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Liu L, Zeng B, Zhang J, Li G, Zong W. Impact of subclinical hypothyroidism on in-hospital outcomes and long-term mortality among acute myocardial infarction patients with diabetic mellitus. Acta Cardiol 2023:1-9. [PMID: 37961871 DOI: 10.1080/00015385.2023.2279421] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Thyroid-stimulating hormone (TSH) has been regarded as a predictor of poor outcomes in patients with acute myocardial infarction (AMI). AMI complicated by diabetes mellitus (DM) tends to have a high prevalence and a worse prognosis. We aim to evaluate the association between thyroid dysfunction and in-hospital outcomes and short- and medium-term mortality in diabetic patients with AMI. METHODS From January 2017 to November 2020, a total of 432 patients with AMI were included in this study, including 209 DM patients and 223 non-DM patients. Baseline characteristics, medical history, and laboratory parameters of patients were recorded after admission. In-hospital outcomes and 30-day mortality were recorded, and long-term mortality was recorded with a median follow-up of 34.2 ± 5.6 months. RESULTS Subclinical hypothyroidism (SCH) was defined as an elevated TSH level of more than with a normal range of circulating thyroid hormones. In AMI with DM group, 26/209 (12.4%) patients were complicated with SCH, these patients tend to be older and experienced worse in-hospital outcomes compared to patients without SCH, including higher rates of acute heart failure, acute kidney injury, and atrial fibrillation. Moreover, patients with SCH had a higher prevalence of 30-day mortality and long-term mortality, compared with patients without SCH. CONCLUSIONS Diabetic AMI patients with SCH had worse in-hospital outcomes and higher 30-day and long-term mortality. Patients with diabetic AMI should pay attention to thyroid function, and SCH is an independent risk factor for short-term and long-term mortality in diabetic AMI patients.
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Affiliation(s)
- Lei Liu
- Department of Cardiology, Hubei No.3 People's Hospital of Jianghan University, Wuhan, China
| | - Bin Zeng
- Renmin Hospital of Wuhan University, Wuhan, China
| | - Jingyi Zhang
- Department of Cardiology, Hubei No.3 People's Hospital of Jianghan University, Wuhan, China
| | - Geng Li
- Department of Cardiology, Hubei No.3 People's Hospital of Jianghan University, Wuhan, China
| | - Wenxia Zong
- Department of Cardiology, The Third People's Hospital of Hubei Province Affiliated to Jianghan University, Wuhan, China
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Xie Y, Wang Z, Chen Z. Analysis of Subclinical Thyroid Dysfunction and Metabolic Abnormality in 28568 Healthy People. Int J Endocrinol 2023; 2023:5216945. [PMID: 37876378 PMCID: PMC10593554 DOI: 10.1155/2023/5216945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/26/2023] [Accepted: 09/29/2023] [Indexed: 10/26/2023] Open
Abstract
We analyzed the detection rates of metabolic syndrome (MetS) and subclinical thyroid dysfunction, including subclinical hyperthyroidism (SCHyper) and subclinical hypothyroidism (SCH), in healthy people, as well as their relationship. Clinical data were collected from 28,568 healthy individuals who underwent physical examinations. The detection rates of SCHyper, SCH, and MetS, as well as in different genders and ages, were analyzed. The detection rate of SCHyper and SCH in females was significantly higher than that in males (P < 0.001), but that of MetS in males was significantly higher than that in females (P < 0.001). In each age group, the detection rate of SCH in females was higher than that in males (P < 0.001). The detection rate of SCH was significantly different in different age groups (P < 0.001). The detection rates of hyperlipidemia (P < 0.001), obesity (P = 0.004), hypertension (P = 0.009), and hyperglycemia (P < 0.001) in the female SCH group were significantly higher than those in the normal group. The detection rates of hyperlipidemia (P = 0.006), obesity (P = 0.04), and hypertension (P = 0.04) in the male SCH group were higher than those in the normal group. The males with SCHyper were more prone to hyperlipidemia (P = 0.02) and obesity (P = 0.03). In addition, the female SCHyper group was not significantly different from the normal group (P > 0.05). Conclusively, the detection rate of SCHyper and SCH in females is higher than that in males, which increases with age. Attention should be paid to subclinical thyroid dysfunction in elderly people, especially females. Early individualized screening and early intervention should be carried out for people with abnormal metabolism.
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Affiliation(s)
- Yan Xie
- Health Management Centre, The First Affiliated Hospital of Army Medical University, Chongqing 400038, China
| | - Zhixue Wang
- Department of Clinical Laboratory, Bishan Hospital of Chongqing Medical University (Bishan Hospital of Chongqing), Chongqing 402760, China
| | - Zongtao Chen
- Health Management Centre, The First Affiliated Hospital of Army Medical University, Chongqing 400038, China
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Ang SP, Chia JE, Jaiswal V, Bandyopadhyay D, Iglesias J, Mohan GVK, Gautam S, Win T, Kumar T, Iqbal A, Chia TH, Aronow W. Subclinical Hypothyroidism and Clinical Outcomes After Percutaneous Coronary Intervention: A Meta-Analysis. Curr Probl Cardiol 2023; 48:101719. [PMID: 36967069 DOI: 10.1016/j.cpcardiol.2023.101719] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 05/06/2023]
Abstract
While subclinical hypothyroidism (SCH) was reportedly associated with an increased risk of cardiovascular mortality, the relationship between SCH and clinical outcomes of patients undergoing percutaneous coronary intervention (PCI) is uncertain. The aim of this study was to assess the association of SCH and cardiovascular outcomes in patients undergoing PCI. We searched PubMed, Embase, Scopus, and CENTRAL databases from its inception until April 1, 2022 for studies comparing the outcomes between SCH and euthyroid patients undergoing PCI. Outcomes of interest include cardiovascular mortality, all-cause mortality, myocardial infarction (MI), major adverse cardiovascular and cerebrovascular events (MACCE), repeat revascularization and heart failure. Outcomes were pooled using the DerSimonian and Laird random-effects model and reported as risk ratios (RR) and 95% confidence intervals (CI). A total of 7 studies involving 1132 patients with SCH and 11,753 euthyroid patients were included in the analysis. Compared with euthyroid patients, patients with SCH had significantly higher risk of cardiovascular mortality (RR 2.16, 95% CI: 1.38-3.38, P < 0.001), all-cause mortality (RR 1.68, 95% CI: 1.23-2.29, P = 0.001) and repeat revascularization (RR 1.96, 95% CI: 1.08-3.58, P = 0.03). However, there were no differences between both groups in terms of incidence of MI (RR 1.81, 95% CI: 0.97-3.37, P = 0.06), MACCE (RR 2.24, 95% CI: 0.55-9.08, P = 0.26) and heart failure (RR 5.38, 95% CI: 0.28-102.35, P = 0.26). Our analysis suggests among patients undergoing PCI, SCH was associated with increased risk of cardiovascular mortality, all-cause mortality and repeat revascularization compared to euthyroid patients.
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Affiliation(s)
- Song Peng Ang
- Division of Internal Medicine, Rutgers Health/Community Medical Center, Toms River, New Jersey
| | - Jia Ee Chia
- Department of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Vikash Jaiswal
- Department of Medicine, Larkin Community Hospital, South Miami, FL.
| | | | - Jose Iglesias
- Department of Nephrology, Rutgers Health/Community Medical Center, Toms River, New Jersey, USA
| | | | - Sudarshan Gautam
- Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY
| | - Thazin Win
- Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Tushar Kumar
- Department of Radiology, Sikkim Manipal Institute of Medical Science, Gangtok, India
| | - Abbas Iqbal
- Department of Medicine, Saidu Group of Teaching Hospital, Swat, Pakistan
| | - Tong Hong Chia
- Department of Oncology, Hospital Sultan Ismail, Johor Bahru, Malaysia
| | - Wilbert Aronow
- Department of Cardiology, Westchester Medical Center and New York Medical College, New York, NY
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Mantzouratou P, Malaxianaki E, Cerullo D, Lavecchia AM, Pantos C, Xinaris C, Mourouzis I. Thyroid Hormone and Heart Failure: Charting Known Pathways for Cardiac Repair/Regeneration. Biomedicines 2023; 11:975. [PMID: 36979954 PMCID: PMC10046827 DOI: 10.3390/biomedicines11030975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Heart failure affects more than 64 million people worldwide, having a serious impact on their survival and quality of life. Exploring its pathophysiology and molecular bases is an urgent need in order to develop new therapeutic approaches. Thyroid hormone signaling, evolutionarily conserved, controls fundamental biological processes and has a crucial role in development and metabolism. Its active form is L-triiodothyronine, which not only regulates important gene expression by binding to its nuclear receptors, but also has nongenomic actions, controlling crucial intracellular signalings. Stressful stimuli, such as acute myocardial infarction, lead to changes in thyroid hormone signaling, and especially in the relation of the thyroid hormone and its nuclear receptor, which are associated with the reactivation of fetal development programmes, with structural remodeling and phenotypical changes in the cardiomyocytes. The recapitulation of fetal-like features of the signaling may be partially an incomplete effort of the myocardium to recapitulate its developmental program and enable cardiomyocytes to proliferate and finally to regenerate. In this review, we will discuss the experimental and clinical evidence about the role of the thyroid hormone in the recovery of the myocardium in the setting of heart failure with reduced and preserved ejection fraction and its future therapeutic implications.
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Affiliation(s)
| | | | - Domenico Cerullo
- Centro Anna Maria Astori, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 24126 Bergamo, Italy
| | - Angelo Michele Lavecchia
- Centro Anna Maria Astori, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 24126 Bergamo, Italy
| | | | - Christodoulos Xinaris
- Centro Anna Maria Astori, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 24126 Bergamo, Italy
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Urgatz B, Razvi S. Subclinical hypothyroidism, outcomes and management guidelines: a narrative review and update of recent literature. Curr Med Res Opin 2023; 39:351-365. [PMID: 36632720 DOI: 10.1080/03007995.2023.2165811] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Subclinical hypothyroidism (SCH) is diagnosed when serum thyroid stimulation hormone (thyrotropin; TSH) levels are above the reference range, accompanied by levels of free thyroxine within its reference range. The management of SCH remains a diagnostic and therapeutic challenge despite many years of research relating to its epidemiology, aetiology, effectiveness of treatment and safety. European Thyroid Association (ETA) guidelines for the management of SCH were published almost a decade ago. This narrative review summarizes the clinical literature relating to SCH and outcomes since the publication of these guidelines. Clinical evidence emerging during the previous decade generally supports the view that SCH is associated with adverse outcomes to an extent that is intermediate between euthyroidism and overt hypothyroidism although evidence that treatment with thyroid hormone replacement is beneficial is lacking. Accordingly, the rationale for the recommendations for intervention in the ETA guidelines based on the age of the patient, level of serum TSH, symptoms and comorbidities remains valid today.
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Affiliation(s)
| | - Salman Razvi
- Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK
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Cohen B, Bental T, Perl L, Vaknin Assa H, Codner P, Orvin K, Barkan YT, Levi A, Kornowski R, Perl L. Hypothyroidism predicts worsened prognosis in patients undergoing percutaneous coronary intervention. Front Cardiovasc Med 2022; 9:984952. [DOI: 10.3389/fcvm.2022.984952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 11/14/2022] [Indexed: 12/02/2022] Open
Abstract
BackgroundThe link between thyroid dysfunction and cardiovascular disease is well established. Hypothyroidism has been significantly associated with increased risk of dyslipidemia, atherosclerosis and heart failure. However, little is known regarding its effect on patients undergoing percutaneous coronary intervention (PCI).AimThe aim of study was to examine the impact of concomitant hypothyroidism on mortality and major adverse cardiac event (MACE) in patients undergoing PCI.MethodsThe Rabin Medical Center PCI registry includes all consecutive patients who have undergone PCI between 2004 and 2020. We identified patients with prior diagnosis of hypothyroidism, and compared rates of mortality and MACE (comprising death, myocardial infarction, target vessel revascularization and/or coronary bypass surgery).ResultsAmong 28,274 patients, 1,922 (6.8%) were found to have hypothryoidism. These patients were older (70.3 ± 10.4 vs. 66.0 ± 11.8 y.o, P < 0.001) and more likely to be women (34.2% vs. 26.1%, P < 0.001). They had a higher prevalence of atrial fibrillation (10.8% vs. 7.7%, P < 0.001), chronic renal dysfunction (25.1% vs. 18.7%, P = 0.04) and dementia (2.9% vs. 1.8%, P = 0.004). PCI was performed on ACS setting in 52–54% of patients in both groups (p = 0.569). Unadjusted 5-year rates of all-cause mortality (26.9% vs. 20.3%, P < 0.001) and MACE (40.3% vs. 29.4%, P < 0.001) were higher for hypothyroid patients. A propensity match score was able to form 672 matched pairs of HT and control patients, showing similar results. Moreover, following multivariate analysis, TSH as a continuous parameter was associated with a higher risk of mortality and MACE (HR, 1.06 per additional 1 mIU/L; CI, 1.02–1.11; P < 0.001 and HR, 1.07; CI, 1.02–1.12; P < 0.001, respectively) at 5-year follow up.ConclusionIn our study, hypothyroidism confers worse outcomes in patients undergoing PCI. Further research is needed to establish effective ways to mitigate this augmented risk.
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Joe YE, Shin YR, Kwak YL, Shim JH, Shon YS, Shim JK. Influence of Mild Thyroid Dysfunction on Outcomes after Off-Pump Coronary Artery Bypass Surgery. J Clin Med 2022; 11:jcm11175033. [PMID: 36078968 PMCID: PMC9457104 DOI: 10.3390/jcm11175033] [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: 07/12/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/21/2022] Open
Abstract
We retrospectively evaluated the association between preoperative mild thyroid dysfunction (subclinical hypothyroidism [SCH] or low triiodothyronine [T3] syndrome) and outcomes in patients who underwent off-pump coronary surgery (OPCAB). Further, 800 patients (2015−2020) were divided into euthyroid, low T3, and SCH groups. The primary outcome assessed the association with composite endpoints (myocardial infarction, prolonged mechanical ventilation [>24 h], acute kidney injury, and 30-day/in-hospital mortality). The secondary outcome assessed the association with long-term mortality and 10% and 8% of the patients exhibited low T3 and SCH, respectively. Incidences of composite endpoints were significantly higher in the low T3 and SCH groups versus the euthyroid group (50.6%, 45.2%, 17.4%, respectively, p < 0.001). Multivariable regression analysis revealed chronic kidney disease, anemia, EuroSCORE, low T3, and SCH as independent risk factors of composite endpoints. The long-term mortality rate (median follow-up, 30 months) was higher in the low T3 and SCH groups than in the euthyroid group (9.6%, 11.3%, 2.4%, respectively, p < 0.001). In the absence of overt thyroid dysfunction, low T3 and SCH were associated with increased risk of adverse outcomes after OPCAB. Moreover, the adverse influences of low T3 and SCH seem to extend to long-term mortality, implying that routine thyroid function tests may enhance accurate risk stratification.
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Affiliation(s)
- Young-Eun Joe
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
| | - Yu Rim Shin
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Young-Lan Kwak
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
| | - Jae Hang Shim
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Guri-si 11923, Gyeonggi-do, Korea
| | - Young Suk Shon
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Guri-si 11923, Gyeonggi-do, Korea
| | - Jae-Kwang Shim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
- Correspondence: ; Tel.: +82-2-2228-8516
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Han C, Xu K, Wang L, Zhang Y, Zhang R, Wei A, Dong L, Hu Y, Xu J, Li W, Li T, Liu C, Qi W, Jin D, Zhang J, Cong H. Impact of persistent subclinical hypothyroidism on clinical outcomes in non-ST-segment elevation acute coronary syndrome undergoing percutaneous coronary intervention. Clin Endocrinol (Oxf) 2022; 96:70-81. [PMID: 34636447 DOI: 10.1111/cen.14613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/22/2021] [Accepted: 09/26/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Data on the association of subclinical hypothyroidism (SCH) with the severity of coronary artery disease and major adverse cardiovascular and cerebral events (MACCE) in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) after percutaneous coronary intervention (PCI) are limited and conflicting. OBJECTIVE We established the baseline rate of SCH and followed the trajectory of thyroid-stimulating hormone (TSH) values during and after hospitalisation for PCI for up to six months and determined whether persistent SCH was associated with the severity of coronary artery disease and MACCE in patients with NSTE-ACS after PCI. DESIGN Population-based prospective cohort study. PATIENTS We included patients with NSTE-ACS who underwent PCI with simple balloon angioplasty or stent implantation for coronary heart disease. MEASUREMENTS Thyroid function tests of patients before PCI and 1 day, 1 week, 1 and 6 months after PCI were performed. Cases showing transient SCH were excluded. Patients were divided into two groups based on the results of four TSH tests: 0.27-4.2 mIU/L (n = 1472, 89.7%) and >4.2 mIU/L (n = 170, 10.4%). The risk factors for the severity of coronary artery lesions were estimated using multinomial logistic regression analysis. Univariate and multivariate Cox regression analyses were used to study the relationship between TSH and MACCE. RESULTS Among 1642 patients, there were 1070 males (65.2%) and 572 females (34.8%), with an average age of 62.5 ± 9.6 years. SCH patients had a wider range of diseased vessels and a higher number of diseased vessels (p < .05). TSH level was an independent risk factor for moderate [odds ratio (OR) = 1.144, 95% confidence interval (95% CI): 1.057-1.237, p = .001] and severe (OR = 1.131, 95% CI: 1.043-1.226, p = .003) coronary artery lesions. After adjusting for covariates, the risk of MACCE [hazard ratio (HR): 4.067, p < .001], nonfatal myocardial infarction (HR: 14.724, p = .003), and unplanned PCI (HR: 5.028, p < .001) were higher in the SCH group than in the euthyroidism group. There were no significant differences in the incidence of heart failure (HR: 6.012, p = .175), nonfatal stroke (HR: 2.039, p = .302), unplanned coronary artery bypass grafting (CABG) (HR: 1.541, p = .57), or cardiac death (HR: 2.704, p = .375) between the two groups. CONCLUSIONS Preoperative TSH levels and changes in thyroid hormone levels several months post-PCI in NSTE-ACS patients are highly significant in practice. Persistent SCH is associated with severe coronary artery lesions and MACCE, and may be a predictor for evaluating the prognosis of PCI-treated NSTE-ACS patients.
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Affiliation(s)
- Chuyi Han
- Thoracic Clinical College, Tianjin Medical University, Tianjin, China
| | - Kaihang Xu
- Thoracic Clinical College, Tianjin Medical University, Tianjin, China
| | - Le Wang
- The Eighth Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Yingyi Zhang
- The Eighth Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Rui Zhang
- The Eighth Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Ao Wei
- The Eighth Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Lijie Dong
- Thoracic Clinical College, Tianjin Medical University, Tianjin, China
| | - Yuecheng Hu
- The Eighth Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Jinghan Xu
- The Eighth Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Wenyu Li
- The Eighth Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Tingting Li
- The Eighth Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Chunwei Liu
- The Eighth Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Wei Qi
- The Eighth Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Dongxia Jin
- The Eighth Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Jingxia Zhang
- The Eighth Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Hongliang Cong
- The Eighth Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
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Li MF, Wei ZT, Li S, Feng QM, Li JB. Association of Mild Thyroid Dysfunction and Adverse Prognosis Among Chinese Patients With Acute ST Segment Elevation Myocardial Infarction. Front Endocrinol (Lausanne) 2022; 13:879443. [PMID: 35574034 PMCID: PMC9097552 DOI: 10.3389/fendo.2022.879443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Thyroid hormones widely affect the cardiovascular system, but the effects of mild thyroid dysfunction on the clinical prognosis of patients with acute ST segment elevation myocardial infarction (STEMI) remains unclear. Our aims were to analyze the relations between mild thyroid dysfunction at admission and clinical outcomes in Chinese patients with STEMI. METHODS A total of 1,176 STEMI patients with the available data of thyroid function and follow-up were analyzed, including 348 patients with mild thyroid dysfunction [subclinical hypothyroidism (n=81), hyperthyroidism (SHyper) (n=51), and low triiodothyronine syndrome (LT3S) (n=216)] and 828 patients with euthyroid function. During a median 4.4-year follow-up, in-hospital mortality, cardiac and all-cause mortalities were subsequently compared among the four groups. RESULTS Compared with the euthyroid group, STEMI patients in the SHyper and LT3S groups faced obviously increased risks of in-hospital death [odds ratio (OR): 5.007, 95% confidence interval (CI): 1.246-20.124, p = 0.023 and OR: 2.491, 95% CI: 1.054-5.887, p = 0.037, respectively) even after adjustment for various confounding factors. During a median 4.4-year follow-up, STEMI patients with LT3S at baseline had higher cardiovascular mortality [hazard ratio (HR): 1.880, 95% CI: 1.178-2.998, p = 0.008] and all-cause mortality HR: 1.647, 95% CI: 1.072-2.531, p = 0.023] than those with euthyroid at baseline, whereas no significantly increased mortality was found for STEMI patients with SCH and SHyper at baseline. CONCLUSIONS STEMI patients with SHyper at admission had increased risk of in-hospital mortality, and STEMI patients with LT3S at baseline had worse prognosis and higher incidences of in-hospital mortality and cardiovascular and all-cause deaths compared with euthyroid patients.
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Affiliation(s)
- Mei-Fang Li
- Department of Emergency, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Ze-Tao Wei
- Department of Emergency, Dan Zhou People’s Hospital, Dan Zhou, China
| | - Shuai Li
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Qi-Ming Feng
- Department of Emergency, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- *Correspondence: Qi-Ming Feng, ; Jing-Bo Li,
| | - Jing-Bo Li
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- *Correspondence: Qi-Ming Feng, ; Jing-Bo Li,
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Liu YS, Wei M, Wang L, Liu G, Ma GP, Ono K, Cao ZL, Yang M, Zheng MQ. The impact of subclinical hypothyroidism on long-term outcomes in older patients undergoing percutaneous coronary intervention. BMC Endocr Disord 2021; 21:43. [PMID: 33673843 PMCID: PMC7934482 DOI: 10.1186/s12902-021-00702-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 02/18/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Subclinical hypothyroidism (SCH) is reportedly associated with an increased risk of adverse events in patients undergoing percutaneous coronary intervention (PCI). The prognostic significance of SCH in the elderly was poorly defined. The purpose of this study was to evaluate the association between SCH and long-term outcomes in older patients undergoing PCI. METHODS Three thousand one hundred sixty-eight patients aged 65 years or older who underwent PCI from January 2012 to October 2014 were included. Patients were divided into SCH group (n = 320) and euthyroidism (ET) group (n = 2848) based on thyroid function test. Cox proportional hazard regression analyses were used to estimate the relative risks (RRs) of all-cause death and cardiac death for patients with SCH during a 4-year follow-up period. RESULTS There were 227 deaths during the follow-up period including 124 deaths caused by cardiac events. There was no significant difference in mortality rate between the SCH group and the ET group (p > 0.05). After adjustment for covariates, compared with patients with ET, the RRs of death from all-cause and cardiac in patients with SCH were 1.261 (95%CI: 0.802-1.982, p = 0.315) and 1.231 (95%CI: 0.650-2.334, p = 0.524), respectively. When SCH was stratified by age, gender, and degree of thyroid-stimulating hormone elevation, no significant associations were also found in any stratum. CONCLUSION Our investigation revealed that SCH was negatively associated with the outcome of PCI in older patients.
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Affiliation(s)
- Yong-Sheng Liu
- Heart Center, The First Hospital of Hebei Medical University, No.89 Donggang Road, Shijiazhuang, 050031, Hebei, China
| | - Mei Wei
- Heart Center, The First Hospital of Hebei Medical University, No.89 Donggang Road, Shijiazhuang, 050031, Hebei, China
| | - Le Wang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, 300222, China
| | - Gang Liu
- Heart Center, The First Hospital of Hebei Medical University, No.89 Donggang Road, Shijiazhuang, 050031, Hebei, China
| | - Guo-Ping Ma
- Heart Center, The First Hospital of Hebei Medical University, No.89 Donggang Road, Shijiazhuang, 050031, Hebei, China
| | - Katsushige Ono
- Department of Pathophysiology, Oita University School of Medicine, Yufu, Oita, 879-5593, Japan
| | - Ze-Long Cao
- Heart Center, The First Hospital of Hebei Medical University, No.89 Donggang Road, Shijiazhuang, 050031, Hebei, China
| | - Man Yang
- Heart Center, The First Hospital of Hebei Medical University, No.89 Donggang Road, Shijiazhuang, 050031, Hebei, China
| | - Ming-Qi Zheng
- Heart Center, The First Hospital of Hebei Medical University, No.89 Donggang Road, Shijiazhuang, 050031, Hebei, China.
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Unknown Subclinical Hypothyroidism and In-Hospital Outcomes and Short- and Long-Term All-Cause Mortality among ST Segment Elevation Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention. J Clin Med 2020; 9:jcm9123829. [PMID: 33256094 PMCID: PMC7760853 DOI: 10.3390/jcm9123829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 02/08/2023] Open
Abstract
Subclinical hypothyroidism (SCH) is defined as an elevated serum thyroid-stimulating hormone (TSH) level with a normal serum-free thyroxine (FT4) level. SCH has been associated with an increased risk of adverse cardiovascular outcomes. We investigated possible associations of unknown SCH with in-hospital outcomes and short- and long-term all-cause mortality in a large cohort of patients with ST segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). This retrospective, single-center observational study evaluated the TSH and FT4 levels of 1593 STEMI patients with no known history of hypothyroidism or thyroid replacement treatment who were admitted to the coronary care unit and underwent PCI between 1/2008 and 8/2017. SCH was defined as TSH levels ≥ 5 mU/mL in the presence of normal FT4 levels. Unknown SCH was detected in 68/1593 (4.2%) STEMI patients. These patients had significantly worse in-hospital outcomes compared to patients without SCH, including higher rates of acute kidney injury (p = 0.003) and left ventricular ejection fraction ≤ 40% (p = 0.03). Moreover, 30-day mortality (p = 0.02) and long-term (mean 4.2 ± 2.3 years) mortality (p = 0.007) were also significantly higher in patients with SCH. The thyroid function of STEMI patients should be routinely tested before they undergo a planned PCI procedure.
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Chang CY, Chien YJ, Lin PC, Chen CS, Wu MY. Nonthyroidal Illness Syndrome and Hypothyroidism in Ischemic Heart Disease Population: A Systematic Review and Meta-Analysis. J Clin Endocrinol Metab 2020; 105:5847674. [PMID: 32459357 DOI: 10.1210/clinem/dgaa310] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 05/21/2020] [Indexed: 02/05/2023]
Abstract
CONTEXT The association of non-thyroidal illness syndrome (NTIS) and hypothyroidism with the prognosis in ischemic heart disease (IHD) population is inconclusive. OBJECTIVE We aimed to evaluate the influence of NTIS and hypothyroidism on all-cause mortality and major adverse cardiac events (MACE) in IHD population. DATA SOURCES We searched PubMed, EMBASE, Scopus, Web of Science, and Cochrane Library from inception through February 17, 2020. STUDY SELECTION Original articles enrolling IHD patients, comparing all-cause mortality and MACE of NTIS and hypothyroidism with those of euthyroidism, and providing sufficient information for meta-analysis were considered eligible. DATA EXTRACTION Relevant information and numerical data were extracted for methodological assessment and meta-analysis. DATA SYNTHESIS Twenty-three studies were included. The IHD population with NTIS was associated with higher risk of all-cause mortality (hazard ratio [HR] = 2.61; 95% confidence interval [CI] = 1.89-3.59) and MACE (HR = 2.22; 95% CI = 1.71-2.89) than that without. In addition, the IHD population with hypothyroidism was also associated with higher risk of all-cause mortality (HR = 1.47; 95% CI = 1.10-1.97) and MACE (HR = 1.53; 95% CI = 1.19-1.97) than that without. In the subgroup analysis, the acute coronary syndrome (ACS) subpopulation with NTIS was associated with higher risk of all-cause mortality (HR = 3.30; 95% CI = 2.43-4.48) and MACE (HR = 2.19; 95% CI = 1.45-3.30). The ACS subpopulation with hypothyroidism was also associated with higher risk of all-cause mortality (HR = 1.67; 95% CI = 1.17-2.39). CONCLUSIONS The IHD population with concomitant NTIS or hypothyroidism was associated with higher risk of all-cause mortality and MACE. Future research is required to provide evidence of the causal relationship and to elucidate whether normalizing thyroid function parameters can improve prognosis.
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Affiliation(s)
- Chun-Yu Chang
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yung-Jiun Chien
- Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Po-Chen Lin
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chien-Sheng Chen
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Meng-Yu Wu
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
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13
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Jabbar A, Ingoe L, Junejo S, Carey P, Addison C, Thomas H, Parikh JD, Austin D, Hollingsworth KG, Stocken DD, Pearce SHS, Greenwood JP, Zaman A, Razvi S. Effect of Levothyroxine on Left Ventricular Ejection Fraction in Patients With Subclinical Hypothyroidism and Acute Myocardial Infarction: A Randomized Clinical Trial. JAMA 2020; 324:249-258. [PMID: 32692386 DOI: 10.1001/jama.2020.9389] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Thyroid hormones play a key role in modulating myocardial contractility. Subclinical hypothyroidism in patients with acute myocardial infarction is associated with poor prognosis. OBJECTIVE To evaluate the effect of levothyroxine treatment on left ventricular function in patients with acute myocardial infarction and subclinical hypothyroidism. DESIGN, SETTING, AND PARTICIPANTS A double-blind, randomized clinical trial conducted in 6 hospitals in the United Kingdom. Patients with acute myocardial infarction including ST-segment elevation and non-ST-segment elevation were recruited between February 2015 and December 2016, with the last participant being followed up in December 2017. INTERVENTIONS Levothyroxine treatment (n = 46) commencing at 25 µg titrated to aim for serum thyrotropin levels between 0.4 and 2.5 mU/L or identical placebo (n = 49), both provided in capsule form, once daily for 52 weeks. MAIN OUTCOMES AND MEASURES The primary outcome measure was left ventricular ejection fraction at 52 weeks, assessed by magnetic resonance imaging, adjusted for age, sex, type of acute myocardial infarction, affected coronary artery territory, and baseline left ventricular ejection fraction. Secondary measures were left ventricular volumes, infarct size (assessed in a subgroup [n = 60]), adverse events, and patient-reported outcome measures of health status, health-related quality of life, and depression. RESULTS Among the 95 participants randomized, the mean (SD) age was 63.5 (9.5) years, 72 (76.6%) were men, and 65 (69.1%) had ST-segment elevation myocardial infarction. The median serum thyrotropin level was 5.7 mU/L (interquartile range, 4.8-7.3 mU/L) and the mean (SD) free thyroxine level was 1.14 (0.16) ng/dL. The primary outcome measurements at 52 weeks were available in 85 patients (89.5%). The mean left ventricular ejection fraction at baseline and at 52 weeks was 51.3% and 53.8%, respectively, in the levothyroxine group compared with 54.0% and 56.1%, respectively, in the placebo group (adjusted difference in groups, 0.76% [95% CI, -0.93% to 2.46%]; P = .37). None of the 6 secondary outcomes showed a significant difference between the levothyroxine and placebo treatment groups. There were 15 (33.3%) and 18 (36.7%) cardiovascular adverse events in the levothyroxine and placebo groups, respectively. CONCLUSIONS AND RELEVANCE In this preliminary study involving patients with subclinical hypothyroidism and acute myocardial infarction, treatment with levothyroxine, compared with placebo, did not significantly improve left ventricular ejection fraction after 52 weeks. These findings do not support treatment of subclinical hypothyroidism in patients with acute myocardial infarction. TRIAL REGISTRATION isrctn.org Identifier: http://www.isrctn.com/ISRCTN52505169.
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Affiliation(s)
- Avais Jabbar
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Cardiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Lorna Ingoe
- Department of Cardiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Department of Endocrinology, Gateshead Health NHS Foundation Trust, Gateshead, United Kingdom
| | - Shahid Junejo
- Department of Endocrinology and Cardiology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, United Kingdom
| | - Peter Carey
- Department of Endocrinology and Cardiology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, United Kingdom
| | - Caroline Addison
- Department of Endocrinology, Gateshead Health NHS Foundation Trust, Gateshead, United Kingdom
| | - Honey Thomas
- Department of Cardiology, Northumbria Healthcare NHS Foundation Trust, Cramlington, United Kingdom
| | - Jehill D Parikh
- Newcastle Magnetic Resonance Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - David Austin
- Department of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Kieren G Hollingsworth
- Newcastle Magnetic Resonance Centre, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Deborah D Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, United Kingdom
| | - Simon H S Pearce
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Cardiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - John P Greenwood
- Leeds University and Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Azfar Zaman
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Cardiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Salman Razvi
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Endocrinology, Gateshead Health NHS Foundation Trust, Gateshead, United Kingdom
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14
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Mourouzis I, Lavecchia AM, Xinaris C. Thyroid Hormone Signalling: From the Dawn of Life to the Bedside. J Mol Evol 2019; 88:88-103. [PMID: 31451837 DOI: 10.1007/s00239-019-09908-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/13/2019] [Indexed: 12/19/2022]
Abstract
Thyroid hormone (TH) signalling is a key modulator of fundamental biological processes that has been evolutionarily conserved in both vertebrate and invertebrate species. TH may have initially emerged as a nutrient signal to convey environmental information to organisms to induce morpho-anatomical changes that could maximise the exploitation of environmental resources, and eventually integrated into the machinery of gene regulation and energy production to become a key regulator of development and metabolism. As such, TH signalling is particularly sensitive to environmental stimuli, and its alterations result in fundamental changes in homeostasis and physiology. Stressful stimuli of various origins lead to changes in the TH-TH receptor (TR) axis in different adult mammalian organs that are associated with phenotypical changes in terminally differentiated cells, the reactivation of foetal development programmes, structural remodelling and pathological growth. Here, we discuss the evolution of TH signalling, review evolutionarily conserved functions of THs in essential biological processes, such as metamorphosis and perinatal development, and analyse the role of TH signalling in the phenotypical and morphological changes that occur after injury, repair and regeneration in adult mammalian organs. Finally, we examine the potential of TH treatment as a therapeutic strategy for improving organ structure and functions following injury.
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Affiliation(s)
- Iordanis Mourouzis
- Department of Pharmacology, University of Athens, 75 Mikras Asias Ave., Goudi, 11527, Athens, Greece
| | - Angelo Michele Lavecchia
- Laboratory of Organ Regeneration, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Stezzano 87, 24126, Bergamo, Italy
| | - Christodoulos Xinaris
- Laboratory of Organ Regeneration, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Stezzano 87, 24126, Bergamo, Italy. .,University of Nicosia Medical School, 93 Agiou Nikolaou Street, Engomi, 2408, Nicosia, Cyprus.
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15
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Seo SM, Koh YS, Park HJ, Kim DB, Her SH, Lee JM, Park CS, Kim PJ, Kim HY, Yoo KD, Jeon DS, Ahn YK, Jeong MH, Chung WS, Seung KB. Thyroid stimulating hormone elevation as a predictor of long-term mortality in patients with acute myocardial infarction. Clin Cardiol 2018; 41:1367-1373. [PMID: 30144126 DOI: 10.1002/clc.23062] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/11/2018] [Accepted: 08/21/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hypothyroidism has been known to be associated with hyperlipidemia, endothelial dysfunction and atherosclerosis. Elevation of thyroid-stimulation hormone (TSH) is a gold standard to detect these conditions. However, no large studies have investigated the association between TSH elevation and long-term clinical outcomes in patients with acute myocardial infarction (AMI). HYPOTHESIS Hypothyroidism is associated with higher mortality in patients with AMI. METHODS A total of 4748 AMI patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents were consecutively enrolled. We analyzed 1977 patients whose thyroid function data available after the exclusion of hyperthyroidism and possible central hypothyroidism. Patients were divided into two groups; euthyroid group (n = 1846) with normal TSH and normal free thyroxine (FT4); hypothyroidism group (n = 131) with elevated TSH and normal or low FT4. The two groups were subsequently compared with their all-cause and cardiac mortalities. RESULTS Median follow-up duration was 3.5 years. Hypothyroidism group were older, included in more females, and had higher incidences of atrial fibrillation, stroke, and renal dysfunction. Elevated TSH was associated with significantly higher all-cause mortality (26.0% vs 11.7%, P < 0.0001) and cardiac mortality (9.2% vs 4.6%, P = 0.014). The multivariate Cox proportional hazards model identified that TSH elevation was a significant predictor of all-cause mortality (adjusted hazard ratio 1.560, 95% confidence interval 1.017 to 2.392, P = 0.041). CONCLUSIONS Our data suggest that AMI patients with TSH elevation had worse clinical outcome. Moreover, TSH elevation was a predictor of all-cause mortality in patients with AMI.
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Affiliation(s)
- Suk Min Seo
- Department of Internal Medicine, Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Yoon-Seok Koh
- Department of Internal Medicine, Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Hun-Jun Park
- Department of Internal Medicine, Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Dong Bin Kim
- Department of Internal Medicine, Cardiovascular Center and Cardiology Division, St. Paul's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Sung Ho Her
- Department of Internal Medicine, Cardiovascular Center and Cardiology Division, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, South Korea
| | - Jong Min Lee
- Department of Internal Medicine, Cardiovascular Center and Cardiology Division, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, South Korea
| | - Chul Soo Park
- Department of Internal Medicine, Cardiovascular Center and Cardiology Division, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Pum-Joon Kim
- Department of Internal Medicine, Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Hee Yeol Kim
- Department of Internal Medicine, Cardiovascular Center and Cardiology Division, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, South Korea
| | - Ki Dong Yoo
- Department of Internal Medicine, Cardiovascular Center and Cardiology Division, St. Vincent's Hospital, The Catholic University of Korea, Suwon, South Korea
| | - Doo Soo Jeon
- Department of Internal Medicine, Cardiovascular Center and Cardiology Division, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, South Korea
| | - Young Keun Ahn
- Department of Internal Medicine, Cardiovascular Center and Cardiology Division, Chonnam National University Hospital, Chonnam National University, Gwangju, South Korea
| | - Myung Ho Jeong
- Department of Internal Medicine, Cardiovascular Center and Cardiology Division, Chonnam National University Hospital, Chonnam National University, Gwangju, South Korea
| | - Wook Sung Chung
- Department of Internal Medicine, Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Ki-Bae Seung
- Department of Internal Medicine, Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
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Pantos C, Mourouzis I. Thyroid hormone receptor α1 as a novel therapeutic target for tissue repair. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:254. [PMID: 30069456 DOI: 10.21037/atm.2018.06.12] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Analogies between the damaged tissue and developing organ indicate that a regulatory network that drives embryonic organ development may control aspects of tissue repair. In this regard, there is a growing body of experimental and clinical evidence showing that TH may be critical for recovery after injury. Especially TRα1 has been reported to play an essential role in cell proliferation and differentiation and thus in the process of repair/regeneration in the heart and other tissues. Patients after myocardial infarction, stroke or therapeutic interventions [such as PCI for coronary artery disease (CAD)] with lower TH levels appear to have increased morbidity and mortality. Accordingly, TH treatment in clinical settings of ischemia/reperfusion such as by-pass surgery seems to be cardioprotective against ischemic injury. Furthermore, TH therapy of donors is shown to result in organ preservation and increased numbers of donors and improved post-transplantation graft survival. TH and thyroid analogs may prove novel therapeutic agents for tissue repair.
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Desai R, Goyal H, Kumar G, Sachdeva R. Impact of Hypothyroidism on Outcomes of Percutaneous Coronary Intervention with Coronary Atherectomy for Calcified Coronary Lesions: A Propensity-matched Analysis. Cureus 2018; 10:e2600. [PMID: 30013864 PMCID: PMC6039155 DOI: 10.7759/cureus.2600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Overt and subclinical hypothyroid states have been depicted as risk factors for a more prominent level of coronary calcification. The utilization of coronary atherectomy with percutaneous coronary intervention (PCI) is on the ascent over the past few years as lesions that are more complex are now attempted with a percutaneous approach. However, the real-world data on hypothyroid status influencing PCI with coronary atherectomy outcomes is very limited. Therefore, we proposed to investigate the outcomes of percutaneous coronary intervention with coronary atherectomy in hypothyroid patients using the largest inpatient database in the United States (US), the National Inpatient Sample (NIS). To minimize the selection bias, we surveyed and compared the outcomes in both the unmatched and propensity-score matched euthyroid and hypothyroid cohorts. Concisely, this propensity-matched analysis, using the largest population-based sample in the US, has established higher cardiovascular comorbidities and worse clinical outcomes of PCI with coronary atherectomy owing to clinical hypothyroidism.
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Affiliation(s)
- Rupak Desai
- Research Fellow, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Hemant Goyal
- Assistant Professor of Medicine, Department of Internal Medicine, Mercer University School of Medicine, Macon, Georgia
| | - Gautam Kumar
- Associate Professor of Medicine, Division of Cardiology, Emory University School of Medicine and Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Rajesh Sachdeva
- Associate Professor of Medicine, Division of Cardiology, Morehouse School of Medicine and Emory University School of Medicine, Atlanta, Georgia
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Lee Y, Lim YH, Shin JH, Park J, Shin J. Data on the impact of subclinical hypothyroidism on clinical outcomes following percutaneous coronary intervention. Data Brief 2017; 16:630-634. [PMID: 29276739 PMCID: PMC5730377 DOI: 10.1016/j.dib.2017.11.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/16/2017] [Accepted: 11/28/2017] [Indexed: 02/02/2023] Open
Abstract
This article contains the data showing the different influence of subclinical hypothyroidism (SCH) on the risk of cardiovascular events after percutaneous coronary intervention (PCI) in various subgroups regarding myocardial infarction, previous PCI, the stent generation, total stent length, the extent of coronary artery disease, diabetes mellitus, obesity, a lipid reduction level and a C-reactive protein level. This article also contains the data showing the association between SCH and the risk of receiving repeat PCI for in-stent restenosis or de novo coronary stenosis. The data are supplemental to our original research article titled “Impact of Subclinical Hypothyroidism on Clinical Outcomes Following Percutaneous Coronary Intervention” (Lee et al., 2017) [1].
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Affiliation(s)
- Yonggu Lee
- Department of Cardiology, Hanyang University Guri Hospital, Guri City, Kyunggi-do, South Korea
| | - Young-Hyo Lim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, South Korea
| | - Jeong-Hun Shin
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, South Korea
| | - Jinkyu Park
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, South Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, South Korea
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