Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China.
Front Endocrinol (Lausanne). 2021 Jan 8;11:605712. doi: 10.3389/fendo.2020.605712. eCollection 2020.
Left ventricular (LV) diastolic dysfunction has been demonstrated to be an independent predictor of the future heart failure. Heart failure is one of the severe complications caused by overt hyperthyroidism. However, the effects of overt hyperthyroidism on diastolic dysfunction are conflicting, and little is known about the prevalence and risk factors of the diastolic dysfunction in patients with overt hyperthyroidism.
A total of 388 patients with overt hyperthyroidism were included and compared with 388 age- and gender- matched euthyroid control subjects. LV diastolic function was evaluated by traditional and tissue-Doppler echocardiography. Routine clinical medical data and echocardiographic parameters were recorded for analysis.
The prevalence of LV diastolic dysfunction was 35.1% among hyperthyroid patients and significantly higher than control subjects whose prevalence was 25.5% ( = 0.003), and it increased with age and body mass index (BMI) in patients with overt hyperthyroidism. The possible risk factors for LV diastolic dysfunction, such as hypertension, diabetes, decreased estimated glomerular filtration rate (eGFR), and increased level of thyroid hormones weren't associated with LV diastolic dysfunction. However, overweight or obese were significantly associated with LV diastolic dysfunction (OR = 3.024, 95% CI = 1.517-6.027, = 0.002) compared with normal BMI. When compared with age <40 years old group, 40-50 years old group, 50-60 years old group and age ≥60 years old group were significantly associated with LV diastolic dysfunction, with ORs of 2.976 (95% CI = 1.744-5.019), 12.424 (95% CI = 4.934-31.283), 24.966 (95% CI = 5.975-104.321), respectively.
LV diastolic dysfunction was very common, in particular, in older and overweight or obese patients with overt hyperthyroidism. Additionally, age and BMI were independent risk factors for LV diastolic dysfunction, while the level of thyroid hormones was not. Therefore, besides the LV systolic function, we also need focus on the diastolic function in patients with overt hyperthyroidism in clinical work, especially the older and overweight or obese patients.
左心室（LV）舒张功能障碍已被证明是心力衰竭未来的独立预测因素。心力衰竭是甲状腺功能亢进症引起的严重并发症之一。然而，显性甲状腺功能亢进症对舒张功能障碍的影响存在争议，关于显性甲状腺功能亢进症患者舒张功能障碍的患病率和危险因素知之甚少。
共纳入 388 例显性甲状腺功能亢进症患者，并与 388 例年龄和性别匹配的甲状腺功能正常对照者进行比较。采用传统和组织多普勒超声心动图评估 LV 舒张功能。记录常规临床医疗数据和超声心动图参数进行分析。
甲状腺功能亢进症患者中 LV 舒张功能障碍的患病率为 35.1%，明显高于甲状腺功能正常对照组（25.5%）（ = 0.003），且随着年龄和体重指数（BMI）的增加而增加。高血压、糖尿病、估算肾小球滤过率（eGFR）降低和甲状腺激素水平升高等 LV 舒张功能障碍的可能危险因素与 LV 舒张功能障碍无关。然而，超重或肥胖与 LV 舒张功能障碍显著相关（OR = 3.024，95%CI = 1.517-6.027， = 0.002），与正常 BMI 相比。与年龄<40 岁组相比，40-50 岁组、50-60 岁组和年龄≥60 岁组与 LV 舒张功能障碍显著相关，OR 值分别为 2.976（95%CI = 1.744-5.019）、12.424（95%CI = 4.934-31.283）、24.966（95%CI = 5.975-104.321）。
LV 舒张功能障碍非常常见，尤其是在显性甲状腺功能亢进症的老年和超重或肥胖患者中。此外，年龄和 BMI 是 LV 舒张功能障碍的独立危险因素，而甲状腺激素水平不是。因此，除了 LV 收缩功能外，我们在临床工作中还需要关注显性甲状腺功能亢进症患者的舒张功能，特别是老年和超重或肥胖患者。
