Cardiac hypertrophy as a result of long-term thyroxine therapy and thyrotoxicosis
Cardiac hypertrophy as a result of long-term thyroxine therapy and thyrotoxicosis
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DOI：
10.1136/hrt.75.4.363
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发表时间：
1996-04-01
期刊：
影响因子：
5.7
通讯作者：
Gammage, MD
中科院分区：
文献类型：
--
作者：
Ching, GW;Franklyn, JA;Gammage, MD
目的：明确长期甲状腺素治疗对心率、血压、左心室收缩功能、左心室大小以及自主神经功能指标的影响，并与甲状腺毒症患者治疗前和治疗期间的结果进行比较。设计：对长期服用甲状腺素的患者进行横断面研究（n = 11），甲状腺毒症患者（n = 23），与对照组（n = 25）进行比较;对甲状腺毒症患者进行的纵向研究，研究其在出现时和开始抗甲状腺药物治疗后的连续性（n = 23）。方法：24小时动态监测脉搏和血压，结果-长期甲状腺素治疗的剂量降低血清促甲状腺素低于正常水平，对血压，心率，左心室收缩功能或每搏输出量指数没有影响，但与左心室质量指数增加18.4%相关（平均（SEM）101.9（3.09）g/m2 vs对照组86.1（4.61），P < 0.01）。甲状腺素治疗，如甲状腺毒症，对自主神经功能的测试没有影响。未经治疗的甲状腺毒症导致收缩压和舒张压的明显变化，以及清醒和睡眠时心率的增加。甲状腺毒症患者就诊时左心室收缩功能增强（射血分数70.5（1.66）% v 65.4（1.79），P < 0.01;缩短分数40.4（1.54）%对35.6（1.46），P < 0.01），每搏输出量指数增加（45.9（2.4）ml/m2 v36.6（1.7），P < 0.001），前臂血流量增加，血管阻力降低。他们的左心室肥大程度与甲状腺素治疗相似（99.3（4.03）g/m2）;所有的变化都在2个月内被抗甲状腺药物纠正。结论-在心率，血压，左心室收缩功能与甲状腺激素对心肌的直接营养作用一致。左心室肥厚的存在决定了进一步的研究对评估长期服用甲状腺素的患者的心血管风险是必要的。
Objectives-To define the effects of long-term thyroxine treatment upon heart rate, blood pressure, left ventricular systolic function, and left ventricular size, as well as indices of autonomic function, and to compare findings with those in patients with thyrotoxicosis before and during treatment.Design-Cross sectional study of patients prescribed thyroxine long term (n = 11), patients with thyrotoxicosis studied at presentation (n = 23), compared with controls (n = 25); longitudinal study of patients with thyrotoxicosis studied at presentation and serially after beginning antithyroid drug treatment (n = 23).Methods-24 h ambulatory monitoring of pulse and blood pressure, echocardiography, forearm plethysmography, and autonomic function tests.Results-Long-term thyroxine treatment in doses that reduced serum thyrotrophin to below normal had no effect on blood pressure, heart rate, left ventricular systolic function or stroke volume index, but was associated with an 18.4% increase in left ventricular mass index (mean (SEM) 101.9 (3.09) g/m(2) v controls 86.1 (4.61), P < 0.01). Thyroxine treatment, like thyrotoxicosis, had no effect on tests of autonomic function. Untreated thyrotoxicosis resulted in pronounced changes in systolic and diastolic blood pressure and an increase in heart rate during waking and sleep. Patients with thyrotoxicosis at presentation had an increase in left ventricular systolic function (ejection fraction 70.5 (1.66)% v 65.4 (1.79), P < 0.01; fractional shortening 40.4 (1.54)% v 35.6 (1.46), P < 0.01), increased stroke volume index (45.9 (2.4) ml/m(2) v 36.6 (1.7), P < 0.001), and an increase in forearm blood flow, and decrease in vascular resistance. They had a similar degree of left ventricular hypertrophy to that associated with thyroxine treatment (99.3 (4.03) g/m(2)); all changes were corrected within 2 months by antithyroid drugs.Conclusions-The development of left ventricular hypertrophy in patients receiving thyroxine in the absence of significant changes in heart rate, blood pressure, and left ventricular systolic function is consistent with a direct trophic effect of thyroid hormone on the myocardium. The presence of left ventricular hypertrophy determines that further studies are essential to assess cardiovascular risk in patients taking thyroxine long term.