The effect of thyroid function on clinical outcome in patients with heart failure
The effect of thyroid function on clinical outcome in patients with heart failure
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DOI：
10.1002/ejhf.42
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发表时间：
2014-02-01
影响因子：
18.2
通讯作者：
Gotsman, Israel
中科院分区：
文献类型：
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作者：
Chen, Shmuel;Shauer, Ayelet;Gotsman, Israel
众所周知，甲状腺功能障碍会影响心脏功能，并且是发生心力衰竭 (HF) 的危险因素。关于仅用促甲状腺激素 (TSH) 水平作为心力衰竭患者预后预测指标的临床意义的数据很少。我们在一大群慢性心力衰竭患者中评估了 TSH 对临床结果的重要性。 方法和结果 对在健康维护组织诊断为心力衰竭的患者 (n=5599) 进行随访，了解与心脏相关的住院治疗和死亡情况。中位 TSH 水平为 2.2 mU/L（四分位距 1.4-3.5）。我们根据 TSH 水平将患者分为四分位数。中位随访时间为 434 天，总体死亡率为 13.2%。高和低 TSH 水平都与死亡率增加相关。调整其他显着预测因子后的 Cox 回归分析表明，与死亡率最低的患者相比，最高 TSH 四分位数与死亡率增加相关 [第二个四分位数：TSH 1.4-2.2 mIU/L，风险比 (HR) 1.36，95% 置信区间 (CI) 1.08-1.71，P = 0.01]。 TSH 也是死亡和心脏相关住院治疗的独立预测因子。对未接受左旋甲状腺素治疗的患者 (78%) 的分析表明，TSH 是死亡率的更强预测因子（HR 1.54，95% CI 1.17-2.03，P = 0.002）。基于公认的 TSH 临床临界值的进一步分析表明，TSH 水平升高至高于正常水平与死亡率和心脏相关住院治疗的增加独立相关。结论 TSH 水平升高与心力衰竭患者较差的临床结果相关。甲状腺失衡会带来心力衰竭的重大风险，值得关注。
Aims Thyroid dysfunction is known to effect cardiac function and is a risk factor for developing heart failure (HF). Data regarding the clinical significance of thyroid-stimulating hormone (TSH) levels alone as a predictor of outcome in patients with HF is sparse. We evaluated the significance of TSH on clinical outcome in a large cohort of patients with chronic HF.Methods and results Patients with a diagnosis of HF at a Health Maintenance Organization (n=5599) were followed for cardiac-related hospitalizations and death. Median TSH levels were 2.2 mlU/L (interquartile range 1.4-3.5). We divided patients into quartiles based on TSH levels. Median follow-up time was 434 days and the overall mortality rate was 13.2%. Both a high and a low TSH level was associated with an increased mortality rate. Cox regression analysis after adjustment for other significant predictors demonstrated that the highest TSH quartile was associated with increased mortality compared with those with the lowest mortality [second quartile: TSH 1.4-2.2 mIU/L, hazard ratio (HR) 1.36, 95% confidence interval (CI) 1.08-1.71, P = 0.01]. TSH was also an independent predictor of death and cardiac-related hospitalization. Analysis of patients not on levothyroxine treatment (78%) demonstrated that TSH was an even stronger predictor of mortality (HR 1.54, 95% CI 1.17-2.03, P = 0.002). Additional analysis based on accepted clinical cut-offs of TSH demonstrated that increasing TSH levels above normal were independently associated with increased mortality and cardiac-related hospitalizations.Conclusions Increased TSH levels are associated with worse clinical outcome in patients with HF. Thyroid imbalance confers significant risk in HF and warrants attention.