Cargando…

Subclinical hypothyroidism is an independent predictor of adverse cardiovascular outcomes in patients with acute decompensated heart failure

AIMS: Altered thyroid hormone metabolism characterized by a low triiodothyronine (T3), so‐called low‐T3 syndrome, is a common finding in patients with severe systemic diseases. Additionally, subclinical thyroid dysfunction, defined as abnormal thyroid stimulating hormone (TSH) and normal thyroxine (...

Descripción completa

Detalles Bibliográficos
Autores principales: Hayashi, Tomohiro, Hasegawa, Takuya, Kanzaki, Hideaki, Funada, Akira, Amaki, Makoto, Takahama, Hiroyuki, Ohara, Takahiro, Sugano, Yasuo, Yasuda, Satoshi, Ogawa, Hisao, Anzai, Toshihisa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5071693/
https://www.ncbi.nlm.nih.gov/pubmed/27818781
http://dx.doi.org/10.1002/ehf2.12084
_version_ 1782461308875046912
author Hayashi, Tomohiro
Hasegawa, Takuya
Kanzaki, Hideaki
Funada, Akira
Amaki, Makoto
Takahama, Hiroyuki
Ohara, Takahiro
Sugano, Yasuo
Yasuda, Satoshi
Ogawa, Hisao
Anzai, Toshihisa
author_facet Hayashi, Tomohiro
Hasegawa, Takuya
Kanzaki, Hideaki
Funada, Akira
Amaki, Makoto
Takahama, Hiroyuki
Ohara, Takahiro
Sugano, Yasuo
Yasuda, Satoshi
Ogawa, Hisao
Anzai, Toshihisa
author_sort Hayashi, Tomohiro
collection PubMed
description AIMS: Altered thyroid hormone metabolism characterized by a low triiodothyronine (T3), so‐called low‐T3 syndrome, is a common finding in patients with severe systemic diseases. Additionally, subclinical thyroid dysfunction, defined as abnormal thyroid stimulating hormone (TSH) and normal thyroxine (T4), causes left ventricular dysfunction. Our objective was to identify the prevalence and prognostic impact of low‐T3 syndrome and subclinical thyroid dysfunction in patients with acute decompensated heart failure (ADHF). METHODS AND RESULTS: We examined 274 ADHF patients who were not receiving thyroid medication or amiodarone on admission (70 ± 15 years, 156 male), who underwent thyroid function tests. Euthyroidism was defined as TSH of 0.45 to 4.49 mIU/L; subclinical hypothyroidism as TSH of 4.5 to 19.9 mIU/L; and subclinical hyperthyroidism as TSH < 0.45 mIU/L, with normal free T4 level for the last two. Additionally, low‐T3 syndrome was defined as free T3 < 4.0 pmol/L among euthyroidism subjects. On admission, 188 patients (69%) showed euthyroidism, 58 (21%) subclinical hypothyroidism, 5 (2%) subclinical hyperthyroidism, and 95 (35%) low‐T3 syndrome. Cox proportional hazards models revealed that higher TSH, but not free T3 and free T4, was independently associated with composite cardiovascular events, including cardiac death and re‐hospitalization for heart failure. Indeed, subclinical hypothyroidism was an independent predictor (hazard ratio: 2.31; 95% confidence interval: 1.44 to 3.67; P < 0.001), whereas low‐T3 syndrome and subclinical hyperthyroidism were not. CONCLUSIONS: Subclinical hypothyroidism on admission was an independent predictor of adverse cardiovascular outcomes in ADHF patients, suggesting a possible interaction between thyroid dysfunction and the pathophysiology of ADHF.
format Online
Article
Text
id pubmed-5071693
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-50716932016-11-02 Subclinical hypothyroidism is an independent predictor of adverse cardiovascular outcomes in patients with acute decompensated heart failure Hayashi, Tomohiro Hasegawa, Takuya Kanzaki, Hideaki Funada, Akira Amaki, Makoto Takahama, Hiroyuki Ohara, Takahiro Sugano, Yasuo Yasuda, Satoshi Ogawa, Hisao Anzai, Toshihisa ESC Heart Fail Original Research Articles AIMS: Altered thyroid hormone metabolism characterized by a low triiodothyronine (T3), so‐called low‐T3 syndrome, is a common finding in patients with severe systemic diseases. Additionally, subclinical thyroid dysfunction, defined as abnormal thyroid stimulating hormone (TSH) and normal thyroxine (T4), causes left ventricular dysfunction. Our objective was to identify the prevalence and prognostic impact of low‐T3 syndrome and subclinical thyroid dysfunction in patients with acute decompensated heart failure (ADHF). METHODS AND RESULTS: We examined 274 ADHF patients who were not receiving thyroid medication or amiodarone on admission (70 ± 15 years, 156 male), who underwent thyroid function tests. Euthyroidism was defined as TSH of 0.45 to 4.49 mIU/L; subclinical hypothyroidism as TSH of 4.5 to 19.9 mIU/L; and subclinical hyperthyroidism as TSH < 0.45 mIU/L, with normal free T4 level for the last two. Additionally, low‐T3 syndrome was defined as free T3 < 4.0 pmol/L among euthyroidism subjects. On admission, 188 patients (69%) showed euthyroidism, 58 (21%) subclinical hypothyroidism, 5 (2%) subclinical hyperthyroidism, and 95 (35%) low‐T3 syndrome. Cox proportional hazards models revealed that higher TSH, but not free T3 and free T4, was independently associated with composite cardiovascular events, including cardiac death and re‐hospitalization for heart failure. Indeed, subclinical hypothyroidism was an independent predictor (hazard ratio: 2.31; 95% confidence interval: 1.44 to 3.67; P < 0.001), whereas low‐T3 syndrome and subclinical hyperthyroidism were not. CONCLUSIONS: Subclinical hypothyroidism on admission was an independent predictor of adverse cardiovascular outcomes in ADHF patients, suggesting a possible interaction between thyroid dysfunction and the pathophysiology of ADHF. John Wiley and Sons Inc. 2016-03-24 /pmc/articles/PMC5071693/ /pubmed/27818781 http://dx.doi.org/10.1002/ehf2.12084 Text en © 2016 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs (http://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research Articles
Hayashi, Tomohiro
Hasegawa, Takuya
Kanzaki, Hideaki
Funada, Akira
Amaki, Makoto
Takahama, Hiroyuki
Ohara, Takahiro
Sugano, Yasuo
Yasuda, Satoshi
Ogawa, Hisao
Anzai, Toshihisa
Subclinical hypothyroidism is an independent predictor of adverse cardiovascular outcomes in patients with acute decompensated heart failure
title Subclinical hypothyroidism is an independent predictor of adverse cardiovascular outcomes in patients with acute decompensated heart failure
title_full Subclinical hypothyroidism is an independent predictor of adverse cardiovascular outcomes in patients with acute decompensated heart failure
title_fullStr Subclinical hypothyroidism is an independent predictor of adverse cardiovascular outcomes in patients with acute decompensated heart failure
title_full_unstemmed Subclinical hypothyroidism is an independent predictor of adverse cardiovascular outcomes in patients with acute decompensated heart failure
title_short Subclinical hypothyroidism is an independent predictor of adverse cardiovascular outcomes in patients with acute decompensated heart failure
title_sort subclinical hypothyroidism is an independent predictor of adverse cardiovascular outcomes in patients with acute decompensated heart failure
topic Original Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5071693/
https://www.ncbi.nlm.nih.gov/pubmed/27818781
http://dx.doi.org/10.1002/ehf2.12084
work_keys_str_mv AT hayashitomohiro subclinicalhypothyroidismisanindependentpredictorofadversecardiovascularoutcomesinpatientswithacutedecompensatedheartfailure
AT hasegawatakuya subclinicalhypothyroidismisanindependentpredictorofadversecardiovascularoutcomesinpatientswithacutedecompensatedheartfailure
AT kanzakihideaki subclinicalhypothyroidismisanindependentpredictorofadversecardiovascularoutcomesinpatientswithacutedecompensatedheartfailure
AT funadaakira subclinicalhypothyroidismisanindependentpredictorofadversecardiovascularoutcomesinpatientswithacutedecompensatedheartfailure
AT amakimakoto subclinicalhypothyroidismisanindependentpredictorofadversecardiovascularoutcomesinpatientswithacutedecompensatedheartfailure
AT takahamahiroyuki subclinicalhypothyroidismisanindependentpredictorofadversecardiovascularoutcomesinpatientswithacutedecompensatedheartfailure
AT oharatakahiro subclinicalhypothyroidismisanindependentpredictorofadversecardiovascularoutcomesinpatientswithacutedecompensatedheartfailure
AT suganoyasuo subclinicalhypothyroidismisanindependentpredictorofadversecardiovascularoutcomesinpatientswithacutedecompensatedheartfailure
AT yasudasatoshi subclinicalhypothyroidismisanindependentpredictorofadversecardiovascularoutcomesinpatientswithacutedecompensatedheartfailure
AT ogawahisao subclinicalhypothyroidismisanindependentpredictorofadversecardiovascularoutcomesinpatientswithacutedecompensatedheartfailure
AT anzaitoshihisa subclinicalhypothyroidismisanindependentpredictorofadversecardiovascularoutcomesinpatientswithacutedecompensatedheartfailure