Wang Chuanhe, Han Su, Li Ying, Tong Fei, Li Zhichao, Sun Zhijun
Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China.
Front Cardiovasc Med. 2022 Apr 12;9:859608. doi: 10.3389/fcvm.2022.859608. eCollection 2022.
Abnormal thyroid hormone secretions can alter the manifestation and prognosis of cardiovascular disease. To assess the effect of the free triiodothyronine (FT3)/free thyroxine (FT4) ratio on the prognosis of patients with heart failure (HF), we performed a propensity-matched study on patients with well-balanced baseline characteristics.
Overall, 8,887 patients with HF were divided into two groups according to the FT3/FT4 ratio. Propensity scores were calculated from each patient. A cohort comprising 2,164 pairs with high or low ratios and with 34 well-balanced baseline characteristics was then assembled. The endpoints were Cardiovascular (CV) mortality and all-cause mortality. The correlation between FT3/FT4 ratio and prognosis was assessed using matched Cox regression analyses. The mean follow-up was 3.3 years.
In the full pre-match cohort, 3,710 (41.7%) patients died, with 2,581 (29.0%) cases of CV mortality. In the matched-pair cohort, all-cause mortality occurred in 923 (1,238/10,000 person-years of follow-up) patients with a high ratio and 1,036 (1,484/10,000 person-years) patients with a low ratio, resulting in a matched HR of 0.841 (95% CI: 0.769-0.919; < 0.001). For CV mortality, the result was 638 (856/10,000 person-years) and 714 (1,023/10,000 person-years) patients, respectively, resulting in a matched HR of 0.844 (95% CI: 0.759-0.940; < 0.001). Subgroup analysis revealed that a low FT3/FT4 ratio had a greater predictive value for all-cause and CV mortality in elderly or male patients and in patients with coronary artery disease (CAD), hypertension, diabetes mellitus, HFmrEF, or HFpEF.
A low FT3/FT4 ratio is valuable for predicting CV mortality and all-cause mortality in patients with HF.
甲状腺激素分泌异常可改变心血管疾病的表现和预后。为评估游离三碘甲状腺原氨酸（FT3）/游离甲状腺素（FT4）比值对心力衰竭（HF）患者预后的影响，我们对基线特征均衡的患者进行了倾向匹配研究。
总共8887例HF患者根据FT3/FT4比值分为两组。计算每位患者的倾向得分。然后组建了一个由2164对高低比值且具有34个均衡基线特征的队列。终点为心血管（CV）死亡率和全因死亡率。使用匹配的Cox回归分析评估FT3/FT4比值与预后之间的相关性。平均随访时间为3.3年。
在完全匹配前队列中，3710例（41.7%）患者死亡，其中2581例（29.0%）为CV死亡。在匹配对队列中，高比值组923例（1238/10000人年随访）患者发生全因死亡，低比值组1036例（1484/10000人年）患者发生全因死亡，匹配后的HR为0.841（95%CI：0.769 - 0.919；P<0.001）。对于CV死亡，结果分别为638例（856/10000人年）和714例（1023/10000人年）患者，匹配后的HR为0.844（95%CI：0.759 - 0.940；P<0.001）。亚组分析显示，低FT3/FT4比值对老年或男性患者以及患有冠状动脉疾病（CAD）、高血压、糖尿病、射血分数保留的心力衰竭（HFmrEF）或射血分数降低的心力衰竭（HFpEF）患者的全因和CV死亡具有更大的预测价值。
低FT3/FT4比值对预测HF患者的CV死亡和全因死亡具有重要价值。
