Subclinical hypothyroidism is an independent predictor of adverse cardiovascular outcomes in patients with acute decompensated heart failure.
Subclinical hypothyroidism is an independent predictor of adverse cardiovascular outcomes in patients with acute decompensated heart failure.
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DOI：
10.1002/ehf2.12084
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发表时间：
2016-09
影响因子：
3.8
通讯作者：
Anzai, Toshihisa
中科院分区：
文献类型：
--
作者：
Hayashi, Tomohiro;Hasegawa, Takuya;Kanzaki, Hideaki;Funada, Akira;Amaki, Makoto;Takahama, Hiroyuki;Ohara, Takahiro;Sugano, Yasuo;Yasuda, Satoshi;Ogawa, Hisao;Anzai, Toshihisa
以低三碘甲状腺原氨酸（T3）为特征的甲状腺激素代谢改变，即所谓的低T3综合征，是重症全身性疾病患者的常见表现。此外，亚临床甲状腺功能障碍（定义为促甲状腺激素[TSH]异常而甲状腺素[T4]正常）会导致左心室功能障碍。我们的目的是确定急性失代偿性心力衰竭（ADHF）患者中低T3综合征和亚临床甲状腺功能障碍的患病率及其对预后的影响。
我们检查了274例入院时未接受甲状腺药物治疗或胺碘酮治疗的ADHF患者（年龄70±15岁，男性156例），这些患者都进行了甲状腺功能检查。甲状腺功能正常定义为TSH为0.45 - 4.49 mIU/L；亚临床甲状腺功能减退定义为TSH为4.5 - 19.9 mIU/L；亚临床甲状腺功能亢进定义为TSH < 0.45 mIU/L，后两者的游离T4水平正常。此外，低T3综合征在甲状腺功能正常的受试者中定义为游离T3 < 4.0 pmol/L。入院时，188例患者（69%）甲状腺功能正常，58例（21%）为亚临床甲状腺功能减退，5例（2%）为亚临床甲状腺功能亢进，95例（35%）为低T3综合征。Cox比例风险模型显示，较高的TSH（而非游离T3和游离T4）与复合心血管事件（包括心脏死亡和因心力衰竭再次住院）独立相关。实际上，亚临床甲状腺功能减退是一个独立的预测因子（风险比：2.31；95%置信区间：1.44 - 3.67；P < 0.001），而低T3综合征和亚临床甲状腺功能亢进则不是。
入院时的亚临床甲状腺功能减退是ADHF患者不良心血管结局的独立预测因子，这表明甲状腺功能障碍与ADHF的病理生理学之间可能存在相互作用。
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). 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. 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.
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影响因子：
5.8
作者：
LIM, CF;DOCTER, R;HENNEMAN, G
通讯作者：
HENNEMAN, G
影响因子：
3.4
作者：
Razvi, Salman;Weaver, Jolanta U.;Pearce, Simon H. S.
通讯作者：
Pearce, Simon H. S.
影响因子：
--
作者：
Friberg, L;Werner, S;Ahnve, S
通讯作者：
Ahnve, S
影响因子：
37.8
作者：
Senni, M;Tribouilloy, CM;Redfield, MM
通讯作者：
Redfield, MM
影响因子：
6.8
作者：
Giovannini, Stefania;Zucchelli, Gian Carlo;Clerico, Aldo
通讯作者：
Clerico, Aldo