Department of Radiology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.
BMC Cardiovasc Disord. 2021 Jun 15;21(1):303. doi: 10.1186/s12872-021-02116-0.
Subclinical hypothyroidism (SCH) has recently been acknowledged as an independent risk factor for coronary artery disease (CAD). However, the characteristics of CAD in patients with SCH are not fully understood. This study aims to evaluate the features of CAD in patients with SCH using coronary computed tomographic angiography (CCTA).
From 1 April, 2018 to 30 June, 2020, 234 consecutive SCH patients with coronary plaques identified on CCTA were included retrospectively. They were further subdivided into different degree of SCH groups (mild SCH vs. moderate SCH vs. severe SCH: 143 vs 62 vs 28) and different gender groups (men with SCH vs. women with SCH:116 vs 118). The distributions and types of plaques, luminal narrowing, segment involvement scores (SIS) and segment stenosis scores (SSS) were evaluated and compared among the different groups.
Patients with severe SCH had fewer calcified plaques (0.7 ± 0.9 vs. 2.0 ± 1.9, p < 0.001) and more non-calcified plaques (0.9 ± 1.0 vs. 0.3 ± 0.5, p < 0.001) than those with mild SCH. As the SCH condition worsened, the proportion of non-calcified plaques significantly increased. Whereas there were no significant discrepancies in SIS and SSS among patients with different grades of SCH (all p > 0.05). Men with SCH had higher SIS (3.9 ± 2.3 vs. 3.0 ± 2.3, p = 0.004) and SSS (7.8 ± 5.4 vs. 5.4 ± 3.0, p = 0.002) than women. Multivariate logistic and linear regression analysis demonstrated that grades of SCH (Moderate SCH, odds ratio [OR] 2.11; 95% CI 1.03-4.34, p = 0.042; severe SCH, OR: 10.00; 95% CI 3.82-26.20, p < 0.001, taken mild SCH as a reference) was independently associated with the presence of non-calcified plaques, whereas sex (B: 1.67; 95% CI 0.27-3.10, p = 0.009) was independently associated with SSS.
Severe SCH is associated with non-calcified plaques, and men with SCH have higher total plaque burden than women. We suggest that it is important to evaluate for coronary plaque in SCH patients, especially those with severe SCH and men with SCH.
亚临床甲状腺功能减退症（SCH）最近被认为是冠心病（CAD）的独立危险因素。然而，SCH 患者 CAD 的特征尚不完全清楚。本研究旨在使用冠状动脉计算机断层扫描血管造影（CCTA）评估 SCH 患者 CAD 的特征。
2018 年 4 月 1 日至 2020 年 6 月 30 日，回顾性纳入 234 例 CCTA 显示冠状动脉斑块的连续 SCH 患者。他们进一步分为不同程度的 SCH 组（轻度 SCH 组 vs. 中度 SCH 组 vs. 重度 SCH 组：143 例 vs. 62 例 vs. 28 例）和不同性别组（SCH 男性组 vs. SCH 女性组：116 例 vs. 118 例）。评估并比较了不同组之间斑块的分布和类型、管腔狭窄、节段受累评分（SIS）和节段狭窄评分（SSS）。
重度 SCH 患者钙化斑块较少（0.7±0.9 比 2.0±1.9，p<0.001），非钙化斑块较多（0.9±1.0 比 0.3±0.5，p<0.001）。随着 SCH 病情恶化，非钙化斑块的比例显著增加。然而，不同程度 SCH 患者的 SIS 和 SSS 无显著差异（均 p>0.05）。SCH 男性 SIS（3.9±2.3 比 3.0±2.3，p=0.004）和 SSS（7.8±5.4 比 5.4±3.0，p=0.002）均高于女性。多变量逻辑和线性回归分析表明，SCH 程度（中度 SCH，比值比[OR]2.11；95%置信区间[CI]1.03-4.34，p=0.042；重度 SCH，OR：10.00；95%CI 3.82-26.20，p<0.001，以轻度 SCH 为参照）与非钙化斑块的存在独立相关，而性别（B：1.67；95%CI 0.27-3.10，p=0.009）与 SSS 独立相关。
重度 SCH 与非钙化斑块有关，SCH 男性的总斑块负荷高于女性。我们建议，SCH 患者，尤其是重度 SCH 患者和 SCH 男性，应评估冠状动脉斑块。
