BronxCare Hospital Center, Division of Cardiology, Bronx, NY, USA.
BronxCare Hospital Center, Division of Cardiology, 1650 Grand Concourse, 12th Floor, Bronx, NY 10457, USA.
Ther Adv Cardiovasc Dis. 2020 Jan-Dec;14:1753944720977742. doi: 10.1177/1753944720977742.
Thyroid hormone (TH) has an essential role on the functional capability of cardiac muscle with its gene modulation and induction of vasodilatory effects. There is considerable evidence to suggest the role of TH in patients with acute coronary syndrome, but less is known about its prognostic role in heart failure (HF) patients. We aim to evaluate the association between subclinical hypothyroid state (SCHS) and event rates including 30-day all-cause and HF readmission in patients with an index hospitalization for acute HF syndrome (AHFS).
A retrospective chart review analysis of 2335 patients admitted with the diagnosis of AHFS between 1 January 2007 and 31 December 2017 was conducted. SCHS was defined as thyroid-stimulating hormone (TSH) level >4.50 mIU/L with a normal thyroxine (T) level. Patients with pre-existing thyroid disease or receiving thyroid replacement therapy were excluded. HF with preserved ejection fraction (HFpEF) was defined as left ventricular ejection fraction (LVEF) >40% and HF with reduced ejection fraction (HFrEF) was defined as having LVEF ⩽40%. Percentage of 30-day, 3-month and 6-month all-cause readmission and mortality rates were calculated in both cohorts of AHFS (HFpEF and HFrEF) with and without SCHS.
The mean age of the 2335 AHFS population was 65 (±14.8) years. Of the 2335 patients admitted with AHFS, 1228 (52.6%) patients were found to have HFrEF and 1107 (47.4%) with HFpEF. There were 170 (7.3%) patients with AHFS found to have SCHS. There were more males than females (54% 46%). The percentage of hospital readmission within 30 days was higher for patients with SCHS compared with those without SCHS in the HFrEF group (42% 30%, = 0.001). Hospital readmission within 30 days for patients with SCHS compared with those without SCHS in the HFpEF group did not differ (36.5% 31%, = 0.47). Additionally, all-cause mortality was higher among patients with SCHS compared with patients without SCHS in the HFrEF group (18.7% 7.0%, < 0.001). All-cause mortality was found similar in both arms of the HFpEF group (9.5% 7.7%, = 0.73).
During an index hospital admission for AHFS, SCHS was an independent predictor of readmission in 30 days in patients with HFrEF but not in patients with HFpEF. Additionally, it was related to adverse outcome such as all-cause mortality in HFrEF patients but not in HFpEF patients. Further studies regarding the concept of tissue thyroid and the potential for a therapeutic target are warranted.
甲状腺激素 (TH) 在心脏肌肉的功能能力方面具有重要作用，其具有基因调节和诱导血管舒张作用。有相当多的证据表明 TH 在急性冠状动脉综合征患者中的作用，但关于其在心力衰竭 (HF) 患者中的预后作用知之甚少。我们旨在评估亚临床甲状腺功能减退状态 (SCHS) 与事件发生率之间的关联，包括 30 天内全因和 HF 再入院，患者因急性 HF 综合征 (AHFS) 入院。
对 2007 年 1 月 1 日至 2017 年 12 月 31 日期间因 AHFS 入院的 2335 名患者进行了回顾性图表分析。SCHS 定义为促甲状腺激素 (TSH) 水平>4.50 mIU/L 且甲状腺素 (T) 水平正常。排除患有甲状腺疾病或正在接受甲状腺替代治疗的患者。射血分数保留的 HF (HFpEF) 定义为左心室射血分数 (LVEF)>40%，射血分数降低的 HF (HFrEF) 定义为 LVEF≤40%。计算 AHFS（HFpEF 和 HFrEF）两个队列中存在和不存在 SCHS 的患者的 30 天、3 个月和 6 个月全因再入院和死亡率的百分比。
2335 名 AHFS 人群的平均年龄为 65(±14.8)岁。在因 AHFS 入院的 2335 名患者中，1228 名（52.6%）患者被诊断为 HFrEF，1107 名（47.4%）患者为 HFpEF。有 170 名（7.3%）AHFS 患者被发现患有 SCHS。男性多于女性（54% 46%）。与无 SCHS 的 HFrEF 患者相比，SCHS 患者在 30 天内的住院再入院率更高（42% 30%，=0.001）。与无 SCHS 的 HFpEF 患者相比，SCHS 患者在 30 天内的住院再入院率没有差异（36.5% 31%，=0.47）。此外，与无 SCHS 的患者相比，SCHS 患者的全因死亡率更高HFrEF 组（18.7% 7.0%，<0.001）。HFpEF 组两个臂的全因死亡率相似（9.5% 7.7%，=0.73）。
在因 AHFS 入院期间，SCHS 是 HFrEF 患者 30 天内再入院的独立预测因素，但不是 HFpEF 患者的独立预测因素。此外，它与 HFrEF 患者的全因死亡率等不良结局相关，但与 HFpEF 患者无关。需要进一步研究组织甲状腺的概念和潜在的治疗靶点。
