≥65 岁甲状腺功能障碍与亚临床心脏异常的关联。

Association of Thyroid Dysfunction in Individuals ≥ 65 Years of Age With Subclinical Cardiac Abnormalities.

机构信息

De Matteis Cardiovascular Institute, St. Francis Hospital, The Heart Center/SUNY at Stony Brook, 11537 Roslyn, NY, USA.

Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.

出版信息

J Clin Endocrinol Metab. 2024 Sep 16;109(10):e1847-e1856. doi: 10.1210/clinem/dgae001.

DOI:10.1210/clinem/dgae001

PMID:38183678

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11403323/

Abstract

CONTEXT

The relationship between thyroid dysfunction and measures of myocardial disease in older individuals remains to be defined.

OBJECTIVE

To evaluate the impact of thyroid dysfunction on structure and function of the left heart chambers and blood markers of cardiac disease.

METHODS

Cross-sectional analysis of the Cardiovascular Health Study, a community-based cohort of older individuals recruited from 4 urban areas in the United States. Of 3163 participants studied, 2477 were euthyroid, 465 had subclinical hypothyroidism (SCH), 47 overt hypothyroidism (OH), 45 endogenous (endo) subclinical hyperthyroidism (endo-SCT), and 129 had exogenous (exo) SCT due to thyroid hormone supplementation. Participants underwent clinical evaluation, blood sampling and biomarker measurement, 2-dimensional and speckle tracking echocardiography for assessment of left heart myocardial deformation, circulating biomarkers of diastolic overload (NT-proBNP), fibrosis (sST2, gal-3), and cardiomyocyte injury (hs-cTnT).

RESULTS

SCH was associated with higher NT-proBNP (beta = 0.17, P = .004), whereas OH was associated with higher hs-cTnT (beta = 0.29, P = .005). There were also suggestive associations of SCH with higher sST2, as well as endo-SCT with higher gal-3 and lower (worse) left atrial reservoir strain. Left ventricular longitudinal strain and end diastolic strain rate did not differ significantly from euthyroid participants in SCH, OH, or exo-SCT.

CONCLUSION

In this free-living elderly cohort, subclinical and overt hypothyroidism were associated with abnormalities of blood biomarkers consistent with diastolic overload and myocardial necrosis respectively, whereas subclinical hyperthyroidism tended to be associated with myocardial fibrosis and decreased left atrial strain. Our findings could represent stage B heart failure and illuminate distinct aspects of the pathobiology of heart disease related to thyroid gland dysfunction with potential clinical implications.

摘要

背景

甲状腺功能障碍与老年人心脏疾病指标之间的关系仍有待明确。

目的

评估甲状腺功能障碍对左心腔结构和功能以及心脏疾病血液标志物的影响。

方法

横断面分析心血管健康研究，该研究是一项基于美国 4 个城市的社区老年人队列研究。在 3163 名研究对象中，2477 名甲状腺功能正常，465 名存在亚临床甲状腺功能减退症（SCH），47 名甲状腺功能减退症（OH），45 名内源性（endo）亚临床甲状腺功能亢进症（endo-SCT），129 名由于甲状腺激素补充而出现外源性（exo）SCT。参与者接受临床评估、血液样本和生物标志物测量、二维和斑点追踪超声心动图评估左心心肌变形、循环舒张性负荷生物标志物（NT-proBNP）、纤维化生物标志物（sST2、gal-3）和心肌细胞损伤生物标志物（hs-cTnT）。

结果

SCH 与 NT-proBNP 升高相关（β=0.17，P=0.004），而 OH 与 hs-cTnT 升高相关（β=0.29，P=0.005）。SCH 还与 sST2 升高以及 endo-SCT 与 gal-3 升高和左心房储备应变降低（恶化）相关，提示存在相关性。SCH、OH 或 exo-SCT 中左心室纵向应变和舒张末期应变率与甲状腺功能正常的参与者无显著差异。