Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China.
Front Endocrinol (Lausanne). 2021 Mar 8;12:571765. doi: 10.3389/fendo.2021.571765. eCollection 2021.
This study aims to investigate the role of free triiodothyronine (fT3) in predicting poor prognosis of adult patients with acute myocarditis.
A total of 173 consecutive adult patients with acute myocarditis completed thyroid function evaluations. They were divided into two groups according to fT3 levels: low fT3 group (n = 54, fT3 < 3.54 pmol/liter) and normal fT3 group (n = 119, fT3 ≥ 3.54 pmol/liter). The primary endpoint was major adverse cardiac events (MACE).
During the 3.5 ± 2.8 years follow-up, the rate of MACE was 29.6% versus 3.5% in low fT3 group versus normal fT3 group, respectively ( < 0.0001). Long-term at 8 years MACE-free survival were lower in low fT3 group versus normal fT3 group (52.9% versus 92.3%, log-rank < 0.0001), respectively. Univariate Cox analysis showed that left ventricular ejection fraction (LVEF) < 50% [hazard ratio (HR) 10.231, 95% confidence interval (CI): 3.418-30.624, < 0.0001) and low fT3 level (HR 0.360, 95% CI: 0.223-0.582, < 0.0001) were strongest two predictors of MACE. After adjustment for traditional risk predictors, the prognostic value of fT3 status was still significant (HR 0.540, 95% CI: 0.316-0.922, = 0.024). Compared with normal fT3 group, those in low fT3 group were at a much higher risk of MACE (HR 5.074, 95% CI: 1.518-16.964, = 0.008).
Low T3 syndrome was a strong predictor of poor prognosis in adult patients with acute myocarditis. These findings suggest that fT3 level could serve as a biomarker for risk stratification in acute myocarditis patients.
本研究旨在探讨游离三碘甲状腺原氨酸（fT3）在预测成人急性心肌炎不良预后中的作用。
共纳入 173 例连续的成人急性心肌炎患者，进行甲状腺功能评估。根据 fT3 水平将患者分为两组：低 fT3 组（n=54，fT3<3.54pmol/L）和正常 fT3 组（n=119，fT3≥3.54pmol/L）。主要终点为主要不良心脏事件（MACE）。
在 3.5±2.8 年的随访期间，低 fT3 组的 MACE 发生率为 29.6%，正常 fT3 组为 3.5%（<0.0001）。长期（8 年）MACE 无事件生存率在低 fT3 组低于正常 fT3 组（52.9%比 92.3%，log-rank<0.0001）。单因素 Cox 分析显示，左心室射血分数（LVEF）<50%[风险比（HR）10.231，95%置信区间（CI）：3.418-30.624，<0.0001]和低 fT3 水平（HR 0.360，95%CI：0.223-0.582，<0.0001）是 MACE 的最强两个预测因素。在调整传统风险预测因素后，fT3 状态的预后价值仍然显著（HR 0.540，95%CI：0.316-0.922，=0.024）。与正常 fT3 组相比，低 fT3 组发生 MACE 的风险更高（HR 5.074，95%CI：1.518-16.964，=0.008）。
低 T3 综合征是成人急性心肌炎不良预后的强烈预测因素。这些发现表明 fT3 水平可作为急性心肌炎患者风险分层的生物标志物。
