Heart Failure Center, 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.
Clin Cardiol. 2023 Jul;46(7):757-767. doi: 10.1002/clc.24057. Epub 2023 May 25.
Thyroid dysfunction might have a negative impact on the prognosis of patients with heart failure (HF) and affect the lipid metabolism. The aim of our study was to investigate the prognostic role of thyroid dysfunction and its relationship with lipid profile in hospitalized HF patients.
Thyroid dysfunction strongly correlates with prognosis of HF patients and combination with lipid profile improves the prognostic value.
We performed a single-center retrospective cohort study including hospitalized HF patients between March 2009 and June 2018.
Among enrolled 3733 patients, low fT3 (hazard ratio [HR] 1.33; 95% CI: 1.15-1.54; p < .001), elevated TSH (HR 1.37; 95% CI 1.15-1.64; p < .001), LT3S (HR 1.39; 95% CI: 1.15-1.68; p < .001), overt hyperthyroidism (HR 1.73; 95%CI: 1.00-2.98; p = .048), subclinical hypothyroidism (HR 1.43; 95%CI: 1.13-1.82; p = .003) and overt hypothyroidism (HR 1.76; 95%CI: 1.33-2.34; p < .001) independently increased the risk of composite endpoint defined as the combination of all-cause mortality, heart transplantation, or left ventricular assist device requirement. Higher total cholesterol (HR 0.64; 95%CI: 0.49-0.83; p < .001) was still a protective factor in HF patients. When divided into four groups by fT3 and median lipid profiles, comparison of Kaplan-Meier survival curves for various groups showed good risk stratification (p < .001).
LT3S, overt hyperthyroidism, subclinical and overt hypothyroidism were independently associated with poor outcomes in HF. The combination of fT3 and lipid profile improved the prognostic value.
甲状腺功能障碍可能对心力衰竭（HF）患者的预后产生负面影响，并影响脂代谢。本研究的目的是探讨甲状腺功能障碍的预后作用及其与血脂谱的关系在住院 HF 患者中的作用。
甲状腺功能障碍与 HF 患者的预后密切相关，与血脂谱相结合可提高预后价值。
我们进行了一项单中心回顾性队列研究，纳入了 2009 年 3 月至 2018 年 6 月期间住院的 HF 患者。
在纳入的 3733 名患者中，低 fT3（风险比 [HR] 1.33；95%CI：1.15-1.54；p<.001）、升高的 TSH（HR 1.37；95%CI：1.15-1.64；p<.001）、LT3S（HR 1.39；95%CI：1.15-1.68；p<.001）、显性甲状腺功能亢进（HR 1.73；95%CI：1.00-2.98；p=.048）、亚临床甲状腺功能减退（HR 1.43；95%CI：1.13-1.82；p=.003）和显性甲状腺功能减退（HR 1.76；95%CI：1.33-2.34；p<.001）独立增加了复合终点的风险，定义为全因死亡率、心脏移植或左心室辅助装置需求的组合。较高的总胆固醇（HR 0.64；95%CI：0.49-0.83；p<.001）在 HF 患者中仍然是一个保护因素。当根据 fT3 和中位数血脂谱将患者分为四组时，比较各组的 Kaplan-Meier 生存曲线显示出良好的风险分层（p<.001）。
LT3S、显性甲状腺功能亢进、亚临床和显性甲状腺功能减退与 HF 患者的不良结局独立相关。fT3 和血脂谱的结合提高了预后价值。
