Naser Jwan A, Pislaru Sorin, Stan Marius N, Lin Grace
Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Heart. 2022 May 12;108(11):868-874. doi: 10.1136/heartjnl-2021-319752.
Graves' disease (GD) can both aggravate pre-existing cardiac disease and cause de novo heart failure (HF), but large-scale studies are lacking. We aimed to investigate the incidence, risk factors and outcomes of incident GD-related HF.
Patients with GD (2009-2019) were retrospectively included. HF with reduced ejection fraction (HFrEF) was defined by left ventricular ejection fraction <50% and Framingham criteria, while HF with preserved ejection fraction (HFpEF) was defined according to the HFA-PEFF criteria. HF due to ischaemia, valve disorder or other structural heart disease was excluded. Proportional hazards regression was used to analyse risk factors and outcomes.
Of 1371 patients with GD, HF occurred in 74 (5.4%) patients (31 (2.3%) HFrEF; 43 (3.1%) HFpEF). In HFrEF, atrial fibrillation (AF) (HR 10.5 (3.0-37.3), p<0.001) and thyrotropin receptor antibody (TRAb) level (HR 1.05 (1.01-1.09) per unit, p=0.007) were independent risk factors. In HFpEF, the independent risk factors were chronic obstructive pulmonary disease (HR 7.2 (3.5-14.6), p<0.001), older age (HR 1.5 (1.2-2.0) per 10 years, p=0.001), overt hyperthyroidism (HR 6.4 (1.5-27.1), p=0.01), higher body mass index (BMI) (HR 1.07 (1.03-1.10) per unit, p=0.001) and hypertension (HR 3.1 (1.3-7.2), p=0.008). The risk of cardiovascular hospitalisations was higher in both HFrEF (HR 10.3 (5.5-19.4), p<0.001) and HFpEF (HR 6.7 (3.7-12.2), p<0.001). However, only HFrEF was associated with an increased risk of all-cause mortality (HR 5.17 (1.3-19.9), p=0.02) and ventricular tachycardia/fibrillation (HR 64.3 (15.9-259.7), p<0.001).
De novo HF occurs in 5.4% of patients with GD and is associated with increased risk of cardiovascular hospitalisations and mortality. Risk factors include AF, higher TRAb, higher BMI and overt hyperthyroidism.
格雷夫斯病（GD）既能加重已有的心脏病，又能引发新发心力衰竭（HF），但缺乏大规模研究。我们旨在调查新发GD相关HF的发病率、危险因素和结局。
回顾性纳入2009年至2019年期间的GD患者。射血分数降低的心力衰竭（HFrEF）根据左心室射血分数<50%及弗明翰标准定义，而射血分数保留的心力衰竭（HFpEF）根据HFA-PEFF标准定义。排除因缺血、瓣膜疾病或其他结构性心脏病导致的HF。采用比例风险回归分析危险因素和结局。
在1371例GD患者中，74例（5.4%）发生HF（31例（2.3%）为HFrEF；43例（3.1%）为HFpEF）。在HFrEF中，心房颤动（AF）（风险比（HR）10.5（3.0 - 37.3），p<0.001）和促甲状腺素受体抗体（TRAb）水平（每单位HR 1.05（1.01 - 1.09），p = 0.007）是独立危险因素。在HFpEF中，独立危险因素为慢性阻塞性肺疾病（HR 7.2（3.5 - 14.6），p<0.001）、高龄（每10年HR 1.5（1.2 - 2.0），p = 0.001）、显性甲状腺功能亢进（HR 6.4（1.5 - 27.1），p = 0.01）、较高的体重指数（BMI）（每单位HR 1.07（1.03 - 1.10），p = 0.001）和高血压（HR 3.1（1.3 - 7.2），p = 0.008）。HFrEF（HR 10.3（5.5 - 19.4），p<0.001）和HFpEF（HR 6.7（3.7 - 12.2），p<0.001）患者心血管住院风险均较高。然而，只有HFrEF与全因死亡率增加（HR 5.17（1.3 - 19.9），p = 0.02）和室性心动过速/心室颤动风险增加（HR 64.3（15.9 - 259.7），p<0.001）相关。
5.4%的GD患者会发生新发HF，且与心血管住院和死亡风险增加相关。危险因素包括AF、较高的TRAb、较高的BMI和显性甲状腺功能亢进。
