Iodine-Induced Hyperthyroidism and Long-term Risks of Incident Atrial Fibrillation and Flutter.
Iodine-Induced Hyperthyroidism and Long-term Risks of Incident Atrial Fibrillation and Flutter.
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DOI：
10.1210/clinem/dgad250
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发表时间：
2023-09-18
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--
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尽管碘致甲亢是碘化放射造影剂治疗的一个潜在后果，但其与长期心血管结局的关系以前还没有被研究过。目的探讨碘造影术后甲亢与心房颤动/扑动的关系。美国退伍军人健康管理局(≥)1998年至2021年对年龄18岁、基础血清促甲状腺激素浓度正常、随后1年的促甲状腺激素水平、以及在随后的促甲状腺激素治疗前60天接受碘造影剂的患者进行了回顾性队列研究。用COX比例风险回归分析碘甲亢与正常甲亢发生房颤/扑动的调整危险比(HR)，其95%可信区间为95%。在44 607名退伍军人中，2500名(5.6%)出现了碘引起的甲亢(平均年龄60.9±14.1岁；男性占88%)，房颤/扑动发生率为10.4%，平均随访时间为3.7年(四分位间隔1.9-7.4)。经社会人口学和心血管危险因素调整后，与碘暴露后甲状腺功能正常的患者相比，碘诱导的甲亢患者发生房颤/扑动的风险增加(调整后的HR为1.19，95%可信区间为1.06-1.33)。女性发生房颤/扑动的风险高于男性(女性，HR 1.81，95%CI 1.12~2.92；男性，HR 1.15，95%CI 1.03~1.30；交互作用P=0.04)。高碘负荷后的甲亢与发生房颤/扑动的风险增加有关，尤其是在女性中。观察到的性别差异应在性别更多样化的研究样本中得到证实，并应评估对碘诱导的甲亢后心律失常进行长期监测的成本效益分析。
Although iodine-induced hyperthyroidism is a potential consequence of iodinated radiologic contrast administration, its association with long-term cardiovascular outcomes has not been previously studied. To investigate the relationships between hyperthyroidism observed after iodine contrast administration and incident atrial fibrillation/flutter. Retrospective cohort study of the U.S. Veterans Health Administration (1998-2021) of patients age ≥18 years with a normal baseline serum thyrotropin (TSH) concentration, subsequent TSH <1 year, and receipt of iodine contrast <60 days before the subsequent TSH. Cox proportional hazards regression was employed to ascertain the adjusted hazard ratio (HR) with 95% CI of incident atrial fibrillation/flutter following iodine-induced hyperthyroidism, compared with iodine-induced euthyroidism. Iodine-induced hyperthyroidism was observed in 2500 (5.6%) of 44 607 Veterans (mean ± SD age, 60.9 ± 14.1 years; 88% men) and atrial fibrillation/flutter in 10.4% over a median follow-up of 3.7 years (interquartile range 1.9-7.4). Adjusted for sociodemographic and cardiovascular risk factors, iodine-induced hyperthyroidism was associated with an increased risk of atrial fibrillation/flutter compared with those who remained euthyroid after iodine exposure (adjusted HR 1.19, 95% CI 1.06-1.33). Females were at greater risk for incident atrial fibrillation/flutter than males (females, HR 1.81, 95% CI 1.12-2.92; males, HR 1.15, 95% CI 1.03-1.30; P for interaction = .04). Hyperthyroidism following a high iodine load was associated with an increased risk of incident atrial fibrillation/flutter, particularly among females. The observed sex-based differences should be confirmed in a more sex-diverse study sample, and the cost–benefit analysis of long-term monitoring for cardiac arrhythmias following iodine-induced hyperthyroidism should be evaluated.
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影响因子：
37.8
作者：
Baumgartner C;da Costa BR;Collet TH;Feller M;Floriani C;Bauer DC;Cappola AR;Heckbert SR;Ceresini G;Gussekloo J;den Elzen WPJ;Peeters RP;Luben R;Völzke H;Dörr M;Walsh JP;Bremner A;Iacoviello M;Macfarlane P;Heeringa J;Stott DJ;Westendorp RGJ;Khaw KT;Magnani JW;Aujesky D;Rodondi N;Thyroid Studies Collaboration
通讯作者：
Thyroid Studies Collaboration
影响因子：
5.2
作者：
Gencer B;Cappola AR;Rodondi N;Collet TH
通讯作者：
Collet TH
影响因子：
24
作者：
Ellervik, Christina;Roselli, Carolina;Chasman, Daniel, I
通讯作者：
Chasman, Daniel, I
影响因子：
20.1
作者：
Garcia M;Mulvagh SL;Merz CN;Buring JE;Manson JE
通讯作者：
Manson JE
影响因子：
40.5
作者：
Leung, Angela M.;Braverman, Lewis E.
通讯作者：
Braverman, Lewis E.