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甲状腺与心血管疾病:关于甲状腺功能亢进对心力衰竭影响的重点综述

Thyroid and Cardiovascular Disease: A Focused Review on the Impact of Hyperthyroidism in Heart Failure.

作者信息

Khan Rafay, Sikanderkhel Saad, Gui Junhong, Adeniyi Abdul-Razaq, O'Dell Kimberly, Erickson Marc, Malpartida Juan, Mufti Zarmina, Khan Taiba, Mufti Harris, Al-Adwan Saif Aldeen, Alvarez Diana, Davis Joshua, Pendley Joseph, Patel Dharmendra

机构信息

Department of Cardiology, University of Tennessee at Chattanooga, 975 E 3rd Street, Chattanooga, TN 37403, USA.

Frontier Medical College, Karakoram Highway, Mansehra Rd, Abbottabad, Khyber Pakhtunkhwa, Pakistan.

出版信息

Cardiol Res. 2020 Apr;11(2):68-75. doi: 10.14740/cr1034. Epub 2020 Mar 10.

Abstract

The association between thyroid hormones and cardiovascular conditions has been well studied, specifically, the effects of hypothyroidism on cardiomyopathy, and hyperthyroidism with arrhythmias. Nonetheless, an explicit correlation between hyperthyroidism and cardiomyopathy has yet to be established. Medical databases MEDLINE and PubMed were accessed and queried as primary sources for data acquisition. Search criteria consisted of "hyperthyroidism", "heart failure", and "thyroid and cardiovascular system", which allowed the retrieval of relevant and recent works. From these sources, a consensus was developed and employed to yield an updated review of the etiology of heart failure in the setting of hyperthyroidism. It is rare for patients with hyperthyroidism to remain in a chronic hyperthyroid state, making it difficult to analyze subsequent long-term effects on the cardiovascular system. Related to heart failure, some studies have demonstrated no change in ejection fraction, while others have shown an acute change along with diastolic dysfunction, with or without an underlying rhythm abnormality. Further investigation is warranted to elucidate the mechanism driving such cardiac dysfunction, and whether it is due to vascular changes, tachyarrhythmias, or myocyte remodeling and fibrosis. The intent of this review article is to improve our understanding of how a hyperthyroid state affects cardiovascular function. An enhanced understanding of the effects on cardiovascular physiology will afford physicians the ability to provide more comprehensive care in consideration of both endocrine and cardiovascular pathologies.

摘要

甲状腺激素与心血管疾病之间的关联已得到充分研究,具体而言,甲状腺功能减退对心肌病的影响,以及甲状腺功能亢进与心律失常的关系。尽管如此,甲状腺功能亢进与心肌病之间的明确关联尚未确立。医学数据库MEDLINE和PubMed被用作主要的数据获取来源进行查询。搜索标准包括“甲状腺功能亢进”“心力衰竭”以及“甲状腺与心血管系统”,以便检索相关的近期研究成果。基于这些来源,形成了一种共识并用于对甲状腺功能亢进情况下心力衰竭的病因进行更新综述。甲状腺功能亢进患者很少会一直处于慢性甲状腺功能亢进状态,这使得分析其对心血管系统的后续长期影响变得困难。关于心力衰竭,一些研究表明射血分数没有变化,而另一些研究则显示伴有舒张功能障碍的急性变化,伴有或不伴有潜在的节律异常。有必要进一步研究以阐明导致这种心脏功能障碍的机制,以及它是否是由于血管变化、快速心律失常或心肌细胞重塑和纤维化所致。这篇综述文章的目的是增进我们对甲状腺功能亢进状态如何影响心血管功能的理解。对心血管生理影响的更深入理解将使医生能够在考虑内分泌和心血管疾病的情况下提供更全面的护理。

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