Aroditis K, Pikilidou M, Vourvouri E, Hadjistavri L, Zebekakis P, Yovos J, Efthimiadis G, Karvounis H
1st Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece.
Hypertension Excellence Center, 1st Department of Internal Medicine, AHEPA University Hospital, 1 St. Kyriakidi street, 54636, Thessaloniki, Greece.
Int J Cardiovasc Imaging. 2017 Feb;33(2):187-195. doi: 10.1007/s10554-016-0984-z. Epub 2016 Sep 28.
Overproduction of thyroid hormones leads to structural as well as functional cardiac changes. Conventional echocardiography but also recently developed sophisticated two-dimensional echocardiography speckle (2D-STE) tracking allow elaborate evaluation of these changes. Our purpose was to investigate the effects of thyroid hormones overproduction on the heart in patients with Graves' disease and changes that occur after 6 months thyrostatic therapy. We conducted a prospective, case-control study of 6 months duration. Full echocardiographic assessment at diagnosis and after 6 months of thyrostatic therapy were performed in 44 patients with Graves' disease, aged 37.6 ± 9.1 years. Additionally, 43 euthyroid controls were studied for the same time period. Left ventricular end diastolic diameter (LVEDD) and left ventricular end systolic diameter (LVESD) were higher in the patient group while triscupid annular plane systolic excursion (TAPSE) was lower in the patient group. Moreover, left ventricular (LV) mass index and left atrium (LA) volume index were higher in the Graves' disease group. Diastolic impairment as assessed with conventional echocardiography including tissue Doppler was present in the patient group (E/A ratio 0.87 ± 0.10,). 2D-STE analysis, revealed an increase in the strain rate at the isovolumic relaxation time (SRIVRT, 0.310 ± 0.07 patients versus 0.298 ± 0.09 s controls). Improvement in diastolic and right systolic function as well as in left ventricular structural parameters was observed after restoration of euthyroidism (E/A ratio from 0.87 ± 0.10 versus 0.9 ± 0.08, p < 0.05). Patients with newly diagnosed Graves' showed an improvement in diastolic function, right systolic function and structural parameters after 6 months of thyrostatic treatment.
甲状腺激素分泌过多会导致心脏结构和功能的改变。传统超声心动图以及最近开发的先进二维超声心动图斑点追踪技术（2D-STE）都能对这些变化进行精细评估。我们的目的是研究甲状腺激素分泌过多对格雷夫斯病患者心脏的影响以及甲状腺静态治疗6个月后发生的变化。我们进行了一项为期6个月的前瞻性病例对照研究。对44例年龄为37.6±9.1岁的格雷夫斯病患者在诊断时和甲状腺静态治疗6个月后进行了全面的超声心动图评估。此外，在同一时期对43名甲状腺功能正常的对照者进行了研究。患者组的左心室舒张末期内径（LVEDD）和左心室收缩末期内径（LVESD）较高，而三尖瓣环平面收缩期位移（TAPSE）较低。此外，格雷夫斯病组的左心室（LV）质量指数和左心房（LA）容积指数较高。患者组存在传统超声心动图评估包括组织多普勒评估的舒张功能障碍（E/A比值为0.87±0.10）。2D-STE分析显示，等容舒张期应变率增加（SRIVRT，患者组为0.310±0.07，对照组为0.298±0.09/s）。甲状腺功能恢复正常后，观察到舒张功能、右心室收缩功能以及左心室结构参数有所改善（E/A比值从0.87±0.10变为0.9±0.08，p<0.05）。新诊断的格雷夫斯病患者在接受6个月的甲状腺静态治疗后，舒张功能、右心室收缩功能和结构参数有所改善。
