Pulmonary and systemic hemodynamics in patients with hyperthyroidism.
Grave's disease
Pulmonary hypertension
blood pressure amplification
central blood pressure
hemodynamics in hyperthyroidism
hyperthyroidism
Journal
The American journal of medicine
ISSN: 1555-7162
Titre abrégé: Am J Med
Pays: United States
ID NLM: 0267200
Informations de publication
Date de publication:
15 Dec 2023
15 Dec 2023
Historique:
received:
04
11
2023
revised:
28
11
2023
accepted:
29
11
2023
medline:
18
12
2023
pubmed:
18
12
2023
entrez:
17
12
2023
Statut:
aheadofprint
Résumé
There is an association between hyperthyroidism and pulmonary hypertension. However, the prevalence of pulmonary hypertension in hyperthyroidism and the underlying mechanisms are incompletely defined. Consecutive patients with severe hyperthyroidism, mostly due to Grave's disease, were included in this single-center study. Echocardiographic assessment of pulmonary hemodynamics was performed at of the time hyperthyroidism diagnosis (baseline) and after normalization of thyroid hormones (follow-up; median 11 months). In a subset of patients, right heart catheterization and non-invasive assessment of central hemodynamics was performed. Among all 99 patients, 31% had PH at baseline. The estimated systolic pulmonary artery pressure correlated significantly with the estimated left ventricular filling pressure (E/e'). The invasively measured systolic pulmonary artery pressure correlated well with the estimated systolic pulmonary artery pressure. Cardiac output, E/e', left and right ventricular dimensions were significantly reduced from baseline to follow-up, whereas the estimated pulmonary vascular resistance did not differ. Diastolic blood pressure was significantly higher at follow up with no change in systolic blood pressure. The central systolic blood pressure, however, exhibited a trend for a reduction at follow up, whilst the pulse wave velocity was significantly lower at follow-up. Approximately one third of patients with hyperthyroidism have evidence of pulmonary hypertension. Our data suggest that an increased cardiac output and left ventricular filling pressure are the main mechanisms underlying the elevated systolic pulmonary artery pressure in hyperthyroidism, whereas there is no evidence of significant pulmonary vascular disease.
Sections du résumé
BACKGROUND AND AIMS
OBJECTIVE
There is an association between hyperthyroidism and pulmonary hypertension. However, the prevalence of pulmonary hypertension in hyperthyroidism and the underlying mechanisms are incompletely defined.
METHODS
METHODS
Consecutive patients with severe hyperthyroidism, mostly due to Grave's disease, were included in this single-center study. Echocardiographic assessment of pulmonary hemodynamics was performed at of the time hyperthyroidism diagnosis (baseline) and after normalization of thyroid hormones (follow-up; median 11 months). In a subset of patients, right heart catheterization and non-invasive assessment of central hemodynamics was performed.
RESULTS
RESULTS
Among all 99 patients, 31% had PH at baseline. The estimated systolic pulmonary artery pressure correlated significantly with the estimated left ventricular filling pressure (E/e'). The invasively measured systolic pulmonary artery pressure correlated well with the estimated systolic pulmonary artery pressure. Cardiac output, E/e', left and right ventricular dimensions were significantly reduced from baseline to follow-up, whereas the estimated pulmonary vascular resistance did not differ. Diastolic blood pressure was significantly higher at follow up with no change in systolic blood pressure. The central systolic blood pressure, however, exhibited a trend for a reduction at follow up, whilst the pulse wave velocity was significantly lower at follow-up.
CONCLUSIONS
CONCLUSIONS
Approximately one third of patients with hyperthyroidism have evidence of pulmonary hypertension. Our data suggest that an increased cardiac output and left ventricular filling pressure are the main mechanisms underlying the elevated systolic pulmonary artery pressure in hyperthyroidism, whereas there is no evidence of significant pulmonary vascular disease.
Identifiants
pubmed: 38104644
pii: S0002-9343(23)00760-X
doi: 10.1016/j.amjmed.2023.11.023
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023. Published by Elsevier Inc.
Déclaration de conflit d'intérêts
Declaration of Competing Interest None