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Buber I, Eraydin A, Sevgican CI, Tekin I, Kilic ID, Fenkci SM. The effects of combination treatment with LT4 and LT3 on diastolic functions and atrial conduction time in LT4-treated women with low T3: a short term follow-up study. Endocrine 2023:10.1007/s12020-023-03363-1. [PMID: 37074560 DOI: 10.1007/s12020-023-03363-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/31/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE To investigate the effects of combination treatment with levothyroxine (LT4) and l- triiodothyronine (LT3) on left atrial volume (LAV), diastolic functions, and atrial electro-mechanical delays in LT4-treated women with low triiodothyronine (T3) levels. METHODS This prospective study consisted of 47 female patients between 18 and 65 years old treated at an Endocrinology and Metabolism outpatient clinic between February and April 2022 due to primary hypothyroidism. The study included patients with persistently low T3 levels in at least three measurements, despite LT4 treatment (1.6-1.8 mcg/kg/m2) for 23.13 ± 6.28 months with normal thyrotropin (TSH) and free tetraiodothyronine (fT4) levels. The combination therapy dose was as follows: the fixed LT4 dose (25 mcg) was removed from patients' usual LT4 treatment [100 mcg (min-max, 75-150)], and a fixed LT3 dose (12.5 mcg) was added. Biochemical samples were taken, and an echocardiographic assessment was performed for patients upon their first admission, and after 195.5 ± 12.8 days of receiving LT3 (12.5 mcg) treatment. RESULTS There was a statistically significant reduction at left ventricle (LV) end-systolic diameter (27.69 ± 3.14, 27.13 ± 2.89, p = 0.035), left atrial (LA) maximum volume (14.73 ± 3.22, 13.94 ± 3.15, p = 0.009), LA minimum volume (7.84 ± 2.45, 6.84 ± 2.30, p < 0.001), LA vertical diameter (44.08 ± 6.92, 34.60 ± 4.31, <0.001), LA horizontal diameter (45.65 ± 6.88, 33.43 ± 4.51, p < 0.001), LAVI (50.73 ± 18.62, 41.0 ± 13.02, p < 0.001), total conduction time (103.69 ± 12.70, 79.82 ± 18.40, p < 0.001) after LT3 replacement (respectively pre-post- treatment and p value). CONCLUSION In conclusion, the findings of this study suggest that the addition of LT3 to LT4 treatment may lead to improvements in LAVI and atrial conduction times in patients with low T3. However, further research with larger patient groups and exploration of different LT4 + LT3 dose combinations is needed to better understand the effects of combined hypothyroidism treatment on cardiac functions.
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Affiliation(s)
- Ipek Buber
- Department of Cardiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Ayten Eraydin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Pamukkale University, Denizli, Turkey.
| | | | - Isik Tekin
- Department of Cardiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Ismail Dogu Kilic
- Department of Cardiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Semin Melahat Fenkci
- Department of Endocrinology and Metabolism, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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Huang WH, Sung KT, Kuo JY, Chen YJ, Huang CT, Chien SC, Tsai JP, Lo CI, Hsiao CC, Lin JL, Tsai IH, Yun CH, Su CH, Hung TC, Yeh HI, Hung CL. Atrioventricular Longitudinal Mechanics Using Novel Speckle-Tracking Improved Risk Stratification Beyond Baseline Thyroid Hormone in Asymptomatic Subclinical Hypothyroidism. Circ Cardiovasc Imaging 2021; 14:e012433. [PMID: 34784240 DOI: 10.1161/circimaging.121.012433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hypothyroidism is reportedly associated with increased cardiovascular risk and heart failure. We aimed to elucidate the mechanistic influence of atrio-ventricular deformations and their prognostic utilizations in asymptomatic subclinical hypothyroidism (SCH). METHODS We assessed speckle-tracking of deformations among 4173 population-based asymptomatic individuals classified as euthyroid (0.25< thyroid-stimulating hormone [TSH] ≤4.0 μIU/mL, n=3799) or having mild (4< TSH ≤10.0 μIU/mL, n=349) or marked (TSH >10 μIU/mL, n=25) SCH. We further related deformational indices to outcomes of atrial fibrillation and heart failure. RESULTS Despite borderline differences in indexed left ventricular mass and left atrial volume (P=0.054 and 0.051), those classified as mild and marked SCH presented with modest but significant reductions of global longitudinal strain, and showed elevated E/tissue Doppler imaging (TDI)-e', markedly diminished peak atrial longitudinal strain and higher left atrial stiffness (all P<0.05) when compared with euthyroid subjects. A higher TSH level was independently associated with reduced TDI-s'/TDI-e', worse global atrio-ventricular strains (global longitudinal strain/peak atrial longitudinal strain), elevated E/TDI-e', and worsened left atrial strain rate components (all P<0.05). Over a median 5.6 years (interquartile range, 4.7-6.5 years) follow-up, myocardial deformations yielded independent risk prediction using Cox regression in models adjusted for baseline covariates, N-terminal pro-brain natriuretic peptide, E/e', and treatment effect. Incorporation of global atrio-ventricular strain (global longitudinal strain/peak atrial longitudinal strain) and strain rates further showed improved risk reclassification when added to the baseline TSH strata (classified as euthyroid and mild and marked SCH; all P<0.05). Cox regression models remained significant with improved risk reclassification beyond TSH-based strata by using slightly different deformational cutoffs after excluding marked SCH group. CONCLUSIONS Hypothyroidism, even when asymptomatic, may widely influence subclinical atrio-ventricular mechanical functions that may lead to higher heart failure and atrial fibrillation risk. We proposed the potential usefulness and prognostic utilization of myocardial strains in such population.
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Affiliation(s)
- Wen-Hung Huang
- Division of Cardiology, Department of Internal Medicine (W.-H.H., K.-T.S., J.-Y.K., J.-P.T., C.-I.L., C.-C.H., C.-H.S., H.-I.Y., C.-L.H.), MacKay Memorial Hospital, Taipei, Taiwan
| | - Kuo-Tzu Sung
- Division of Cardiology, Department of Internal Medicine (W.-H.H., K.-T.S., J.-Y.K., J.-P.T., C.-I.L., C.-C.H., C.-H.S., H.-I.Y., C.-L.H.), MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine (K.-T.S., J.-Y.K., J.-P.T., J.-L.L., C.-H.S., H.-I.Y., C.-L.H.), Mackay Medical College, New Taipei City, Taiwan
| | - Jen-Yuan Kuo
- Division of Cardiology, Department of Internal Medicine (W.-H.H., K.-T.S., J.-Y.K., J.-P.T., C.-I.L., C.-C.H., C.-H.S., H.-I.Y., C.-L.H.), MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine (K.-T.S., J.-Y.K., J.-P.T., J.-L.L., C.-H.S., H.-I.Y., C.-L.H.), Mackay Medical College, New Taipei City, Taiwan
| | - Ying-Ju Chen
- Telemedicine Center (Y.-J.C., H.-I.Y., C.-L.H.), MacKay Memorial Hospital, Taipei, Taiwan
| | - Chun-Ta Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine (C.-T.H., J.-L.L.), MacKay Memorial Hospital, Taipei, Taiwan
| | | | - Jui-Peng Tsai
- Division of Cardiology, Department of Internal Medicine (W.-H.H., K.-T.S., J.-Y.K., J.-P.T., C.-I.L., C.-C.H., C.-H.S., H.-I.Y., C.-L.H.), MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine (K.-T.S., J.-Y.K., J.-P.T., J.-L.L., C.-H.S., H.-I.Y., C.-L.H.), Mackay Medical College, New Taipei City, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan (J.-P.T., T.-C.H.)
| | - Chi-In Lo
- Division of Cardiology, Department of Internal Medicine (W.-H.H., K.-T.S., J.-Y.K., J.-P.T., C.-I.L., C.-C.H., C.-H.S., H.-I.Y., C.-L.H.), MacKay Memorial Hospital, Taipei, Taiwan
| | - Chih-Chung Hsiao
- Division of Cardiology, Department of Internal Medicine (W.-H.H., K.-T.S., J.-Y.K., J.-P.T., C.-I.L., C.-C.H., C.-H.S., H.-I.Y., C.-L.H.), MacKay Memorial Hospital, Taipei, Taiwan
| | - Jiun-Lu Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine (C.-T.H., J.-L.L.), MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine (K.-T.S., J.-Y.K., J.-P.T., J.-L.L., C.-H.S., H.-I.Y., C.-L.H.), Mackay Medical College, New Taipei City, Taiwan
| | | | - Chun-Ho Yun
- Department of Radiology (C.-H.Y.), MacKay Memorial Hospital, Taipei, Taiwan
| | - Cheng-Huang Su
- Department of Medicine (K.-T.S., J.-Y.K., J.-P.T., J.-L.L., C.-H.S., H.-I.Y., C.-L.H.), Mackay Medical College, New Taipei City, Taiwan
| | - Ta-Chuan Hung
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan (J.-P.T., T.-C.H.)
| | - Hung-I Yeh
- Division of Cardiology, Department of Internal Medicine (W.-H.H., K.-T.S., J.-Y.K., J.-P.T., C.-I.L., C.-C.H., C.-H.S., H.-I.Y., C.-L.H.), MacKay Memorial Hospital, Taipei, Taiwan.,Telemedicine Center (Y.-J.C., H.-I.Y., C.-L.H.), MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine (K.-T.S., J.-Y.K., J.-P.T., J.-L.L., C.-H.S., H.-I.Y., C.-L.H.), Mackay Medical College, New Taipei City, Taiwan
| | - Chung-Lieh Hung
- Division of Cardiology, Department of Internal Medicine (W.-H.H., K.-T.S., J.-Y.K., J.-P.T., C.-I.L., C.-C.H., C.-H.S., H.-I.Y., C.-L.H.), MacKay Memorial Hospital, Taipei, Taiwan.,Telemedicine Center (Y.-J.C., H.-I.Y., C.-L.H.), MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine (K.-T.S., J.-Y.K., J.-P.T., J.-L.L., C.-H.S., H.-I.Y., C.-L.H.), Mackay Medical College, New Taipei City, Taiwan.,Institute of Biomedical Sciences (C.-L.H.), Mackay Medical College, New Taipei City, Taiwan
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Dogdus M, Diker S, Yenercag M, Gurgun C. Evaluation of left atrial and ventricular myocardial functions by three-dimensional speckle tracking echocardiography in patients with euthyroid Hashimoto's thyroiditis. Int J Cardiovasc Imaging 2020; 37:459-465. [PMID: 32897525 DOI: 10.1007/s10554-020-02011-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 08/31/2020] [Indexed: 11/24/2022]
Abstract
Hashimoto's Thyroiditis (HsT) is one of the most frequently occurring autoimmune diseases, characterized by lymphocytic infiltration, destruction and fibrosis of thyroid tissue and the presence of antibodies to thyroid peroxidase and thyroglobulin. The effects of euthyroid Hashimoto's thyroiditis (eHsT) on cardiovascular system are unclear. We aimed to identify if any deteriorations in LA and LV myocardial functions in patients with eHsT by 3D-STE in the current study. Fifty eight patients with eHsT and 60 age- and gender-matched controls were enrolled into the study. All participants underwent laboratory analyses which included thyroid hormones and thyroid autoantibody levels; and conventional 2D echocardiographic and 3D-STE analyses were performed. The mean age of the study patients was 34.5 ± 9 years, and 68.6% were female. Left ventricular global longitudinal strain (LV-GLS) was significantly depressed in the eHsT (+) group than in the control group (- 15.3 ± 3.6 vs. - 22.8 ± 3.8, p < 0.001). The LV-GLS was found to be disrupted linearly as thyroid autoantibodies increased (r = 0.684 for anti-TPO-ab and LV-GLS; r = 0.649 for anti-Tg-ab and LV-GLS). The present study demonstrated that 3D-STE is useful in the early detection of LV myocardial dysfunction in patients with eHsT. We found that eHsT had a negative effect on LV myocardial dynamics. According to these findings, these myocardial alterations that are present early in the disease process may be considered as a reason to start medical treatment earlier, even at the euthyroid stage to prevent LV myocardial impairment.
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Affiliation(s)
- Mustafa Dogdus
- Department of Cardiology, Training and Research Hospital, Usak University, 64100, Usak, Turkey.
| | - Suleyman Diker
- Department of Internal Medicine, Training and Research Hospital, Usak University, 64100, Usak, Turkey
| | - Mustafa Yenercag
- Department of Cardiology, Faculty of Medicine, Ordu University, 52200, Ordu, Turkey
| | - Cemil Gurgun
- Department of Cardiology, Faculty of Medicine, Ege University, 35100, Izmir, Turkey
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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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Tadic M, Genger M, Cuspidi C, Belyavskiy E, Frydas A, Dordevic A, Morris DA, Völkl J, Parwani AS, Pieske B, Haßfeld S. Phasic Left Atrial Function in Cancer Patients Before Initiation of Anti-Cancer Therapy. J Clin Med 2019; 8:jcm8040421. [PMID: 30934794 PMCID: PMC6518037 DOI: 10.3390/jcm8040421] [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] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 03/21/2019] [Accepted: 03/23/2019] [Indexed: 12/24/2022] Open
Abstract
We aimed to explore left atrial (LA) remodeling in the patients with solid cancer before initiation of chemo- or radiotherapy. This retrospective investigation included 92 chemo- and radiotherapy-naive cancer patients and 40 age- and gender-matched controls with a similar cardiovascular risk profile as the cancer group. All participants underwent comprehensive echocardiographic examination before the start of chemo- or radiotherapy. LA phasic function was evaluated in volumetric and strain method. Indexed minimal and pre-A LA volumes were significantly higher in the cancer patients. Total and passive LA emptying fraction (EF) were significantly lower, whereas active LAEF was significantly higher in the cancer patients. LA total longitudinal strain was significantly lower in the cancer patients. Strain rate analysis of LA phasic function showed that LA function during systole and early diastole was reduced in the cancer group, while it was increased during late diastole. These findings indicated that LA reservoir and conduit functions, assessed with LA volumetric and strain analysis, were deteriorated in the cancer group. On the other hand, LA booster pump function was elevated in the cancer group in comparison with the controls. In the whole population, cancer was associated with reduced LA total longitudinal strain independently of age, gender, BMI, LV hypertrophy, E/e’ ratio, diabetes, and hypertension. LA phasic function was impaired in the chemo- and radiotherapy-naive cancer patients in comparison with the control group. Cancer, LV hypertrophy, and hypertension were associated with reduced LA longitudinal strain independently of other important clinical parameters.
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Affiliation(s)
- Marijana Tadic
- Department of Internal Medicine and Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), 13353 Berlin, Germany.
| | - Martin Genger
- Department of Internal Medicine and Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), 13353 Berlin, Germany.
| | - Cesare Cuspidi
- Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, 13353 Meda 20821, Italy.
| | - Evgeny Belyavskiy
- Department of Internal Medicine and Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), 13353 Berlin, Germany.
| | - Athanasios Frydas
- Department of Internal Medicine and Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), 13353 Berlin, Germany.
| | - Aleksandar Dordevic
- Department of Internal Medicine and Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), 13353 Berlin, Germany.
| | - Daniel A Morris
- Department of Internal Medicine and Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), 13353 Berlin, Germany.
| | - Jakob Völkl
- Department of Internal Medicine and Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), 13353 Berlin, Germany.
| | - Abdul Shokor Parwani
- Department of Internal Medicine and Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), 13353 Berlin, Germany.
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), 13353 Berlin, Germany.
- Deutsches Zentrum für Herz-Kreislauf-Forschung, Standort Berlin/Charité, 13353 Berlin, Germany.
- Department of Cardiology, Deutsches Herzzentrum Berlin, 13353 Berlin, Germany.
| | - Sabine Haßfeld
- Department of Internal Medicine and Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), 13353 Berlin, Germany.
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