非缺血性扩张型心肌病伴严重左心室功能障碍患者促甲状腺激素处于正常范围与主要不良心血管事件风险
Thyroid-stimulating hormone within the normal range and risk of major adverse cardiovascular events in nonischemic dilated cardiomyopathy patients with severe left ventricular dysfunction.
作者信息
Li Xiaofei, Yao Yan, Chen Zhaoran, Fan Siyang, Hua Wei, Zhang Shu, Fan Xiaohan
机构信息
State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
出版信息
Clin Cardiol. 2019 Jan;42(1):120-128. doi: 10.1002/clc.23117. Epub 2018 Dec 20.
BACKGROUND
The association between thyroid-stimulating-hormone (TSH) and prognosis of nonischemic dilated cardiomyopathy (NIDCM) in patients with normal thyroid function remains unclear.
HYPOTHESIS
Our aim was to investigate the association between TSH and major adverse cardiovascular events in euthyroid NIDCM patients.
METHODS
The original cohort consisted of 216 consecutive euthyroid NIDCM patients, with left ventricular ejection fraction (LVEF) ≤35%, who were observed from 2010 to 2013. Patients with persistent ventricular arrhythmia (VA) histories, amiodarone taken for VA prevention, or on heart transplant list within 1 year were excluded. A follow-up evaluation was performed, and VA events, heart failure (HF) exacerbation/heart transplant, cardiac death, or death from any cause were separately evaluated.
RESULTS
A total of 184 patients were enrolled, and 97.8% (180/184) ultimately received follow-up evaluations. During the median 4.6-year follow-up, 24 VA events, 28 cardiac deaths, 30 all-cause deaths, 40 HF exacerbations, and 11 heart transplant events occurred. Serum TSH levels showed good predictive efficacies for VA events (area under the curve [AUC] = 0.702, 95% confidence interval [CI]: 0.629-0.767), and the risk of VA events increased, according to serum TSH quarters, as determined by Kaplan-Meier analysis (2.2% vs 13.4% vs 21.0% vs 30.0%, Q1-Q4, P = 0.011). Multivariable Cox analysis showed that patients at the Q4 level of serum TSH (>2.67 mIU/L) suffered an increased risk of VA events, compared with those at the Q1 level of TSH (hazard ratio [HR] = 15.88, 95% CI: 2.01-65.15) or those at the other three quarters (HR = 3.17, 95% CI: 1.38-7.26). However, the Q4 TSH level was not associated with other adverse cardiac events.
CONCLUSION
An association between TSH levels and the risk of VA events may exist in euthyroid NIDCM patients.
背景
甲状腺功能正常的患者中，促甲状腺激素（TSH）与非缺血性扩张型心肌病（NIDCM）预后之间的关联尚不清楚。
假设
我们的目的是研究甲状腺功能正常的NIDCM患者中TSH与主要不良心血管事件之间的关联。
方法
原始队列由2010年至2013年观察的216例连续的甲状腺功能正常的NIDCM患者组成，其左心室射血分数（LVEF）≤35%。排除有持续性室性心律失常（VA）病史、服用胺碘酮预防VA或在1年内列入心脏移植名单的患者。进行了随访评估，并分别评估了VA事件、心力衰竭（HF）加重/心脏移植、心源性死亡或任何原因导致的死亡。
结果
共纳入184例患者，97.8%（180/184）最终接受了随访评估。在中位4.6年的随访期间，发生了24例VA事件、28例心源性死亡、30例全因死亡、40例HF加重和11例心脏移植事件。血清TSH水平对VA事件显示出良好的预测效能（曲线下面积[AUC]=0.702，95%置信区间[CI]：0.629-0.767），根据Kaplan-Meier分析，VA事件的风险根据血清TSH四分位数增加（Q1-Q4分别为2.2%对13.4%对21.0%对30.0%，P=0.011）。多变量Cox分析显示，血清TSH处于Q4水平（>2.67 mIU/L）的患者与TSH处于Q1水平的患者相比，VA事件风险增加（风险比[HR]=15.88，95%CI：2.01-65.15），或与其他三个四分位数的患者相比（HR=3.17，95%CI：1.38-7.26）。然而，Q4 TSH水平与其他不良心脏事件无关。
结论
甲状腺功能正常的NIDCM患者中，TSH水平与VA事件风险之间可能存在关联。
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