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Mendez DA, Ortiz RM. Thyroid hormones and the potential for regulating glucose metabolism in cardiomyocytes during insulin resistance and T2DM. Physiol Rep 2021; 9:e14858. [PMID: 34405550 PMCID: PMC8371345 DOI: 10.14814/phy2.14858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 12/30/2022] Open
Abstract
In order for the heart to maintain its continuous mechanical work and provide the systolic movement to uphold coronary blood flow, substantial synthesis of adenosine triphosphate (ATP) is required. Under normal conditions cardiac tissue utilizes roughly 70% fatty acids (FA), and 30% glucose for the production of ATP; however, during impaired metabolic conditions like insulin resistance and diabetes glucose metabolism is dysregulated and FA account for 99% of energy production. One of the major consequences of a shift in FA metabolism in cardiac tissue is an increase in reactive oxygen species (ROS) and lipotoxicity, which ultimately lead to mitochondrial dysfunction. Thyroid hormones (TH) have direct effects on cardiac function and glucose metabolism during impaired metabolic conditions suggesting that TH may improve glucose metabolism in an insulin resistant condition. None-classical TH signaling in the heart has shown to phosphorylate protein kinase B (Akt) and increase activity of phosphoinositide-3-kinase (PI3K), which are critical mediators in the insulin-stimulated glucose uptake pathway. Studies on peripheral tissues such as skeletal muscle and adipocytes have demonstrated TH treatment improved glucose intolerance in a diabetic model and increased insulin-regulated glucose transporter (GLUT4) mRNA levels. GLUT4 is a downstream target of thyroid response element (TRE), which demonstrates that THs regulate glucose via GLUT4. Elevated 3,5,3'-triiodothyronine (T3) increased glucose oxidation rate and decreased the glycolytic intermediate, fructose 6-phosphate (F6P) in cardiomyocytes, in addition to increasing mitochondrial biogenesis and pyruvate transport across the mitochondrial membrane. These findings along with a few other studies on T3 treatment in cardiac tissue suggest TH may improve glucose metabolism in an insulin resistant model and ameliorate the effects of diabetes and metabolic syndrome. This review highlights the potential benefits of exogenous TH on ameliorating metabolic dysfunction in the heart.
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Affiliation(s)
- Dora A. Mendez
- Department of Molecular & Cell BiologySchool of Natural SciencesUniversity of CaliforniaMercedCAUSA
| | - Rudy M. Ortiz
- Department of Molecular & Cell BiologySchool of Natural SciencesUniversity of CaliforniaMercedCAUSA
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2
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Abdel-Moneim A, Gaber AM, Gouda S, Osama A, Othman SI, Allam G. Relationship of thyroid dysfunction with cardiovascular diseases: updated review on heart failure progression. Hormones (Athens) 2020; 19:301-309. [PMID: 32488814 DOI: 10.1007/s42000-020-00208-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 05/05/2020] [Indexed: 12/21/2022]
Abstract
Heart disease remains the leading cause of death globally. Heart failure (HF) is a clinical syndrome that results from impairment of the ability of the ventricle to fill with or eject blood. Over the past two decades, accumulated evidence has revealed the contribution of thyroid hormones to cardiovascular (CV) events, exerting their action through genomic and non-genomic pathways within the cardiomyocytes. The pivotal role of thyroid hormones in maintaining cardiac homeostasis has been observed in previous investigations which suggest that the CV system is adversely impacted by fluctuations in thyroid hormone levels, such as those that occur in hypothyroidism, hyperthyroidism, and low triiodothyronine syndrome (LT3S). Thyroid dysfunction has direct effects on myocardial contractility, systolic and diastolic blood pressure, heart mass, heart rate, ejection fraction, and heart output, which may ultimately lead to HF. Recent clinical data have shown that thyroid hormone replacement therapy for hypothyroid patients appears to provide the potential for reducing CV events. Therefore, this review aims to address the impact of thyroid hormone dysfunction on pathophysiological mechanisms contributing to the development and progression of HF.
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Affiliation(s)
- Adel Abdel-Moneim
- Molecular Physiology Division, Faculty of Science, Beni-Suef University, Salah Salem St., Beni Suef, 62511,, Egypt.
| | - Asmaa M Gaber
- Molecular Physiology Division, Faculty of Science, Beni-Suef University, Salah Salem St., Beni Suef, 62511,, Egypt
| | - Sherouk Gouda
- Zoology/Chemistry Program, Faculty of Science, Beni-Suef University, Beni Suef, Egypt
| | - Aya Osama
- Zoology/Chemistry Program, Faculty of Science, Beni-Suef University, Beni Suef, Egypt
| | - Sarah I Othman
- Biology Department, Faculty of Science, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Gamal Allam
- Immunology Section, Department of Zoology, Faculty of Science, Beni-Suef University, Beni-Suef, Egypt
- Egyptian-Korean Faculty for Technological Industry and Energy, Beni-Suef Technological University, Beni-Suef, Egypt
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3
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Neves JS, Vale C, von Hafe M, Borges-Canha M, Leite AR, Almeida-Coelho J, Lourenço A, Falcão-Pires I, Carvalho D, Leite-Moreira A. Thyroid hormones and modulation of diastolic function: a promising target for heart failure with preserved ejection fraction. Ther Adv Endocrinol Metab 2020; 11:2042018820958331. [PMID: 33088475 PMCID: PMC7543162 DOI: 10.1177/2042018820958331] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 08/20/2020] [Indexed: 12/16/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome with high mortality for which there is no proven therapy to improve its prognosis. Thyroid dysfunction is common in heart failure (HF) and is associated with worse prognosis. In this review, we discuss the cardiovascular effects of thyroid hormones, the pathophysiology of HFpEF, the prognostic impact of thyroid function, and the potential of thyroid hormones for treatment of HFpEF. Thyroid hormones have a central role in cardiovascular homeostasis, improving cardiac function through genomic and non-genomic mechanisms. Both overt and subclinical hypothyroidism are associated with increased risk of HF. Even when plasmatic thyroid hormones levels are normal, patients with HF may have local cardiac hypothyroidism due to upregulation of type 3 iodothyronine deiodinase. Thyroid hormones improve several pathophysiological mechanisms of HFpEF, including diastolic dysfunction and extra-cardiac abnormalities. Supplementation with thyroid hormones (levothyroxine and/or liothyronine), modulation of deiodinase activity, and heart-specific thyroid receptor agonists are potential therapeutic approaches for the treatment of HFpEF. Further preclinical and clinical studies are needed to clarify the role of thyroid hormones in the treatment of HFpEF.
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Affiliation(s)
- João Sérgio Neves
- Departamento de Cirurgia e Fisiologia, Unidade
de Investigação Cardiovascular, Faculdade de Medicina, Universidade do
Porto, Porto, Portugal
- Department of Endocrinology, Diabetes and
Metabolism, Centro Hospitalar Universitário de São João, Faculdade de
Medicina, Universidade do Porto, Porto, Portugal
| | - Catarina Vale
- Departamento de Cirurgia e Fisiologia, Unidade
de Investigação Cardiovascular, Faculdade de Medicina, Universidade do
Porto, Porto, Portugal
| | - Madalena von Hafe
- Departamento de Cirurgia e Fisiologia, Unidade
de Investigação Cardiovascular, Faculdade de Medicina, Universidade do
Porto, Porto, Portugal
| | - Marta Borges-Canha
- Departamento de Cirurgia e Fisiologia, Unidade
de Investigação Cardiovascular, Faculdade de Medicina, Universidade do
Porto, Porto, Portugal
- Department of Endocrinology, Diabetes and
Metabolism, Centro Hospitalar Universitário de São João, Faculdade de
Medicina, Universidade do Porto, Porto, Portugal
| | - Ana Rita Leite
- Departamento de Cirurgia e Fisiologia, Unidade
de Investigação Cardiovascular, Faculdade de Medicina, Universidade do
Porto, Porto, Portugal
| | - João Almeida-Coelho
- Departamento de Cirurgia e Fisiologia, Unidade
de Investigação Cardiovascular, Faculdade de Medicina, Universidade do
Porto, Porto, Portugal
| | - André Lourenço
- Departamento de Cirurgia e Fisiologia, Unidade
de Investigação Cardiovascular, Faculdade de Medicina, Universidade do
Porto, Porto, Portugal
| | - Inês Falcão-Pires
- Departamento de Cirurgia e Fisiologia, Unidade
de Investigação Cardiovascular, Faculdade de Medicina, Universidade do
Porto, Porto, Portugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and
Metabolism, Centro Hospitalar Universitário de São João, Faculdade de
Medicina, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde
da Universidade do Porto, Portugal
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4
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Deus AFD, Silva VLD, de Souza SLB, Mota GAF, Sant'Ana PG, Vileigas DF, Lima-Leopoldo AP, Leopoldo AS, Campos DHSD, de Tomasi LC, Padovani CR, Kolwicz SC, Cicogna AC. Myocardial Dysfunction after Severe Food Restriction Is Linked to Changes in the Calcium-Handling Properties in Rats. Nutrients 2019; 11:nu11091985. [PMID: 31443528 PMCID: PMC6770438 DOI: 10.3390/nu11091985] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/09/2019] [Accepted: 08/14/2019] [Indexed: 12/13/2022] Open
Abstract
Severe food restriction (FR) impairs cardiac performance, although the causative mechanisms remain elusive. Since proteins associated with calcium handling may contribute to cardiac dysfunction, this study aimed to evaluate whether severe FR results in alterations in the expression and activity of Ca2+-handling proteins that contribute to impaired myocardial performance. Male 60-day-old Wistar–Kyoto rats were fed a control or restricted diet (50% reduction in the food consumed by the control group) for 90 days. Body weight, body fat pads, adiposity index, as well as the weights of the soleus muscle and lung, were obtained. Cardiac remodeling was assessed by morphological measures. The myocardial contractile performance was analyzed in isolated papillary muscles during the administration of extracellular Ca2+ and in the absence or presence of a sarcoplasmic reticulum Ca2+-ATPase (SERCA2a) specific blocker. The expression of Ca2+-handling regulatory proteins was analyzed via Western Blot. Severe FR resulted in a 50% decrease in body weight and adiposity measures. Cardiac morphometry was substantially altered, as heart weights were nearly twofold lower in FR rats. Papillary muscles isolated from FR hearts displayed mechanical dysfunction, including decreased developed tension and reduced contractility and relaxation. The administration of a SERCA2a blocker led to further decrements in contractile function in FR hearts, suggesting impaired SERCA2a activity. Moreover, the FR rats presented a lower expression of L-type Ca2+ channels. Therefore, myocardial dysfunction induced by severe food restriction is associated with changes in the calcium-handling properties in rats.
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Affiliation(s)
- Adriana Fernandes de Deus
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University, Botucatu 18618687, Brazil
| | - Vítor Loureiro da Silva
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University, Botucatu 18618687, Brazil
| | - Sérgio Luiz Borges de Souza
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University, Botucatu 18618687, Brazil
| | | | - Paula Grippa Sant'Ana
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University, Botucatu 18618687, Brazil
| | - Danielle Fernandes Vileigas
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University, Botucatu 18618687, Brazil
| | - Ana Paula Lima-Leopoldo
- Department of Sports, Center of Physical Education and Sports, Federal University of Espírito Santo, Vitória 29075-910, Brazil
| | - André Soares Leopoldo
- Department of Sports, Center of Physical Education and Sports, Federal University of Espírito Santo, Vitória 29075-910, Brazil
| | | | - Loreta Casquel de Tomasi
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University, Botucatu 18618687, Brazil
| | - Carlos Roberto Padovani
- Department of Biostatistics, Institute of Biosciences, São Paulo State University, Botucatu 18618970, Brazil
| | - Stephen C Kolwicz
- Department of Health and Exercise Physiology, Ursinus College, Collegeville, PA 19426, USA
| | - Antonio Carlos Cicogna
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University, Botucatu 18618687, Brazil.
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Romano SN, Edwards HE, Souder JP, Ryan KJ, Cui X, Gorelick DA. G protein-coupled estrogen receptor regulates embryonic heart rate in zebrafish. PLoS Genet 2017; 13:e1007069. [PMID: 29065151 PMCID: PMC5669493 DOI: 10.1371/journal.pgen.1007069] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 11/03/2017] [Accepted: 10/11/2017] [Indexed: 01/31/2023] Open
Abstract
Estrogens act by binding to estrogen receptors alpha and beta (ERα, ERβ), ligand-dependent transcription factors that play crucial roles in sex differentiation, tumor growth and cardiovascular physiology. Estrogens also activate the G protein-coupled estrogen receptor (GPER), however the function of GPER in vivo is less well understood. Here we find that GPER is required for normal heart rate in zebrafish embryos. Acute exposure to estrogens increased heart rate in wildtype and in ERα and ERβ mutant embryos but not in GPER mutants. GPER mutant embryos exhibited reduced basal heart rate, while heart rate was normal in ERα and ERβ mutants. We detected gper transcript in discrete regions of the brain and pituitary but not in the heart, suggesting that GPER acts centrally to regulate heart rate. In the pituitary, we observed gper expression in cells that regulate levels of thyroid hormone triiodothyronine (T3), a hormone known to increase heart rate. Compared to wild type, GPER mutants had reduced levels of T3 and estrogens, suggesting pituitary abnormalities. Exposure to exogenous T3, but not estradiol, rescued the reduced heart rate phenotype in gper mutant embryos, demonstrating that T3 acts downstream of GPER to regulate heart rate. Using genetic and mass spectrometry approaches, we find that GPER regulates maternal estrogen levels, which are required for normal embryonic heart rate. Our results demonstrate that estradiol plays a previously unappreciated role in the acute modulation of heart rate during zebrafish embryonic development and suggest that GPER regulates embryonic heart rate by altering maternal estrogen levels and embryonic T3 levels. Estrogen hormones are important for the formation and function of the nervous, reproductive and cardiovascular systems. Here we report that acute exposure to estrogens increases heart rate, a previously unappreciated function of estrogens. Using zebrafish with mutations in genes that respond to estrogens, we found that heart rate is regulated not by the typical molecules that respond to estrogens–the nuclear estrogen receptors–but rather by a different molecule, the G protein-coupled estrogen receptor. We also show that estrogens increase heart rate by increasing levels of thyroid hormone. Our results reveal a new function for the G protein-coupled estrogen receptor and a new connection between estrogens and thyroid hormone. Environmental compounds that mimic estrogens can be harmful because they can influence gonad function. Our results suggest that endocrine disrupting compounds may also influence cardiac function.
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Affiliation(s)
- Shannon N. Romano
- Department of Pharmacology & Toxicology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Hailey E. Edwards
- Department of Pharmacology & Toxicology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Jaclyn Paige Souder
- Department of Pharmacology & Toxicology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Kevin J. Ryan
- Department of Pharmacology & Toxicology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Xiangqin Cui
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Daniel A. Gorelick
- Department of Pharmacology & Toxicology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- * E-mail:
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6
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Mavropoulos SA, Khan NS, Levy ACJ, Faliks BT, Sison CP, Pavlov VA, Zhang Y, Ojamaa K. Nicotinic acetylcholine receptor-mediated protection of the rat heart exposed to ischemia reperfusion. Mol Med 2017; 23:120-133. [PMID: 28598489 DOI: 10.2119/molmed.2017.00091] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 05/31/2017] [Indexed: 12/11/2022] Open
Abstract
Reperfusion injury following acute myocardial infarction is associated with significant morbidity. Activation of neuronal or non-neuronal cholinergic pathways in the heart has been shown to reduce ischemic injury and this effect has been attributed primarily to muscarinic acetylcholine receptors. In contrast, the role of nicotinic receptors, specifically alpha-7 subtype (α7nAChR) in the myocardium remains unknown which offers an opportunity to potentially repurpose several agonists/modulators that are currently under development for neurologic indications. Treatment of ex vivo and in vivo rat models of cardiac ischemia/reperfusion (I/R) with a selective α7nAChR agonist (GTS21) showed significant increases in left ventricular developing pressure, and rates of pressure development without effects on heart rate. These positive functional effects were blocked by co-administration with methyllycaconatine (MLA), a selective antagonist of α7nAChRs. In vivo, delivery of GTS21 at the initiation of reperfusion, reduced infarct size by 42% (p<0.01) and decreased tissue reactive oxygen species (ROS) by 62% (p<0.01). Flow cytometry of MitoTracker Red stained mitochondria showed that mitochondrial membrane potential was normalized in mitochondria isolated from GTS21 treated compared to untreated I/R hearts. Intracellular ATP concentration in cultured cardiomyocytes exposed to hypoxia/reoxygenation was reduced (p<0.001), but significantly increased to normoxic levels with GTS21 treatment, and this was abrogated by MLA pretreatment. Activation of stress-activated kinases, JNK and p38MAPK, were significantly reduced by GTS21 in I/R. We conclude that targeting myocardial 17nAChRs in I/R may provide therapeutic benefit by improving cardiac contractile function through a mechanism that preserves mitochondrial membrane potential, maintains intracellular ATP and reduces ROS generation, thus limiting infarct size.
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Affiliation(s)
- Spyros A Mavropoulos
- Center for Heart and Lung Research, Northwell Health, Manhasset, NY.,Hofstra Northwell School of Medicine at Hofstra University, Hempstead, NY
| | - Nayaab S Khan
- Center for Heart and Lung Research, Northwell Health, Manhasset, NY
| | - Asaph C J Levy
- Hofstra Northwell School of Medicine at Hofstra University, Hempstead, NY
| | - Bradley T Faliks
- Hofstra Northwell School of Medicine at Hofstra University, Hempstead, NY
| | - Cristina P Sison
- Biostatistics Unit, The Feinstein Institute for Medical Research at Northwell Health, Manhasset, NY
| | - Valentin A Pavlov
- Biostatistics Unit, The Feinstein Institute for Medical Research at Northwell Health, Manhasset, NY.,Laboratory for Biomedical Sciences, The Feinstein Institute for Medical Research at Northwell Health, Manhasset, NY
| | - Youhua Zhang
- Dept. of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Kaie Ojamaa
- Center for Heart and Lung Research, Northwell Health, Manhasset, NY.,Hofstra Northwell School of Medicine at Hofstra University, Hempstead, NY.,Dept. of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
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7
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Jabbar A, Pingitore A, Pearce SHS, Zaman A, Iervasi G, Razvi S. Thyroid hormones and cardiovascular disease. Nat Rev Cardiol 2016; 14:39-55. [PMID: 27811932 DOI: 10.1038/nrcardio.2016.174] [Citation(s) in RCA: 377] [Impact Index Per Article: 47.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Myocardial and vascular endothelial tissues have receptors for thyroid hormones and are sensitive to changes in the concentrations of circulating thyroid hormones. The importance of thyroid hormones in maintaining cardiovascular homeostasis can be deduced from clinical and experimental data showing that even subtle changes in thyroid hormone concentrations - such as those observed in subclinical hypothyroidism or hyperthyroidism, and low triiodothyronine syndrome - adversely influence the cardiovascular system. Some potential mechanisms linking the two conditions are dyslipidaemia, endothelial dysfunction, blood pressure changes, and direct effects of thyroid hormones on the myocardium. Several interventional trials showed that treatment of subclinical thyroid diseases improves cardiovascular risk factors, which implies potential benefits for reducing cardiovascular events. Over the past 2 decades, accumulating evidence supports the association between abnormal thyroid function at the time of an acute myocardial infarction (MI) and subsequent adverse cardiovascular outcomes. Furthermore, experimental studies showed that thyroid hormones can have an important therapeutic role in reducing infarct size and improving myocardial function after acute MI. In this Review, we summarize the literature on thyroid function in cardiovascular diseases, both as a risk factor as well as in the setting of cardiovascular diseases such as heart failure or acute MI, and outline the effect of thyroid hormone replacement therapy for reducing the risk of cardiovascular disease.
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Affiliation(s)
- Avais Jabbar
- Institute of Genetic Medicine, Newcastle University, Central Parkway, Newcastle upon Tyne NE1 3BZ, UK.,Freeman Hospital, Freeman Rd, High Heaton, Newcastle upon Tyne NE7 7DN, UK
| | | | - Simon H S Pearce
- Institute of Genetic Medicine, Newcastle University, Central Parkway, Newcastle upon Tyne NE1 3BZ, UK.,Department of Endocrinology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
| | - Azfar Zaman
- Institute of Genetic Medicine, Newcastle University, Central Parkway, Newcastle upon Tyne NE1 3BZ, UK.,Freeman Hospital, Freeman Rd, High Heaton, Newcastle upon Tyne NE7 7DN, UK
| | - Giorgio Iervasi
- Clinical Physiology Institute, CNR, Via Moruzzi 1, 56124, Pisa, Italy
| | - Salman Razvi
- Institute of Genetic Medicine, Newcastle University, Central Parkway, Newcastle upon Tyne NE1 3BZ, UK.,Gateshead Health NHS Foundation Trust, Saltwell Road South, Gateshead NE8 4YL, UK
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9
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Visveswaran GK, Gidea C, Baran D, Cohen M, Zucker MJ. Acute left ventricular dysfunction complicating pregnancy on ECMO: Tri-iodothyronine to the rescue with real time transesophageal echocardiography. J Cardiol Cases 2015; 13:33-36. [PMID: 30546606 DOI: 10.1016/j.jccase.2015.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 08/16/2015] [Accepted: 09/29/2015] [Indexed: 11/28/2022] Open
Abstract
Cardiac dysfunction is a common accompaniment to severe sepsis. Clinical management of the same complicating pregnancy presents unique challenges balancing maternal and fetal well-being. Can short-term intravenous (IV) tri-iodothyronine (T3) be used in the management of these patients? T3 has been reported in varied clinical settings to favorably affect cardiac lusitropy, inotropy, and chronotropy without significant side effects. We report a case of acute severe left ventricular dysfunction in a pregnant woman with severe acute respiratory distress syndrome on veno-venous extracorporeal membrane oxygenation managed with short-term IV T3. Hemodynamic stability was rapidly achieved and the improvement in contractility imaged in real time by transesophageal echocardiography. <Learning objective: Tri-iodothyronine (T3) rapidly affects cardiac inotropy, lusitropy, chronotropy, and systemic vascular resistance. Widespread application of intravenous T3 for treatment of heart failure is currently limited by a paucity of scientific literature. Selective short-term intravenous T3 use is an underutilized adjunct in the management of acute left ventricular dysfunction.>.
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Affiliation(s)
| | - Claudia Gidea
- Heart Failure Treatment and Transplant Program, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - David Baran
- Heart Failure Treatment and Transplant Program, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Marc Cohen
- Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Mark J Zucker
- Heart Failure Treatment and Transplant Program, Newark Beth Israel Medical Center, Newark, NJ, USA
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10
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Meuwese CL, Dekkers OM, Stenvinkel P, Dekker FW, Carrero JJ. Nonthyroidal illness and the cardiorenal syndrome. Nat Rev Nephrol 2013; 9:599-609. [PMID: 23999398 DOI: 10.1038/nrneph.2013.170] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The cardiorenal syndrome represents a final common pathway for renal and congestive heart failure and heralds a poor prognosis. Factors that link the failing heart and the failing kidneys--the so-called cardiorenal connectors--are, therefore, of clinical and therapeutic interest. Alterations in the levels and function of thyroid hormones that fit the spectrum of nonthyroidal illnesses could be considered to be cardiorenal connectors as both renal failure and heart failure progress with the development of nonthyroidal illness. In addition, circumstantial evidence suggests that nonthyroidal illness can induce deterioration in the function of the heart and the kidneys via multiple pathways. As a consequence, these reciprocal associations could result in a vicious cycle of deterioration that likely contributes to increased mortality. In this Review, we describe the evidence for a pathophysiological role of nonthyroidal illness in the cardiorenal syndrome. We also discuss the available data from studies that have investigated the efficacy of thyroid hormone replacement therapy in patients with renal failure and the rationale for interventional trials to examine the effects of normalization of the thyroid hormone profile in patients with renal failure and congestive heart failure.
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Affiliation(s)
- Christiaan L Meuwese
- Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
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11
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Mitchell JE, Hellkamp AS, Mark DB, Anderson J, Johnson GW, Poole JE, Lee KL, Bardy GH. Thyroid function in heart failure and impact on mortality. JACC. HEART FAILURE 2013; 1:48-55. [PMID: 24159562 PMCID: PMC3803999 DOI: 10.1016/j.jchf.2012.10.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The aim of this study was to investigate whether patients with systolic heart failure (HF) and abnormal thyroid function are at increased risk for death. BACKGROUND Thyroid hormone homeostasis is vital to the optimal functioning of the cardiovascular system, but an independent prognostic effect of thyroid abnormalities in patients with HF has not been established. METHODS In SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial), which randomized patients with ischemic or nonischemic HF to placebo or amiodarone or implantable cardioverter-defibrillator therapy, thyroid-stimulating hormone (TSH) was measured at baseline and at 6-month intervals throughout the 5-year study. RESULTS Of 2,225 patients, the majority (87%) had normal TSH levels (0.3 to 5.0 μU/ml) at baseline, 12% had values suggestive of hypothyroidism, and 1% had values consistent with hyperthyroidism. Compared with euthyroid patients, those hypothyroid at baseline were older and included more women and Caucasians (all p values <0.05). Over the median follow-up period of 45.5 months, among patients euthyroid at baseline, 89 developed abnormally low TSH levels, and 341 developed abnormally high values. Patients randomized to amiodarone (median dose 300 mg) had an elevated risk for developing abnormal TSH levels compared with implantable cardioverter-defibrillator therapy or placebo (p < 0.0001). Patients with baseline or new-onset abnormal thyroid function had a higher mortality than those with normal thyroid function, even after controlling for other known mortality predictors (hazard ratio: 1.58; 95% confidence interval: 1.29 to 1.94; p < 0.0001 for hypothyroid; hazard ratio: 1.85; 95% confidence interval: 1.21 to 2.83; p = 0.0048 for hyperthyroid). Implantable cardioverter-defibrillator benefit did not vary with thyroid function. CONCLUSIONS Abnormal thyroid function in patients with symptomatic HF and ejection fractions ≤35% is associated with significantly increased risk for death, even after controlling for known mortality predictors.
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Affiliation(s)
- Judith E. Mitchell
- State University of New York Downstate Medical Center, Brooklyn, New York
| | - Anne S. Hellkamp
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Daniel B. Mark
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Jill Anderson
- Seattle Institute for Cardiac Research, Seattle, Washington
| | | | | | - Kerry L. Lee
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Gust H. Bardy
- Seattle Institute for Cardiac Research, Seattle, Washington
- University of Washington, Seattle, Washington
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12
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Affiliation(s)
- Anthony Martin Gerdes
- Cardiovascular Health Research Center, Sanford Research/University of South Dakota, 1100 E 21st Street, Sioux Falls, SD 57105, USA.
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13
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Yamagishi T, Bessho M, Yanagida S, Nishizawa K, Kusuhara M, Ohsuzu F, Tamai S. Severe, short-term food restriction improves cardiac function following ischemia/reperfusion in perfused rat hearts. Heart Vessels 2010; 25:417-25. [PMID: 20676965 DOI: 10.1007/s00380-009-1222-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 11/19/2009] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to clarify the characteristics of improved ischemic tolerance induced by severe, short-term food restriction in isolated, perfused rat hearts. Male Wistar (8 week-old) rats were given a food intake equivalent to a 70% reduction on the food intake of ad-libitum fed rats for 11 days (FR group and AL group, respectively). After this period, hearts were isolated and perfused in the Langendorff mode, and subjected to 20 min of global ischemia followed by 30 min of reperfusion. Although the coronary flow rate in the FR group (63.0 +/- 3.1 ml/min/g dry weight) was higher than that in the AL group (47.1 +/- 1.3 ml/min/g dry weight) during preischemic perfusion, the lactate release into the coronary effluent and absolute values of +dP/dt and -dP/dt in the FR group (2422 +/- 161 and -1282 +/- 51) were inversely lower than in the AL group (2971 +/- 156 and -1538 +/- 74, respectively). An increase in ischemic contracture was suppressed in the FR group. Following reperfusion, cardiac function, high-energy phosphate content, and intracellular pH, as measured by 31P-nuclear magnetic resonance spectroscopy, had recovered to a much greater degree in the FR group than in the AL group. The serum T3 level was significantly lower in the FR group (2.7 +/- 0.1 pg/ml) than in the AL group (3.6 +/- 0.1 pg/ml), and the levels of triglycerides, free fatty acids, insulin, and glucose were also significantly lower in the FR group than in the AL group. The protein expressions of myocyte enhancer factor 2A, Na(+), K(+)-ATPase, and phospholamban in the cardiac tissue were higher in the FR group than in the AL group. These results suggested that severe, short-term food restriction improves ischemic tolerance in rat hearts via altered expression of functional proteins induced by low serum T3 levels, decreased coronary conductance, and change in metabolic flux.
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Affiliation(s)
- Tadashi Yamagishi
- Department of Laboratory Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan.
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Pinotti MF, Leopoldo AS, Silva MDP, Sugizaki MM, do Nascimento AF, Lima-Leopoldo AP, Aragon FF, Padovani CR, Cicogna AC. A comparative study of myocardial function and morphology during fasting/refeeding and food restriction in rats. Cardiovasc Pathol 2009; 19:e175-82. [PMID: 19914094 DOI: 10.1016/j.carpath.2009.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 08/10/2009] [Accepted: 08/14/2009] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND This study compared the influence of fasting/refeeding cycles and food restriction on rat myocardial performance and morphology. METHODS Sixty-day-old male Wistar rats were submitted to food ad libitum (C), 50% food restriction (R50), and fasting/refeeding cycles (RF) for 12 weeks. Myocardial function was evaluated under baseline conditions and after progressive increase in calcium and isoproterenol. Myocardium ultrastructure was examined in the papillary muscle. RESULTS Fasting/refeeding cycles maintained rat body weight and left ventricle weight between control and food-restricted rats. Under baseline conditions, the time to peak tension (TPT) was more prolonged in R50 than in RF and C rats. Furthermore, the maximum tension decline rate (-dT/dt) increased less in R50 than in RF with calcium elevation. While the R50 group showed focal changes in many muscle fibers, such as the disorganization or loss of myofilaments, polymorphic mitochondria with disrupted cristae, and irregular appearance or infolding of the plasma membrane, the RF rats displayed few alterations such as loss or disorganization of myofibrils. CONCLUSION Food restriction promotes myocardial dysfunction, not observed in RF rats, and higher morphological damage than with fasting/refeeding. The increase in TPT may be attributed possibly to the disorganization and loss of myofibrils; however, the mechanisms responsible for the alteration in -dT/dt in R50 needs to be further clarified.
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Affiliation(s)
- Matheus Fécchio Pinotti
- Department of Internal Medicine, School of Medicine, State University "Júlio de Mesquita Filho", UNESP, Botucatu, São Paulo, Brazil
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15
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Affiliation(s)
- Luigi Saccà
- Department of Internal Medicine and Cardiovascular Sciences, University Federico II, Naples, Italy.
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16
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Sugizaki MM, Leopoldo AS, Okoshi MP, Bruno A, Conde SJ, Lima-Leopoldo AP, Padovani CR, Carvalho RF, Nascimento AFD, Campos DHSD, Nogueira CR, Cicogna AC. Severe food restriction induces myocardial dysfunction related to SERCA2 activity. Can J Physiol Pharmacol 2009; 87:666-73. [DOI: 10.1139/y09-060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Previous studies have shown that food restriction promotes myocardial dysfunction in rats. However, the molecular mechanisms that are responsible are unclear. We investigated the role of sarcoplasmic reticulum Ca2+-ATPase (SERCA2) on myocardial performance in food-restricted rats. Male Wistar–Kyoto rats, 60 days old, were fed a control or restricted diet (daily energy intake reduced to 50% of the control) for 90 days. Expression of Serca2a, phospholamban (PLB), Na+/Ca2+ exchanger (NCX), and thyroid hormone receptor (TRα1, TRβ1) mRNA was determined by quantitative PCR. SERCA2 activity was measured by using 20 µmol/L cyclopiazonic acid (CPA) in a left ventricular papillary muscle preparation during isometric contraction in basal conditions and during post-rest contraction. Serum concentrations of thyroxine (T4) and thyrotropin (TSH) were also determined. The 50%-restricted diet reduced body and ventricular weight and serum T4 and TSH levels. The interaction of CPA and food restriction reduced peak developed tension and maximum rate of tension decline (–dT/dt), but increased the resting tension intensity response during post-rest contraction. PLB and NCX mRNA were upregulated and TRα1 mRNA was downregulated by food restriction. These results suggest that food restriction promotes myocardial dysfunction related to impairment of sarcoplasmic reticulum Ca2+ uptake as a result of a hypothyroid state.
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Affiliation(s)
- Mário Mateus Sugizaki
- Department of Clinical and Cardiology, School of Medicine, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Biostatistics, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Morphology, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Physical Education, FIB, Faculdades Integradas de Bauru, São Paulo, Brazil
| | - André Soares Leopoldo
- Department of Clinical and Cardiology, School of Medicine, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Biostatistics, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Morphology, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Physical Education, FIB, Faculdades Integradas de Bauru, São Paulo, Brazil
| | - Marina Politi Okoshi
- Department of Clinical and Cardiology, School of Medicine, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Biostatistics, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Morphology, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Physical Education, FIB, Faculdades Integradas de Bauru, São Paulo, Brazil
| | - Alessandro Bruno
- Department of Clinical and Cardiology, School of Medicine, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Biostatistics, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Morphology, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Physical Education, FIB, Faculdades Integradas de Bauru, São Paulo, Brazil
| | - Sandro José Conde
- Department of Clinical and Cardiology, School of Medicine, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Biostatistics, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Morphology, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Physical Education, FIB, Faculdades Integradas de Bauru, São Paulo, Brazil
| | - Ana Paula Lima-Leopoldo
- Department of Clinical and Cardiology, School of Medicine, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Biostatistics, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Morphology, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Physical Education, FIB, Faculdades Integradas de Bauru, São Paulo, Brazil
| | - Carlos Roberto Padovani
- Department of Clinical and Cardiology, School of Medicine, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Biostatistics, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Morphology, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Physical Education, FIB, Faculdades Integradas de Bauru, São Paulo, Brazil
| | - Robson Francisco Carvalho
- Department of Clinical and Cardiology, School of Medicine, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Biostatistics, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Morphology, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Physical Education, FIB, Faculdades Integradas de Bauru, São Paulo, Brazil
| | - André Ferreira do Nascimento
- Department of Clinical and Cardiology, School of Medicine, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Biostatistics, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Morphology, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Physical Education, FIB, Faculdades Integradas de Bauru, São Paulo, Brazil
| | - Dijon Henrique Salomé de Campos
- Department of Clinical and Cardiology, School of Medicine, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Biostatistics, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Morphology, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Physical Education, FIB, Faculdades Integradas de Bauru, São Paulo, Brazil
| | - Célia Regina Nogueira
- Department of Clinical and Cardiology, School of Medicine, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Biostatistics, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Morphology, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Physical Education, FIB, Faculdades Integradas de Bauru, São Paulo, Brazil
| | - Antonio Carlos Cicogna
- Department of Clinical and Cardiology, School of Medicine, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Biostatistics, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Morphology, Institute of Biological Sciences, UNESP State University Júlio Mesquita Filho, Botucatu, São Paulo, Brazil
- Department of Physical Education, FIB, Faculdades Integradas de Bauru, São Paulo, Brazil
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17
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Henderson KK, Danzi S, Paul JT, Leya G, Klein I, Samarel AM. Physiological replacement of T3 improves left ventricular function in an animal model of myocardial infarction-induced congestive heart failure. Circ Heart Fail 2009; 2:243-52. [PMID: 19808346 DOI: 10.1161/circheartfailure.108.810747] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Patients with congestive heart failure (CHF) often have low serum triiodothyronine (T(3)) concentrations. In a rodent model of myocardial infarction-induced CHF and low serum T(3), we hypothesized that replacing T(3) to euthyroid levels would improve left ventricular function without producing untoward signs of thyrotoxicosis. METHODS AND RESULTS Adult male Sprague-Dawley rats were subjected to left anterior descending coronary artery ligation (myocardial infarction). One week post-myocardial infarction, left ventricular fractional shortening was significantly reduced to 22+/-1% in CHF animals versus 38+/-1% for sham-operated controls (P<0.001). Serum T(3) concentration was also significantly reduced (80+/-3 versus 103+/-6 ng/dL; P<0.001), in CHF animals versus Shams. At 9 weeks post-myocardial infarction, systolic function (+dP/dt max) was significantly attenuated in CHF animals (4773+/-259 versus 6310+/-267 mmHg/s; P<0.001) as well as diastolic function measured by half time to relaxation (15.9+/-1.2 versus 11.1+/-0.3 ms; P<0.001). alpha-myosin heavy chain expression was also significantly reduced by 77% (P<0.001), and beta-myosin heavy chain expression was increased by 21%. Continuous T(3) replacement was initiated 1 week post-myocardial infarction with osmotic mini-pumps (6 microg/kg/d), which returned serum T(3) concentrations to levels similar to Sham controls while resting conscious heart rate, arterial blood pressure and the incidence of arrhythmias were not different. At 9 weeks, systolic function was significantly improved by T(3) replacement (6279+/-347 mmHg/s; P<0.05) and a trend toward improved diastolic function (12.3+/-0.6 ms) was noted. T(3) replacement in CHF animals also significantly increased alpha- and reduced beta-MHC expression, (P<0.05). CONCLUSIONS These data indicate that T(3) replacement to euthyroid levels improves systolic function and tends to improve diastolic function, potentially through changes in myocardial gene expression.
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MESH Headings
- Animals
- Blood Pressure
- Diastole
- Disease Models, Animal
- Gene Expression Regulation
- Heart Failure/etiology
- Heart Failure/metabolism
- Heart Failure/physiopathology
- Heart Failure/therapy
- Heart Rate
- Hormone Replacement Therapy
- Hypertrophy, Left Ventricular/etiology
- Hypertrophy, Left Ventricular/physiopathology
- Hypertrophy, Left Ventricular/therapy
- Infusion Pumps, Implantable
- Male
- Myocardial Contraction
- Myocardial Infarction/complications
- Myocardial Infarction/metabolism
- Myocardial Infarction/physiopathology
- Myocardial Infarction/therapy
- Myosin Heavy Chains/genetics
- RNA, Messenger/metabolism
- Rats
- Rats, Sprague-Dawley
- Recovery of Function
- Systole
- Time Factors
- Triiodothyronine/administration & dosage
- Triiodothyronine/blood
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/metabolism
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Left/therapy
- Ventricular Myosins/genetics
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Affiliation(s)
- Kyle K Henderson
- Department of Medicine and the Cardiovascular Institute, Loyola University Medical Center, Maywood, Ill 60153, USA.
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18
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Abstract
The cardiovascular signs and symptoms of thyroid disease are some of the most profound and clinically relevant findings that accompany both hyperthyroidism and hypothyroidism. On the basis of the understanding of the cellular mechanisms of thyroid hormone action on the heart and cardiovascular system, it is possible to explain the changes in cardiac output, cardiac contractility, blood pressure, vascular resistance, and rhythm disturbances that result from thyroid dysfunction. The importance of the recognition of the effects of thyroid disease on the heart also derives from the observation that restoration of normal thyroid function most often reverses the abnormal cardiovascular hemodynamics. In the present review, we discuss the appropriate thyroid function tests to establish a suspected diagnosis as well as the treatment modalities necessary to restore patients to a euthyroid state. We also review the alterations in thyroid hormone metabolism that accompany chronic congestive heart failure and the approach to the management of patients with amiodarone-induced alterations in thyroid function tests.
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Affiliation(s)
- Irwin Klein
- Department of Medicine and the Feinstein Institute for Medical Research, North Shore University Hospital, 350 Community Dr, Manhasset, NY 11030, USA.
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19
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Rosolowska-Huszcz D, Kozlowska L, Rydzewski A. Influence of low protein diet on nonthyroidal illness syndrome in chronic renal failure. Endocrine 2005; 27:283-8. [PMID: 16230785 DOI: 10.1385/endo:27:3:283] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2005] [Revised: 06/20/2005] [Accepted: 06/29/2005] [Indexed: 12/17/2022]
Abstract
Renal failure causes alterations in thyroid hormone metabolism known as nonthyroidal illness syndrome. In the present study we have examined the effect of a low protein diet (LPD) on circulating levels of hormones of the pituitary-thyroid axis, and tumor necrosis factor alpha (TNF-alpha) in patients with chronic renal failure. Seventeen subjects with conservatively treated chronic renal failure (estimated creatinine clearance 39.5+/-11.1 mL/min) were studied before and after 8 wk of dietary intervention (0.6 g/kg of ideal body mass protein, 30% of calories derived from fat, 62% of calories derived from carbohydrates, and 10 mg/kg of phosphorus). Body fat and fat-free mass remained unchanged. Urea and TNF-alpha serum concentrations significantly decreased, whereas T3 and total and free T4 serum concentrations increased significantly. Triiodothyronine level after treatment correlated negatively with baseline urea level. Changes in T3, T4, and fT4 serum concentrations as well as calculated peripheral deiodinase activity correlated negatively with their baseline values. Alterations in TNF-alpha correlated positively with protein intake, whereas changes in T4 and T4/TSH were inversely related to vegetal protein intake. In conclusion, low protein, low phosphorus diet, which is often prescribed to patients with moderate impairment of renal function, exerts a beneficial effect on low T3 syndrome coexisting with renal failure. The effect of low protein diet on the pituitary-thyroid axis is dependent on the degree of renal functional impairment and LPD-induced decrease in TNF-alpha may also contribute to the observed effects of dietary treatment.
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20
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Kuzman JA, Thomas TA, Vogelsang KA, Said S, Anderson BE, Gerdes AM. Effects of induced hyperthyroidism in normal and cardiomyopathic hamsters. J Appl Physiol (1985) 2005; 99:1428-33. [PMID: 15976357 DOI: 10.1152/japplphysiol.00515.2005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Thyroid hormones (TH) enhance cardiac function and reverse gene changes typical of pathological hypertrophy. However, reports in humans, but not animals, indicate that excess TH can cause heart failure. Also, the effects of TH on normal and cardiomyopathic hearts are likely to be different. The goal of this study was to characterize the effects of prolonged hyperthyroidism on cardiac function, chamber and cellular remodeling, and protein expression in both normal and cardiomyopathic hearts. Hyperthyroidism was induced in 3-mo-old normal BIO F1B and dilated cardiomyopathic BIO TO2 hamsters. After TH treatment for 10 days and 2 mo, hemodynamics, echos, myocyte length, histology, and protein expression were assessed. After 10 days and 2 mo, there were no differences between TO2-treated (Tx) and TO2-untreated (Untx) hamsters in chamber diameters or left ventricular function. After 2 mo of treatment, however, F1B-Tx showed evidence of dilated heart failure vs. F1B-Untx. Chamber diameters were increased, and ejection fraction and positive and negative changes in pressure over time were reduced. In F1B-Tx and TO2-Tx hamsters, beta-myosin isoform expression was reduced, whereas alpha-myosin increased significantly in F1B-Tx only. In TO2-Tx hamsters, the percent of viable myocardium was increased, and percent fibronecrosis was reduced vs. TO2-Untx. Myocyte length increased with TH treatment in both hamster strains. We conclude that 1) excess TH can induce heart failure in normal animals as observed in humans, 2) reversal of myosin heavy chain expression does not necessarily improve heart function, and 3) excess TH altered cellular remodeling but did not adversely affect chamber function or dimensions in TO2 hamsters.
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Affiliation(s)
- James A Kuzman
- Cardiovascular Research Institute, South Dakota Health Research Foundation, University of South Dakota, Sioux Falls, 57105, USA
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21
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Danzi S, Dubon P, Klein I. Effect of serum triiodothyronine on regulation of cardiac gene expression: role of histone acetylation. Am J Physiol Heart Circ Physiol 2005; 289:H1506-11. [PMID: 15894578 DOI: 10.1152/ajpheart.00182.2005] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Thyroid hormone regulates the transcription of several important cardiac genes. Although the thyroid gland produces predominantly thyroxine (T(4)), it is triiodothyronine (T(3)) that is transported across the sarcolemma and binds to nuclear thyroid hormone receptor proteins; yet various studies suggest that serum T(3) levels do not accurately reflect cellular T(3) action. To address this question, we studied the dose-response relationship of T(3) administered by constant infusion in hypothyroid animals with the simultaneous in vivo transcription rate of the cardiac-specific alpha-myosin heavy chain (MHC) gene, measured by quantitating alpha-MHC heteronuclear (hn)RNA content. Constant infusion of 4 mug T(3) x kg body wt(-1) x day(-1) for 3 days normalized serum T(3) and restored transcription to euthyroid levels; in contrast, daily injections of the same dose increased alpha-MHC transcription by only 55% of that obtained by infusion. Although infusion of T(3) at 1.25 microg T(3) x kg body wt(-1) x day(-1) was not sufficient to restore serum T(3) to normal, it was capable of restoring transcription to normal at 3 days, but when administered for 12 days, transcription of alpha-MHC was found to be 50% of euthyroid levels, demonstrating a decreased sensitivity to T(3) over time. Treatment with trichostatin A (TSA) to inhibit histone deacetylation increased levels of total nuclear acetylated histone H4 by almost 50% but was without effect on the real-time PCR measures of alpha-MHC hnRNA. TSA administered together with T(3) (10 mug T(3)/kg body wt) significantly increased transcription of alpha-MHC after 30 h, thus demonstrating a potential role for histones as cofactors in the T(3) regulation of cardiac alpha-MHC transcription.
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Affiliation(s)
- Sara Danzi
- North Shore University Hospital, 350 Community Drive, Manhasset, NY 11030, USA
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22
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Iervasi G, Pingitore A, Landi P, Raciti M, Ripoli A, Scarlattini M, L'Abbate A, Donato L. Low-T3 syndrome: a strong prognostic predictor of death in patients with heart disease. Circulation 2003; 107:708-13. [PMID: 12578873 DOI: 10.1161/01.cir.0000048124.64204.3f] [Citation(s) in RCA: 306] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Clinical and experimental data have suggested a potential negative impact of low-T3 state on the prognosis of cardiac diseases. The aim of the present prospective study was to assess the role of thyroid hormones in the prognosis of patient population with heart disease. METHODS AND RESULTS A total of 573 consecutive cardiac patients underwent thyroid function profile evaluation. They were divided in two subgroups: group I, 173 patients with low T3, ie, with free T3 (fT3) <3.1 pmol/L, and group II, 400 patients with normal fT3 (>or=3.1 pmol/L). We considered cumulative and cardiac death events. During the 1-year follow-up, there were 25 cumulative deaths in group I and 12 in group II (14.4% versus 3%, P<0.0001); cardiac deaths were 13 in group I and 6 in group II (7.5% versus 1.5%, P=0.0006). According to the Cox model, fT3 was the most important predictor of cumulative death (hazard ratio [HR] 3.582, P<0.0001), followed by dyslipidemia (HR 2.955, P=0.023), age (HR 1.051, P<0.005), and left ventricular ejection fraction (HR 1.037, P=0.006). At the logistic multivariate analysis, fT3 was the highest independent predictor of death (HR 0.395, P=0.003). A prevalence of low fT3 levels was found in patients with NYHA class III-IV illness compared with patients with NYHA class I-II (chi(2) 5.65, P=0.019). CONCLUSIONS Low-T3 syndrome is a strong predictor of death in cardiac patients and might be directly implicated in the poor prognosis of cardiac patients.
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Affiliation(s)
- Giorgio Iervasi
- C.N.R. Clinical Physiology Institute and Scuola Superiore di Studi Univeritari S. Anna, Pisa, Italy.
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23
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Ojamaa K, Kenessey A, Shenoy R, Klein I. Thyroid hormone metabolism and cardiac gene expression after acute myocardial infarction in the rat. Am J Physiol Endocrinol Metab 2000; 279:E1319-24. [PMID: 11093920 DOI: 10.1152/ajpendo.2000.279.6.e1319] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In a rat model of acute myocardial infarction (MI) produced by coronary artery ligation, thyroid hormone metabolism was altered with significant reductions (54%) in serum triiodo-L-thyronine (T(3)), the cellular active hormone metabolite. T(3) has profound effects on the heart; therefore, rats were treated with T(3) after acute MI for 2 or 3 wk, at either replacement or elevated doses, to determine whether cardiac function and gene expression could be normalized. Acute MI resulted in a 50% (P < 0.001) decrease in percent ejection fraction (%EF) with a 32-35% increase (P < 0.01) in compensatory left ventricle (LV) hypertrophy. Treatment of the MI animals with either replacement or elevated doses of T(3) significantly increased %EF to 64 and 73% of control, respectively. Expression levels of several T(3)-responsive genes were altered in the hypertrophied LV after MI, including significant decreases in alpha-myosin heavy chain (MHC), sarcoplasmic reticulum calcium-activated ATPase (SERCA2), and Kv1.5 mRNA, whereas beta-MHC and phospholamban (PLB) mRNA were significantly increased. Normalization of serum T(3) did not restore expression of all T(3)-regulated genes, indicating altered T(3) responsiveness in the postinfarcted myocardium. Although beta-MHC and Kv1.5 mRNA content was returned to control levels, alpha-MHC and SERCA2 were unresponsive to T(3) at replacement doses, and only at higher doses of T(3) was alpha-MHC mRNA returned to control values. The present study showed that acute MI in the rat was associated with a fall in serum T(3) levels, LV dysfunction, and altered expression of T(3)-responsive genes and that T(3) treatment significantly improved cardiac function, with normalization of some, but not all, of the changes in gene expression.
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Affiliation(s)
- K Ojamaa
- Divisions of Endocrinology and Pediatric Cardiology, Departments of Medicine and Pediatrics, North Shore University Hospital/New York University School of Medicine, Manhasset, New York 11030, USA.
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