短期左甲状腺素治疗对重度显性甲状腺功能减退症患者心肌损伤的影响：一项心脏 MRI 研究的证据。
Effects of short-term levothyroxine therapy on myocardial injuries in patients with severe overt hypothyroidism: Evidence from a cardiac MRI Study.
机构信息
Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, P.R. China.
Department of Radiology, China-Japan Friendship Hospital, Beijing, P.R. China.
出版信息
J Magn Reson Imaging. 2017 Sep;46(3):897-904. doi: 10.1002/jmri.25628. Epub 2017 Mar 21.
PURPOSE
To investigate using magnetic resonance imaging (MRI) myocardial injuries and cardiac function in patients with newly diagnosed severe primary overt hypothyroidism (HT) before and after achieving euthyroidism by short-term levothyroxine treatment. Levothyroxine treatment improves cardiovascular performance and ventricular remodeling in patients with HT, but diffuse myocardial injuries induced by HT are difficult to detect clinically.
MATERIALS AND METHODS
Myocardial longitudinal relaxation time (T ) mapping using the modified Look-Locker inversion-recovery (MOLLI) sequences at 3.0T was performed before and after euthyroidism was achieved by levothyroxine treatment in 24 patients with Hashimoto's thyroiditis, and compared to 17 healthy controls. Subjects underwent measurements of T values and left ventricular stroke volume (SV), ejection fraction (EF), cardiac index (CI), and peak filling rate (PFR). Cardiac data were expressed as an index, as per body surface area, except for heart rate and EF.
RESULTS
Patients with untreated HT exhibited significantly longer native myocardial T values (all P < 0.05) accompanied by reduced SV (30.7 ± 5.6 vs. 34.9 ± 6.8 mL/m , P < 0.05), CI (2.1 ± 0.4 vs. 2.4 ± 0.4 L/min/m , P < 0.05), and PFR (3.5 ± 0.9 vs. 4.2 ± 1.1 EDV/s, P < 0.05) compared to healthy controls at baseline. Achieving euthyroidism resulted in a significant decrease in T values and improved SV, CI, and PFR values (all P < 0.05) in the patients with HT. Negative correlations of the T values with free triiodothyronine (r = -0.55, P < 0.001) and PFR (r = -0.46, P = 0.0016) were observed.
CONCLUSION
We suggest that the negative effect induced by severe overt HT on the cardiovascular system can be significantly improved by restoring euthyroidism with short-term levothyroxine therapy.
LEVEL OF EVIDENCE
1 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:897-904.
目的
应用磁共振心肌 T 弛豫时间（T ） mapping 技术探讨新诊断的严重原发性显性甲状腺功能减退症（HT）患者在短期左甲状腺素治疗实现甲状腺功能正常后心肌损伤和心功能的变化。左甲状腺素治疗可改善 HT 患者的心血管功能和心室重构，但 HT 引起的弥漫性心肌损伤在临床上很难检测到。
材料与方法
在 24 例桥本甲状腺炎患者中，应用 3.0T 磁共振 Look-Locker 反转恢复（MOLLI）序列进行心肌纵向弛豫时间（T ） mapping 检查，在左甲状腺素治疗实现甲状腺功能正常前后与 17 例健康对照者进行比较。所有受试者均测量 T 值、左心室每搏量（SV）、射血分数（EF）、心指数（CI）和峰值充盈率（PFR）。除心率和 EF 外，心功能数据均按体表面积表示为指数。
结果
未经治疗的 HT 患者的心肌 T 值明显延长（均 P ＜ 0.05），SV（30.7 ± 5.6 比 34.9 ± 6.8 mL/m ，P ＜ 0.05）、CI（2.1 ± 0.4 比 2.4 ± 0.4 L/min/m ，P ＜ 0.05）和 PFR（3.5 ± 0.9 比 4.2 ± 1.1 EDV/s，P ＜ 0.05）均显著降低，与健康对照组相比。HT 患者甲状腺功能正常后 T 值明显降低，SV、CI 和 PFR 值明显升高（均 P ＜ 0.05）。T 值与游离三碘甲状腺原氨酸（r ＝ -0.55，P ＜ 0.001）和 PFR（r ＝ -0.46，P ＝ 0.0016）呈负相关。
结论
我们认为，通过短期左甲状腺素治疗恢复甲状腺功能正常，可显著改善严重显性 HT 对心血管系统的不良影响。
证据水平
1 技术效果：阶段 2 J. MAGN. RESON. IMAGING 2017；46：897-904.
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