Subclinical hypothyroidism predicts outcome in heart failure: insights from the T.O.S.CA. registry.
Heart failure
Hormones
Mortality
Subclinical hypothyroidism
Journal
Internal and emergency medicine
ISSN: 1970-9366
Titre abrégé: Intern Emerg Med
Pays: Italy
ID NLM: 101263418
Informations de publication
Date de publication:
08 Jun 2024
08 Jun 2024
Historique:
received:
04
04
2024
accepted:
28
05
2024
medline:
8
6
2024
pubmed:
8
6
2024
entrez:
8
6
2024
Statut:
aheadofprint
Résumé
Subclinical hypothyroidism (SH), defined as increased serum thyroid-stimulating hormone (TSH) with normal free T4 (fT4) levels, is frequently observed in the general population. Prevalence ranges from 0.6% to 1.8% in the adult population, depending on age, sex, and iodine intake. Several studies reported a worse prognosis in patients with heart failure with reduced ejection fraction (HFrEF) and SH, but they considered heterogeneous populations suffering mainly from severe SH. Aim of this study was to evaluate if SH was independently associated with the occurrence of cardiovascular death considering 30 months of follow-up. 277 HFrEF patients enrolled in the prospective, multicenter, observational T.O.S.CA. (Terapia Ormonale Scompenso CArdiaco) registry, were included in this analysis. Patients were divided into two groups according to the presence of SH (serum TSH levels > 4.5 mIU/L with normal fT4 levels). Data regarding clinical status, echocardiography, and survival were analyzed. Twenty-three patients displayed SH (87% mild vs 13% severe), while 254 were euthyroid. No differences were found in terms of age, sex, HF etiology, and left ventricular ejection fraction. When compared with the euthyroid group, SH patients showed higher TSH levels (7.7 ± 4.1 vs 1.6 ± 0.9, p < 0.001), as expected, with comparable levels of fT4 (1.3 ± 0.3 vs 1.3 ± 0.3, p = NS). When corrected for established predictors of poor outcome in HF, the presence of SH resulted to be an independent predictor of cardiovascular mortality (HR: 2.96; 5-95% CI:1.13-7.74; p = 0.03). Since thyroid tests are widely available and inexpensive, they should be performed in HF patients to detect subclinical disorders, evaluate replacement therapy, and improve prognosis.
Identifiants
pubmed: 38850355
doi: 10.1007/s11739-024-03665-w
pii: 10.1007/s11739-024-03665-w
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) (2012) The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction: an individual patient data meta-analysis. Eur Heart J 33:1750–1757
doi: 10.1093/eurheartj/ehr254
Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP et al (2020) Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation 141:e139–e596
doi: 10.1161/CIR.0000000000000757
pubmed: 31992061
Bozkurt B, Aguilar D, Deswal A, Dunbar SB, Francis GS, Horwich T et al (2016) Contributory risk and management of comorbidities of hypertension, obesity, diabetes mellitus, hyperlipidemia, and metabolic syndrome in chronic heart failure: a scientific statement from the American Heart Association. Circulation 134:e535–e578
doi: 10.1161/CIR.0000000000000450
pubmed: 27799274
Cittadini A, Salzano A, Iacoviello M, Triggiani V, Rengo G, Cacciatore F et al (2021) Multiple hormonal and metabolic deficiency syndrome predicts outcome in heart failure: the T.O.S.CA. Registry. Eur J Prev Cardiol 28:1691–1700
doi: 10.1093/eurjpc/zwab020
pubmed: 33693736
Kannan L, Shaw PA, Morley MP, Brandimarto J, Fang JC, Sweitzer NK et al (2018) Thyroid dysfunction in heart failure and cardiovascular outcomes. Circ Heart Fail 11:e005266
doi: 10.1161/CIRCHEARTFAILURE.118.005266
pubmed: 30562095
pmcid: 6352308
Chen S, Shauer A, Zwas DR, Lotan C, Keren A, Gotsman I (2014) The effect of thyroid function on clinical outcome in patients with heart failure. Eur J Heart Fail 16:217–226
doi: 10.1002/ejhf.42
pubmed: 24464626
McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M et al (2023) 2023 Focused update of the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 44:3627–3639
doi: 10.1093/eurheartj/ehad195
pubmed: 37622666
Triggiani V, Cittadini A, Lisco G (2022) Effect of levothyroxine replacement therapy in patients with subclinical hypothyroidism and chronic heart failure: a systematic review. Front Endocrinol (Lausanne) 13:1013641
doi: 10.3389/fendo.2022.1013641
pubmed: 36457560
Iacoviello M, Guida P, Guastamacchia E, Triggiani V, Forleo C, Catanzaro R et al (2008) Prognostic role of sub-clinical hypothyroidism in chronic heart failure outpatients. Curr Pharm Des 14:2686–2692
doi: 10.2174/138161208786264142
pubmed: 19006851
Rodondi N, Newman AB, Vittinghoff E, de Rekeneire N, Satterfield S, Harris TB et al (2005) Subclinical hypothyroidism and the risk of heart failure, other cardiovascular events, and death. Arch Intern Med 165:2460–2466
doi: 10.1001/archinte.165.21.2460
pubmed: 16314541
Bossone E, Arcopinto M, Iacoviello M, Triggiani V, Cacciatore F, Maiello C et al (2018) Multiple hormonal and metabolic deficiency syndrome in chronic heart failure: rationale, design, and demographic characteristics of the T.O.S.CA. Registry. Intern Emerg Med 13:661–671
doi: 10.1007/s11739-018-1844-8
pubmed: 29619769
Pearce SH, Brabant G, Duntas LH, Monzani F, Peeters RP, Razvi S et al (2013) 2013 ETA guideline: management of subclinical hypothyroidism. Eur Thyroid J 2:215–228
doi: 10.1159/000356507
pubmed: 24783053
pmcid: 3923601
Arcopinto M, Salzano A, Giallauria F, Bossone E, Isgaard J, Marra AM et al (2017) Growth hormone deficiency is associated with worse cardiac function, physical performance, and outcome in chronic heart failure: insights from the T.O.S.CA. GHD study. PLoS ONE 12:e0170058
doi: 10.1371/journal.pone.0170058
pubmed: 28095492
pmcid: 5240983
Peeters RP (2017) Subclinical hypothyroidism. N Engl J Med 376:2556–2565
doi: 10.1056/NEJMcp1611144
pubmed: 28657873
Stott DJ, Rodondi N, Kearney PM, Ford I, Westendorp RGJ, Mooijaart SP et al (2017) Thyroid hormone therapy for older adults with subclinical hypothyroidism. N Engl J Med 376:2534–2544
doi: 10.1056/NEJMoa1603825
pubmed: 28402245
Frey A, Kroiss M, Berliner D, Seifert M, Allolio B, Güder G et al (2013) Prognostic impact of subclinical thyroid dysfunction in heart failure. Int J Cardiol 168:300–305
doi: 10.1016/j.ijcard.2012.09.064
pubmed: 23041000
Perez AC, Jhund PS, Stott DJ, Gullestad L, Cleland JG, van Veldhuisen DJ et al (2014) Thyroid-stimulating hormone and clinical outcomes: the CORONA trial (controlled rosuvastatin multinational study in heart failure). JACC Heart Fail 2:35–40
doi: 10.1016/j.jchf.2013.07.008
pubmed: 24622117
Wang W, Guan H, Gerdes AM, Iervasi G, Yang Y, Tang YD (2015) Thyroid status, cardiac function, and mortality in patients with idiopathic dilated cardiomyopathy. J Clin Endocrinol Metab 100:3210–3218
doi: 10.1210/jc.2014-4159
pubmed: 26052725
Hayashi T, Hasegawa T, Kanzaki H, Funada A, Amaki M, Takahama H et al (2016) Subclinical hypothyroidism is an independent predictor of adverse cardiovascular outcomes in patients with acute decompensated heart failure. ESC Heart Fail 3:168–176
doi: 10.1002/ehf2.12084
pubmed: 27818781
pmcid: 5071693
Sato Y, Yoshihisa A, Kimishima Y, Kiko T, Watanabe S, Kanno Y et al (2018) Subclinical hypothyroidism is associated with adverse prognosis in heart failure patients. Can J Cardiol 34:80–87
doi: 10.1016/j.cjca.2017.10.021
pubmed: 29275887
Ripoli A, Pingitore A, Favilli B, Bottoni A, Turchi S, Osman NF et al (2005) Does subclinical hypothyroidism affect cardiac pump performance? Evidence from a magnetic resonance imaging study. J Am Coll Cardiol 45:439–445
doi: 10.1016/j.jacc.2004.10.044
pubmed: 15680725
Di Bello V, Monzani F, Giorgi D, Bertini A, Caraccio N, Valenti G et al (2000) Ultrasonic myocardial textural analysis in subclinical hypothyroidism. J Am Soc Echocardiogr 13:832–840
doi: 10.1067/mje.2000.106397
pubmed: 10980086
Biondi B, Cappola AR, Cooper DS (2019) Subclinical hypothyroidism: a review. JAMA 322:153–160
doi: 10.1001/jama.2019.9052
pubmed: 31287527
Asoğlu E, Akbulut T, Doğan Z, Asoğlu R (2021) Evaluation of the aortic velocity propagation, epicardial fat thickness, and carotid intima-media thickness in patients with subclinical hypothyroidism. Rev Cardiovasc Med 22:959–966
doi: 10.31083/j.rcm2203104
pubmed: 34565096
Owen PJ, Sabit R, Lazarus JH (2007) Thyroid disease and vascular function. Thyroid 17:519–524
doi: 10.1089/thy.2007.0051
pubmed: 17614771
Berezin AE, Kremzer AA, Martovitskaya YV, Samura TA, Berezina TA (2016) Pattern of circulating endothelial-derived microparticles among chronic heart failure patients with dysmetabolic comorbidities: the impact of subclinical hypothyroidism. Diabetes Metab Syndr 10:29–36
doi: 10.1016/j.dsx.2015.08.001
pubmed: 26319410
Taddei S, Caraccio N, Virdis A, Dardano A, Versari D, Ghiadoni L et al (2006) Low-grade systemic inflammation causes endothelial dysfunction in patients with Hashimoto’s thyroiditis. J Clin Endocrinol Metab 91:5076–5082
doi: 10.1210/jc.2006-1075
pubmed: 16968790
Vayá A, Giménez C, Sarnago A, Alba A, Rubio O, Hernández-Mijares A et al (2014) Subclinical hypothyroidism and cardiovascular risk. Clin Hemorheol Microcirc 58:1–7
doi: 10.3233/CH-141871
pubmed: 25339098
Gupta G, Sharma P, Kumar P, Itagappa M (2015) Study on subclinical hypothyroidism and its association with various inflammatory markers. J Clin Diagn Res 9:BC04-6
pubmed: 26674140
Razvi S, Shakoor A, Vanderpump M, Weaver JU, Pearce SH (2008) The influence of age on the relationship between subclinical hypothyroidism and ischemic heart disease: a metaanalysis. J Clin Endocrinol Metab 93:2998–3007
doi: 10.1210/jc.2008-0167
pubmed: 18505765
Cai P, Peng Y, Chen Y, Wang Y, Wang X (2021) Blood pressure characteristics of subclinical hypothyroidism: an observation study combined with office blood pressure and 24-h ambulatory blood pressure. J Hypertens 39:453–460
doi: 10.1097/HJH.0000000000002655
pubmed: 32941202
Tsuda S, Nakayama M, Matsukuma Y, Yoshitomi R, Haruyama N, Fukui A et al (2021) Subclinical hypothyroidism is independently associated with poor renal outcomes in patients with chronic kidney disease. Endocrine 73:141–150
doi: 10.1007/s12020-021-02611-6
pubmed: 33474711
Meuwese CL, van Diepen M, Cappola AR, Sarnak MJ, Shlipak MG, Bauer DC et al (2019) Low thyroid function is not associated with an accelerated deterioration in renal function. Nephrol Dial Transplant 34:650–659
doi: 10.1093/ndt/gfy071
pubmed: 29684213
Rhee CM, Kim S, Gillen DL, Oztan T, Wang J, Mehrotra R et al (2015) Association of thyroid functional disease with mortality in a national cohort of incident hemodialysis patients. J Clin Endocrinol Metab 100:1386–1395
doi: 10.1210/jc.2014-4311
pubmed: 25632971
pmcid: 4399303
Feller M, Snel M, Moutzouri E, Bauer DC, de Montmollin M, Aujesky D et al (2018) Association of thyroid hormone therapy with quality of life and thyroid-related symptoms in patients with subclinical hypothyroidism: a systematic review and meta-analysis. JAMA 320:1349–1359
doi: 10.1001/jama.2018.13770
pubmed: 30285179
pmcid: 6233842
Khalife WI, Tang YD, Kuzman JA, Thomas TA, Anderson BE, Said S et al (2005) Treatment of subclinical hypothyroidism reverses ischemia and prevents myocyte loss and progressive LV dysfunction in hamsters with dilated cardiomyopathy. Am J Physiol Heart Circ Physiol 289:H2409–H2415
doi: 10.1152/ajpheart.00483.2005
pubmed: 16024568
Gerdes AM, Iervasi G (2010) Thyroid replacement therapy and heart failure. Circulation 122:385–393
doi: 10.1161/CIRCULATIONAHA.109.917922
pubmed: 20660814
Zhang M, Sara JD, Matsuzawa Y, Gharib H, Bell MR, Gulati R et al (2016) Clinical outcomes of patients with hypothyroidism undergoing percutaneous coronary intervention. Eur Heart J 37:2055–2065
doi: 10.1093/eurheartj/ehv737
pubmed: 26757789
pmcid: 4940453