Worku Berhane, Tortolani Anthony J, Gulkarov Iosif, Isom O Wayne, Klein Irwin
Department of Cardiothoracic Surgery, New York Methodist Hospital, Brooklyn, New York; Department of Cardiothoracic Surgery, New York Presbyterian Hospital/Weil Cornell Medical Center, New York City, New York.
J Card Surg. 2015 Apr;30(4):307-12. doi: 10.1111/jocs.12513. Epub 2015 Feb 2.
Although studies analyzing the effect of thyroid supplementation on postoperative morbidity and mortality from cardiac surgery have been inconclusive, they suggest a role in the prevention of postoperative atrial fibrillation. To further explore this relationship we conducted a retrospective study to determine whether abnormalities in routine preoperative thyroid function studies correlate with the incidence of postoperative atrial fibrillation.
From May 2004 until July 2011, 821 patients with complete thyroid function testing performed preoperatively underwent cardiac surgery. Preoperative, intraoperative, and postoperative laboratory, clinical and hemodynamic data including postoperative electrocardiogram monitoring were retrospectively evaluated.
Mean age was 65.7 years and 36% (294) of patients were female. Mean preoperative ejection fraction was 48.6% and 18% (100) had clinical heart failure. Ninety percent (682) of patients were euthyroid and 10% (77) were hypothyroid. Atrial fibrillation occurred significantly more frequently in hypothyroid patients (33.4% vs. 22.5%; p = .033). In multivariable analysis, increasing thyroid stimulating hormone (TSH) level (OR: 1.11; CI: 1.01 to 1.22; p = .030) was an independent predictor of postoperative atrial fibrillation. Beta blocker use within 24 hours prior to operation was protective (OR: .54; CI: .35 to .83; p = .005). Length of stay was significantly longer in patients with postoperative atrial fibrillation (9.1 vs. 6.5 days; p < .001).
In the current study, preoperative hypothyroidism was associated with postoperative atrial fibrillation. Further studies are warranted to delineate whether preoperative hypothyroidism is a useful biomarker for selecting patients most likely to benefit from preoperative thyroid supplementation in the prevention of postoperative atrial fibrillation.
尽管分析甲状腺补充剂对心脏手术后发病率和死亡率影响的研究尚无定论，但这些研究表明其在预防术后房颤方面具有一定作用。为进一步探究这种关系，我们进行了一项回顾性研究，以确定术前常规甲状腺功能检查异常是否与术后房颤的发生率相关。
2004年5月至2011年7月，821例术前进行了完整甲状腺功能检查的患者接受了心脏手术。对术前、术中和术后的实验室、临床和血流动力学数据，包括术后心电图监测进行了回顾性评估。
平均年龄为65.7岁，36%（294例）为女性。术前平均射血分数为48.6%，18%（100例）有临床心力衰竭。90%（682例）患者甲状腺功能正常，10%（77例）为甲状腺功能减退。甲状腺功能减退患者房颤的发生率显著更高（33.4%对22.5%；p = 0.033）。在多变量分析中，甲状腺刺激激素（TSH）水平升高（比值比：1.11；可信区间：1.01至1.22；p = 0.030）是术后房颤的独立预测因素。术前24小时内使用β受体阻滞剂具有保护作用（比值比：0.54；可信区间：0.35至0.83；p = 0.005）。术后房颤患者的住院时间显著更长（9.1天对6.5天；p < 0.001）。
在本研究中，术前甲状腺功能减退与术后房颤相关。有必要进一步研究以确定术前甲状腺功能减退是否是选择最有可能从术前甲状腺补充剂中受益以预防术后房颤的患者的有用生物标志物。
