Department of Cardiology, The Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China.
Department of Anesthesiology, The Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China.
Clin Cardiol. 2023 Dec;46(12):1569-1577. doi: 10.1002/clc.24156. Epub 2023 Sep 15.
Hypertrophic cardiomyopathy (HCM) is a common cardiac genetic disorder that clinically manifests with sudden death and progressive heart failure. Moreover, thyroid dysfunction is associated with increased cardiovascular morbidity and mortality risks. Therefore, this study aimed to clarify whether thyroid hormones could serve as an independent predictor of adverse events in patients with HCM.
The cohort consisted of 782 patients with HCM who had thyroid hormones baseline data and were admitted to the Affiliated Hospital of Jiaxing University. Patients were divided into two groups according to serum levels of free triiodothyronine (fT3): the normal fT3 and low triiodothyronine (T3) syndrome groups. Low T3 syndrome was defined as fT3 < 2.43 pmol/L with a normal thyroid-stimulating hormone (TSH) level. Patients whose TSH levels were abnormally high or abnormally low were excluded from this study. The primary endpoint was the occurrence of sudden cardiac death (SCD) events, and the secondary endpoint was a composite of worsening heart failure (WHF) events, including heart failure death, cardiac decompensation, hospitalization for heart failure, and HCM-related stroke. The Kaplan-Meier and Cox regression were performed for the survival analysis.
After a median follow-up of 52 months, 75 SCD events and 134 WHF events were recorded. The Kaplan-Meier survival curves showed that the cumulative incidence of SCD events and WHF events were significantly higher in patients with low T3 syndrome (log-rank p = .02 and log-rank p = .001, respectively). Furthermore, multivariate Cox regression analysis demonstrated that low T3 syndrome is a strong predictor of SCD events and WHF events (adjusted hazard ratio [HR: 1.53, 95% confidence interval [CI]: 1.13-2.24, p < .01; HR: 3.87, 95% CI: 2.91-4.98, p < .001, respectively).
Low T3 syndrome is highly prevalent among patients with HCM and was independently associated with an increased risk of SCD events and WHF events. The routine assessment of serum fT3 levels may provide risk stratification in this population.
肥厚型心肌病（HCM）是一种常见的心脏遗传性疾病，临床上表现为猝死和进行性心力衰竭。此外，甲状腺功能障碍与心血管发病率和死亡率的增加相关。因此，本研究旨在阐明甲状腺激素是否可作为 HCM 患者不良事件的独立预测因子。
该队列纳入了 782 名 HCM 患者，他们有甲状腺激素的基线数据，并被收入嘉兴大学附属医院。根据游离三碘甲状腺原氨酸（fT3）的血清水平，患者被分为两组：正常 fT3 和低三碘甲状腺原氨酸（T3）综合征组。低 T3 综合征定义为 fT3<2.43pmol/L，同时甲状腺刺激激素（TSH）水平正常。本研究排除了 TSH 水平异常升高或异常降低的患者。主要终点是发生心脏性猝死（SCD）事件，次要终点是恶化心力衰竭（WHF）事件的复合终点，包括心力衰竭死亡、心脏失代偿、心力衰竭住院和 HCM 相关中风。进行 Kaplan-Meier 和 Cox 回归进行生存分析。
中位随访 52 个月后，记录了 75 例 SCD 事件和 134 例 WHF 事件。Kaplan-Meier 生存曲线显示，低 T3 综合征患者的 SCD 事件和 WHF 事件的累积发生率明显更高（对数秩检验 p=0.02 和对数秩检验 p=0.001）。此外，多变量 Cox 回归分析表明，低 T3 综合征是 SCD 事件和 WHF 事件的强烈预测因子（调整后的危险比[HR]：1.53，95%置信区间[CI]：1.13-2.24，p<0.01；HR：3.87，95%CI：2.91-4.98，p<0.001）。
低 T3 综合征在 HCM 患者中发生率较高，与 SCD 事件和 WHF 事件的风险增加独立相关。常规评估血清 fT3 水平可能为该人群提供风险分层。
