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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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Malhotra Y, Kaushik RM, Kaushik R. Echocardiographic evaluation of left ventricular diastolic dysfunction in subclinical hypothyroidism: A case-control study. Endocr Res 2017; 42:198-208. [PMID: 28287839 DOI: 10.1080/07435800.2017.1292524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To study the prevalence of left ventricular diastolic dysfunction (LVDD) in patients with subclinical hypothyroidism (SCH) and the response of LVDD to L-thyroxine therapy. MATERIALS AND METHODS This cross-sectional case-control study with one longitudinal arm included 67 patients with SCH attending a tertiary care hospital in Uttarakhand, India, and 67 age- and sex-matched healthy controls. LVDD was assessed by 2D, pulsed-wave Doppler (PWD), continuous wave Doppler (CWD), and tissue Doppler echocardiography (TDE). Patients with LVDD received L-thyroxine therapy with reassessment for LVDD 6 months later. RESULTS SCH patients had a higher prevalence of LVDD than controls (13.43% versus 1.49%; p = 0.017). LVDD showed a significant association with gender (p = 0.004) and serum FT4 (p = 0.001). E velocity, E' velocity, A' velocity, iso-volumetric relaxation time (IVRT), E/A, and E'/A' ratios were significantly lower, while A velocity, deceleration time (DT), E/E' ratio, left atrial (LA) volume index, and peak tricuspid regurgitation (TR) velocity were significantly higher in cases than controls (p < 0.05 each). The E/A ratio correlated significantly with age, serum very low-density lipoprotein (VLDL), triglycerides (TG), thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and high-density lipoprotein (HDL) (p < 0.05 each). E' velocity correlated significantly with age, serum total cholesterol, VLDL, and TG (p < 0.05 each), DT with serum total cholesterol (p = 0.047), and LA volume index with age (p = 0.021). Age (p = 0.016) and serum HDL (p = 0.029) were independent predictors of E/A ratio. Gender was an independent predictor for LVDD (p = 0.003). Echocardiographic indices for LVDD showed significant improvement after 6 months of L-thyroxine therapy (p < 0.05 each). CONCLUSIONS LVDD occurs commonly in SCH patients. It can be detected timely using echocardiography and may be reversed by L-thyroxine therapy.
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Affiliation(s)
- Yuthika Malhotra
- a Department of Medicine , Himalayan Institute of Medical Sciences, Swami Rama Himalayan University , Dehradun , Uttarakhand , India
| | - Rajeev Mohan Kaushik
- a Department of Medicine , Himalayan Institute of Medical Sciences, Swami Rama Himalayan University , Dehradun , Uttarakhand , India
| | - Reshma Kaushik
- a Department of Medicine , Himalayan Institute of Medical Sciences, Swami Rama Himalayan University , Dehradun , Uttarakhand , India
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