Tadic Marijana, Celic Vera, Cuspidi Cesare, Ilic Sanja, Zivanovic Vladimir, Marjanovic Tamara
Departments of Cardiology (M.T., V.C., V.Z., T.M.) and Endocrinology (S.I.), University Clinical Hospital Center Dr Dragisa Misovic-Dedinje, Belgrade, Serbia; School of Medicine, University of Belgrade, Serbia (M.T., V.C., V.Z.); and Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy (C.C.).
J Ultrasound Med. 2016 Feb;35(2):287-95. doi: 10.7863/ultra.15.03054. Epub 2015 Dec 29.
Right heart function and mechanics have not been investigated in patients with subclinical hyperthyroidism. Our aim was to investigate right ventricular (RV) and right atrial (RA) function and deformation as evaluated by 3-dimensional echocardiography (3DE) and speckle-tracking 2-dimensional echocardiography (2DE) in these individuals.
We included 39 untreated women with endogenous subclinical hyperthyroidism and 39 healthy women matched by age. All participants underwent laboratory analyses that included thyroid hormone levels and comprehensive 2DE and 3DE examinations.
Three-dimensional echocardiographic RV volumes were significantly elevated in the patients with subclinical hyperthyroidism (P < .05), whereas the 3DE RV ejection fraction was reduced in this group, but with borderline significance. Two-dimensional echocardiographic longitudinal RV and RA strain were significantly reduced in the patients with subclinical hyperthyroidism. Two-dimensional echocardiographic RV systolic and early diastolic strain rates were reduced, whereas late diastolic strain rates were increased in the patients with subclinical hyperthyroidism. The same changes were detected in RA mechanics among the patients with subclinical hyperthyroidism. The thyrotropin (TSH) level correlated with the left ventricular mass index, transmitral early diastolic peak flow velocity (E)/late diastolic flow velocity (A) ratio, tricuspid E/A ratio, 2DE RV global strain, 2DE RA, strain, and 3DE RV end-diastolic volume. A multivariate regression analysis showed that the mitral E/A ratio, 2DE RV global strain, and 3DE RV end-diastolic volume were independently associated with the TSH level.
Right ventricular and RA function as evaluated by 3DE and speckle-tracking 2DE is significantly impaired in patients with subclinical hyperthyroidism. The TSH level correlated with parameters for RV function and mechanics in the whole study population.
亚临床甲状腺功能亢进患者的右心功能和力学尚未得到研究。我们的目的是通过三维超声心动图（3DE）和斑点追踪二维超声心动图（2DE）评估这些个体的右心室（RV）和右心房（RA）功能及变形情况。
我们纳入了39名未经治疗的内源性亚临床甲状腺功能亢进女性和39名年龄匹配的健康女性。所有参与者均接受了实验室分析，包括甲状腺激素水平检测以及全面的2DE和3DE检查。
亚临床甲状腺功能亢进患者的三维超声心动图RV容积显著升高（P <.05），而该组的3DE RV射血分数降低，但具有临界显著性。亚临床甲状腺功能亢进患者的二维超声心动图RV和RA纵向应变显著降低。亚临床甲状腺功能亢进患者的二维超声心动图RV收缩期和舒张早期应变率降低，而舒张晚期应变率升高。亚临床甲状腺功能亢进患者的RA力学也出现了相同变化。促甲状腺激素（TSH）水平与左心室质量指数、二尖瓣舒张早期峰值流速（E）/舒张晚期流速（A）比值、三尖瓣E/A比值、2DE RV整体应变、2DE RA应变以及3DE RV舒张末期容积相关。多变量回归分析显示，二尖瓣E/A比值、2DE RV整体应变和3DE RV舒张末期容积与TSH水平独立相关。
通过3DE和斑点追踪2DE评估，亚临床甲状腺功能亢进患者的右心室和RA功能显著受损。在整个研究人群中，TSH水平与RV功能和力学参数相关。
