Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Front Endocrinol (Lausanne). 2020 Sep 24;11:554762. doi: 10.3389/fendo.2020.554762. eCollection 2020.
Hypothyroidism is known to be correlated with multiple heart diseases. However, the influence of hypothyroidism on the patients with heart valve disease (HVD) is still unclear. The purpose of our study was to investigate the impact of hypothyroidism on echocardiographic characteristics of patients with heart valve disease. We conducted a retrospective cohort study which included 2,128 patients with HVD, and they were divided into euthyroid, subclinical hypothyroidism (SCHypoT), and overt hypothyroidism (OHypoT) group. Echocardiographic characteristics before and after valve surgery between groups were compared by using propensity score (PS) analysis. Kaplan-Meier analysis was used to compare the percent of recovery of left atrial (LA) enlargement between groups. Overall, 463 patients had hypothyroidism (404 SCHypoT patients and 59 OHypoT patients), and 1,665 patients were euthyroid. At baseline, hypothyroidism was associated with significantly higher left atrial diameter (LAD), interventricular septum thickness, left ventricular posterior wall thickness, pulmonary artery systolic pressure, and lower left ventricular ejection fraction. After valve surgery, only LAD remained significantly higher in the patients with hypothyroidism. Additionally, patients with hypothyroidism had a significantly lower recovery rate of LA enlargement after valve surgery compared with euthyroid patients. Hypothyroidism was associated with a larger LAD in patients with HVD before and after surgery, which may suggest that hypothyroidism is a risk factor of LA enlargement of HVD. Besides, hypothyroidism was associated with a significantly lower recovery rate of LA enlargement after valve surgery.
甲状腺功能减退症与多种心脏病相关。然而，甲状腺功能减退症对心脏瓣膜病（HVD）患者的影响仍不清楚。本研究旨在探讨甲状腺功能减退症对心脏瓣膜病患者超声心动图特征的影响。
我们进行了一项回顾性队列研究，纳入了 2128 例 HVD 患者，将其分为甲状腺功能正常、亚临床甲状腺功能减退症（SCHypoT）和显性甲状腺功能减退症（OHypoT）组。采用倾向评分（PS）分析比较各组瓣膜手术后的超声心动图特征。采用 Kaplan-Meier 分析比较各组左心房（LA）扩大恢复比例。
总体而言，463 例患者患有甲状腺功能减退症（404 例 SCHypoT 患者和 59 例 OHypoT 患者），1665 例患者甲状腺功能正常。基线时，甲状腺功能减退症与左心房直径（LAD）、室间隔厚度、左心室后壁厚度、肺动脉收缩压明显升高，左心室射血分数明显降低相关。瓣膜手术后，只有 LAD 在甲状腺功能减退症患者中仍显著升高。此外，与甲状腺功能正常的患者相比，甲状腺功能减退症患者瓣膜手术后 LA 扩大的恢复率明显较低。
甲状腺功能减退症与 HVD 患者术前和术后的 LAD 增大有关，这可能提示甲状腺功能减退症是 HVD 左心房增大的危险因素。此外，甲状腺功能减退症与瓣膜手术后 LA 扩大的恢复率明显较低有关。
