11:e005266. [PMID: 30562095 DOI: 10.1161/circheartfailure.118.005266] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The effects of thyroid dysfunction in patients with preexisting heart failure have not been adequately studied. We examined the prevalence of thyroid dysfunction and associations with cardiovascular outcomes in a large, prospective cohort of outpatients with preexisting heart failure. METHODS AND RESULTS We examined associations between thyroid dysfunction and New York Heart Association class, atrial fibrillation, and a composite end point of ventricular assist device placement, heart transplantation, or death in 1365 participants with heart failure enrolled in the Penn Heart Failure Study. Mean age was 57 years, 35% were women, and the majority had New York Heart Association class II (45%) or III (32%) symptoms. More severe heart failure was associated with higher thyroid-stimulating hormone (TSH), higher free thyroxine (FT4), and lower total triiodothyronine (TT3) concentrations ( P<0.001 all models). Atrial fibrillation was positively associated with higher levels of FT4 alone ( P≤0.01 all models). There were 462 composite end points over a median 4.2 years of follow-up. In adjusted models, compared with euthyroidism, subclinical hypothyroidism (TSH 4.51-19.99 mIU/L with normal FT4) was associated with an increased risk of the composite end point overall (hazard ratio, 1.82; 95% CI, 1.27-2.61; P=0.001) and in the subgroup with TSH ≥7.00 mIU/L (hazard ratio, 3.25; 95% CI, 1.96-5.39; P<0.001), but not in the subgroup with TSH 4.51-6.99 mIU/L (hazard ratio, 1.26; 95% CI, 0.78-2.06; P=0.34). Isolated low T3 was also associated with the composite end point (hazard ratio, 2.12; 95% CI, 1.65-2.72; P<0.001). CONCLUSIONS In patients with preexisting heart failure, subclinical hypothyroidism with TSH ≥7 mIU/L and isolated low T3 levels are associated with poor prognosis. Clinical trials are needed to explore therapeutic effects of T4 and T3 administration in heart failure.
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Affiliation(s)
- Lakshmi Kannan
- Division of Endocrinology, Diabetes, and Metabolism (L.K., A.R.C.) at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Pamela A Shaw
- Department of Biostatistics, Epidemiology, and Informatics (P.A.S.) at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Michael P Morley
- the Cardiovascular Institute (M.P.M., J.B., T.P.C.) at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Jeffrey Brandimarto
- the Cardiovascular Institute (M.P.M., J.B., T.P.C.) at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - James C Fang
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City (J.C.F.)
| | - Nancy K Sweitzer
- Division of Cardiology, University of Arizona College of Medicine, Tucson (N.K.S.)
| | - Thomas P Cappola
- Division of Cardiovascular Medicine (T.P.C.) at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- the Cardiovascular Institute (M.P.M., J.B., T.P.C.) at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Anne R Cappola
- Division of Endocrinology, Diabetes, and Metabolism (L.K., A.R.C.) at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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12
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Subclinical thyroid dysfunction is associated with adverse prognosis in heart failure patients with reduced ejection fraction. BMC Cardiovasc Disord 2019; 19:83. [PMID: 30947691 PMCID: PMC6450005 DOI: 10.1186/s12872-019-1055-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 03/20/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Subclinical thyroid dysfunction whose typical patterns include subclinical hypothyroidism and subclinical hyperthyroidism, has been indicated to be associated with an increased risk of heart failure (HF). However, the relationship between subclinical thyroid dysfunction and the clinical outcomes of HF patients is uncertain. This meta-analysis was conducted to assess the association between subclinical thyroid dysfunction and the clinical outcomes of HF patients. METHODS Pubmed, Embase, Web of Science and Cochrane Central Register of Clinical Trials were searched for eligible studies published up to August 1, 2018 which reported the association between subclinical thyroid dysfunction and the clinical outcomes of HF patients. The pooled hazard ratio (HR) with the corresponding 95% confidence interval (CI) was used to assess the association. RESULTS Fourteen studies met the eligibility criteria and a total of 21,221 patients with heart failure were included in the meta-analysis. Compared with HF patients with euthyroidism, the pooled HR of subclinical hypothyroidism for all-cause mortality was 1.45 (95% CI 1.26-1.67) in a randomized effects model with mild heterogeneity (I2 = 40.1, P = 0.073). The pooled HR of subclinical hypothyroidism for cardiac death and/or hospitalization was 1.33 (1.17-1.50) in a randomized effects model with moderate heterogeneity (I2 = 69.4, P < 0.001). Subclinical hyperthyroid can increase the risk of all-cause mortality without heterogeneity (HR 1.31, 95% CI 1.10-1.55, I2 = 25.5%, P = 0.225) but have no influence on the risk of cardiac death and/or hospitalization (HR 1.03, 95% CI 0.87-1.23, I2 = 0.0%, P = 0.958). These significant adverse associations were also retained in subgroup analysis. Sensitivity analysis demonstrated the stability of the results of our meta-analysis. CONCLUSIONS Both subclinical hypothyroidism and subclinical hyperthyroidism are associated with adverse prognosis in patients with HF. Subclinical thyroid dysfunction may be a useful and promising predictor for the long-term prognosis in HF patients.
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Mastorci F, Sabatino L, Vassalle C, Pingitore A. Cardioprotection and Thyroid Hormones in the Clinical Setting of Heart Failure. Front Endocrinol (Lausanne) 2019; 10:927. [PMID: 32047475 PMCID: PMC6997485 DOI: 10.3389/fendo.2019.00927] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 12/19/2019] [Indexed: 01/14/2023] Open
Abstract
Ischemic heart disease is the main cause of morbidity and mortality worldwide and is becoming more widespread with population aging. Cardioprotection is a dynamic process characterized by mechanisms related to myocardial damage and activation of protective factors. Targeting these processes could be attractive as a new therapeutic strategy in the evolution of post-ischemic heart failure (HF). In this context, the role of thyroid hormone (TH)-mediated cardioprotection is supported by a number of findings regarding the modulation of neuroendocrine systems, inflammatory and oxidative stress status, pro-survival intracellular pathways, and epigenetic factors, its effects on cardiac angiogenesis, structure, and function and on the preservation of mitochondrial function and morphology, and its beneficial effects on cell growth and redifferentiation. Moreover, the numerous effects of TH on the heart involve genomic mechanisms, which include cardiac differentiation during the perinatal period and non-genomic action, directed toward the maintenance of cardiovascular homeostasis. This evidence suggests that there is an opportunity to treat HF patients with TH. This review is mainly focused on the clinical evidence of the role of the thyroid system in the complex setting of HF.
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Affiliation(s)
| | | | | | - Alessandro Pingitore
- Clinical Physiology Institute, CNR, Pisa, Italy
- *Correspondence: Alessandro Pingitore
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14
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Moon S, Kim MJ, Yu JM, Yoo HJ, Park YJ. Subclinical Hypothyroidism and the Risk of Cardiovascular Disease and All-Cause Mortality: A Meta-Analysis of Prospective Cohort Studies. Thyroid 2018; 28:1101-1110. [PMID: 29978767 DOI: 10.1089/thy.2017.0414] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To determine the impact of subclinical hypothyroidism (SCH) on the risk of cardiovascular disease (CVD) and all-cause mortality, a comprehensive meta-analysis was performed according to the age or coexisting CVD risk status of the participants. METHODS Studies regarding the association of SCH with all-cause mortality from PubMed and Embase databases were included. The pooled relative risk (RR) of CVD and all-cause mortality was calculated using the Mantel-Haenszel method. A subgroup analysis of participants with high CVD risk was conducted, including history of coronary, cerebral, or peripheral artery disease; dilated cardiomyopathy; heart failure; atrial fibrillation; venous thromboembolism; diabetes mellitus; or chronic kidney disease. RESULTS In total, 35 eligible articles incorporating 555,530 participants were included. SCH was modestly associated with CVD and all-cause mortality (RR for CVD = 1.33 [confidence interval (CI) 1.14-1.54]; RR for all-cause mortality = 1.20 [CI 1.07-1.34]). However, the association was not observed in participants aged ≥65 years. Subgroup analysis showed that participants with SCH and high CVD risk showed a significantly higher risk of all-cause mortality (RR for CVD = 2.20 [CI 1.28-3.77]; RR for all-cause mortality = 1.66 [CI 1.41-1.94]), whereas those with SCH and low CVD risk did not. Additional subgroup analysis of six studies with a mean participant age of ≥65 years and high CVD risk showed a significant high risk of all-cause mortality in the SCH group (RR = 1.41 [CI 1.08-1.85]; I2 = 0%). CONCLUSIONS SCH is associated with an increased CVD risk and all-cause mortality, particularly in participants with high CVD risk.
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Affiliation(s)
- Shinje Moon
- 1 Department of Internal Medicine, Hallym University College of Medicine , Seoul, Republic of Korea
- 2 Department of Internal Medicine, Graduate School, Hanyang University , Seoul, Republic of Korea
| | - Min Joo Kim
- 3 Department of Internal Medicine, Seoul National University Hospital , Seoul, Republic of Korea
| | - Jae Myung Yu
- 1 Department of Internal Medicine, Hallym University College of Medicine , Seoul, Republic of Korea
| | - Hyung Joon Yoo
- 1 Department of Internal Medicine, Hallym University College of Medicine , Seoul, Republic of Korea
| | - Young Joo Park
- 3 Department of Internal Medicine, Seoul National University Hospital , Seoul, Republic of Korea
- 4 Department of Internal Medicine, Seoul National University , Seoul, Republic of Korea
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15
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Gil-Cayuela C, Ortega A, Tarazón E, Martínez-Dolz L, Cinca J, González-Juanatey JR, Lago F, Roselló-Lletí E, Rivera M, Portolés M. Myocardium of patients with dilated cardiomyopathy presents altered expression of genes involved in thyroid hormone biosynthesis. PLoS One 2018; 13:e0190987. [PMID: 29320567 PMCID: PMC5761948 DOI: 10.1371/journal.pone.0190987] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 12/22/2017] [Indexed: 11/18/2022] Open
Abstract
Background The association between dilated cardiomyopathy (DCM) and low thyroid hormone (TH) levels has been previously described. In these patients abnormal thyroid function is significantly related to impaired left ventricular (LV) function and increased risk of death. Although TH was originally thought to be produced exclusively by the thyroid gland, we recently reported TH biosynthesis in the human ischemic heart. Objectives Based on these findings, we evaluated whether the genes required for TH production are also altered in patients with DCM. Methods Twenty-three LV tissue samples were obtained from patients with DCM (n = 13) undergoing heart transplantation and control donors (n = 10), and used for RNA sequencing analysis. The number of LV DCM samples was increased to 23 to determine total T4 and T3 tissue levels by ELISA. Results We found that all components of TH biosynthesis are expressed in human dilated heart tissue. Expression of genes encoding thyroperoxidase (–2.57-fold, P < 0.05) and dual oxidase 2 (2.64-fold, P < 0.01), the main enzymatic system of TH production, was significantly altered in patients with DCM and significantly associated with LV remodeling parameters. Thyroxine (T4) cardiac tissue levels were significantly increased (P < 0.01), whilst triiodothyronine (T3) levels were significantly diminished (P < 0.05) in the patients. Conclusions Expression of TH biosynthesis machinery in the heart and total tissue levels of T4 and T3, are altered in patients with DCM. Given the relevance of TH in cardiac pathology, our results provide a basis for new gene-based therapeutic strategies for treating DCM.
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Affiliation(s)
- Carolina Gil-Cayuela
- Cardiocirculatory Unit, Health Research Institute of La Fe University Hospital (IIS La Fe), Valencia, Spain
- Members of the Center for Biomedical Research Network in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Ana Ortega
- Cardiocirculatory Unit, Health Research Institute of La Fe University Hospital (IIS La Fe), Valencia, Spain
- Members of the Center for Biomedical Research Network in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Estefanía Tarazón
- Cardiocirculatory Unit, Health Research Institute of La Fe University Hospital (IIS La Fe), Valencia, Spain
- Members of the Center for Biomedical Research Network in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Luis Martínez-Dolz
- Members of the Center for Biomedical Research Network in Cardiovascular Diseases (CIBERCV), Madrid, Spain
- Heart Failure and Transplantation Unit, Cardiology Department, La Fe University Hospital, Valencia, Spain
| | - Juan Cinca
- Members of the Center for Biomedical Research Network in Cardiovascular Diseases (CIBERCV), Madrid, Spain
- Cardiology Service of Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | - José Ramón González-Juanatey
- Members of the Center for Biomedical Research Network in Cardiovascular Diseases (CIBERCV), Madrid, Spain
- Cellular and Molecular Cardiology Research Unit, Department of Cardiology and Institute of Biomedical Research, University Clinical Hospital, Santiago de Compostela, Spain
| | - Francisca Lago
- Members of the Center for Biomedical Research Network in Cardiovascular Diseases (CIBERCV), Madrid, Spain
- Cellular and Molecular Cardiology Research Unit, Department of Cardiology and Institute of Biomedical Research, University Clinical Hospital, Santiago de Compostela, Spain
| | - Esther Roselló-Lletí
- Cardiocirculatory Unit, Health Research Institute of La Fe University Hospital (IIS La Fe), Valencia, Spain
- Members of the Center for Biomedical Research Network in Cardiovascular Diseases (CIBERCV), Madrid, Spain
- * E-mail: (MR); (MP); (ERL)
| | - Miguel Rivera
- Cardiocirculatory Unit, Health Research Institute of La Fe University Hospital (IIS La Fe), Valencia, Spain
- Members of the Center for Biomedical Research Network in Cardiovascular Diseases (CIBERCV), Madrid, Spain
- * E-mail: (MR); (MP); (ERL)
| | - Manuel Portolés
- Cardiocirculatory Unit, Health Research Institute of La Fe University Hospital (IIS La Fe), Valencia, Spain
- Members of the Center for Biomedical Research Network in Cardiovascular Diseases (CIBERCV), Madrid, Spain
- * E-mail: (MR); (MP); (ERL)
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Subclinical Hypothyroidism and Its Association with Increased Cardiovascular Mortality. Cardiol Res Pract 2017; 2017:7539735. [PMID: 29170719 PMCID: PMC5467346 DOI: 10.1155/2017/7539735] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/25/2017] [Accepted: 04/19/2017] [Indexed: 01/07/2023] Open
Abstract
Thyroid hormones play an important role in regulating different metabolism functions and multiple organs' performance. Changes in the thyroid hormone axis can lead to profound effects on the stability of vital organs and systems, especially the cardiovascular system. Hypothyroidism is classified according to the clinical presentation as overt and subclinical. There is some evidence supporting the benefits of thyroxine hormone replacement for subclinical hypothyroidism on cardiovascular mortality outcomes. However, the clinical relevance of measuring and treating high thyroid-stimulating hormone (TSH) levels in newly diagnosed heart failure patients with preserved ejection fraction requires further study. In this report, we review the current evidence regarding the prognostic significance of subclinical hypothyroidism in heart failure patients with preserved ejection fraction.
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17
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Hassan A, Altamirano-Ufion A, Zulfiqar B, Boddu P. Sub-Clinical Hypothyroidism and Its Association With Increased Cardiovascular Mortality: Call for Action. Cardiol Res 2017; 8:31-35. [PMID: 28515819 PMCID: PMC5421483 DOI: 10.14740/cr524w] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 01/07/2023] Open
Abstract
Thyroid hormones play an important role in regulating different functions regarding metabolism and performance in multiple organs. Any change in the thyroid hormones axis can lead to profound effect on the vital organ stability especially the cardiovascular system. Hypothyroidism is classified according to the clinical presentation as overt and subclinical. Currently, there exists a paucity of evidence on the beneficial effects of thyroxine hormone replacement on cardiovascular mortality outcomes in subclinical hypothyroidism. Also, the clinical relevance of measuring and treating supra-normal thyroid-stimulating hormone levels in newly diagnosed heart failure patients with preserved ejection fraction requires further study. Here we review the current evidence regarding the prognostic significance of sub-clinical hypothyroidism in patients with heart failure with preserved ejection fraction.
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Affiliation(s)
- Abdalla Hassan
- Advocate Illinois Masonic Medical Center, Chicago, IL, USA
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18
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What is the association of hypothyroidism with risks of cardiovascular events and mortality? A meta-analysis of 55 cohort studies involving 1,898,314 participants. BMC Med 2017; 15:21. [PMID: 28148249 PMCID: PMC5289009 DOI: 10.1186/s12916-017-0777-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 01/03/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Whether hypothyroidism is an independent risk factor for cardiovascular events is still disputed. We aimed to assess the association between hypothyroidism and risks of cardiovascular events and mortality. METHODS We searched PubMed and Embase from inception to 29 February 2016. Cohort studies were included with no restriction of hypothyroid states. Priori main outcomes were ischemic heart disease (IHD), cardiac mortality, cardiovascular mortality, and all-cause mortality. RESULTS Fifty-five cohort studies involving 1,898,314 participants were identified. Patients with hypothyroidism, compared with euthyroidism, experienced higher risks of IHD (relative risk (RR): 1.13; 95% confidence interval (CI): 1.01-1.26), myocardial infarction (MI) (RR: 1.15; 95% CI: 1.05-1.25), cardiac mortality (RR: 1.96; 95% CI: 1.38-2.80), and all-cause mortality (RR: 1.25; 95% CI: 1.13-1.39); subclinical hypothyroidism (SCH; especially with thyrotropin level ≥10 mIU/L) was also associated with higher risks of IHD and cardiac mortality. Moreover, cardiac patients with hypothyroidism, compared with those with euthyroidism, experienced higher risks of cardiac mortality (RR: 2.22; 95% CI: 1.28-3.83) and all-cause mortality (RR: 1.51; 95% CI: 1.26-1.81). CONCLUSIONS Hypothyroidism is a risk factor for IHD and cardiac mortality. Hypothyroidism is associated with higher risks of cardiac mortality and all-cause mortality compared with euthyroidism in the general public or in patients with cardiac disease.
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Arora A, Porwal Y, Kumari P, Kumar D. Reversible dilated cardiomyopathy in a case of primary hypothyroidism. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2016. [DOI: 10.1016/j.injms.2016.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pingitore A, Iervasi G, Forini F. Role of the Thyroid System in the Dynamic Complex Network of Cardioprotection. Eur Cardiol 2016; 11:36-42. [PMID: 30310446 DOI: 10.15420/ecr.2016:9:2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Cardioprotection is a common goal of new therapeutic strategies in patients with coronary artery disease and/or left ventricular dysfunction. Myocardial damage following ischaemia/reperfusion injury lead to left ventricular adverse remodelling through many mechanisms arising from different cell types in different myocardial districts, namely the border and remote zone. Cardioprotection must face this complex, dynamic network of cooperating units. In this scenario, thyroid hormones can represent an effective therapeutic strategy due to the numerous actions and regulating mechanisms carried out at the level of the myocytes, interstitium and the vasculature, as well as to the activation of different pro-survival intracellular pathways involved in cardioprotection.
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Affiliation(s)
| | - Giorgio Iervasi
- Clinical Physiology Institute, National Research Council (CNR), Pisa, Italy
| | - Francesca Forini
- Clinical Physiology Institute, National Research Council (CNR), Pisa, Italy
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A Prospective Study on Cardiovascular Dysfunction in Patients with Hyperthyroidism and Its Reversal After Surgical Cure. World J Surg 2015; 40:622-8. [DOI: 10.1007/s00268-015-3352-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ning N, Gao D, Triggiani V, Iacoviello M, Mitchell JE, Ma R, Zhang Y, Kou H. Prognostic Role of Hypothyroidism in Heart Failure: A Meta-Analysis. Medicine (Baltimore) 2015; 94:e1159. [PMID: 26222845 PMCID: PMC4554113 DOI: 10.1097/md.0000000000001159] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 06/06/2015] [Accepted: 06/23/2015] [Indexed: 01/07/2023] Open
Abstract
Hypothyroidism is a risk factor of heart failure (HF) in the general population. However, the relationship between hypothyroidism and clinical outcomes in patients with established HF is still inconclusive.We conducted a systematic review and meta-analysis to clarify the association of hypothyroidism and all-cause mortality as well as cardiac death and/or hospitalization in patients with HF. We searched MEDLINE via PubMed, EMBASE, and Scopus databases for studies of hypothyroidism and clinical outcomes in patients with HF published up to the end of January 2015. Random-effects models were used to estimate summary relative risk (RR) statistics. We included 13 articles that reported RR estimates and 95% confidence intervals (95% CIs) for hypothyroidism with outcomes in patients with HF. For the association of hypothyroidism with all-cause mortality and with cardiac death and/or hospitalization, the pooled RR was 1.44 (95% CI: 1.29-1.61) and 1.37 (95% CI: 1.22-1.55), respectively. However, the association disappeared on adjustment for B-type natriuretic protein level (RR 1.17, 95% CI: 0.90-1.52) and in studies of patients with mean age <65 years (RR 1.23, 95% CI: 0.88-1.76).We found hypothyroidism associated with increased all-cause mortality as well as cardiac death and/or hospitalization in patients with HF. Further diagnostic and therapeutic procedures for hypothyroidism may be needed for patients with HF.
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Affiliation(s)
- Ning Ning
- From the Department of Nuclear Medicine (NN), The Second Affiliated Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi, P.R. China; Department of Cardiology (DG, RM, YZ, HK), The Second Affiliated Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi, P.R. China; Endocrinology and Metabolic Diseases (VT), Interdisciplinary Department of Medicine, University of Bari, Bari, Italy; Cardiology Unit (MI), Department of Emergency and Organs Transplantation, University of Bari, Bari, Italy; and State University of New York Downstate Medical Center (JE), Brooklyn, NY
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