Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, China.
School of Medical Imaging, Binzhou Medical University, Binzhou, China.
Front Endocrinol (Lausanne). 2024 Jun 11;15:1334684. doi: 10.3389/fendo.2024.1334684. eCollection 2024.
The meta-analysis aimed to explore the cardiac adaptation in hypothyroidism patients by cardiac magnetic resonance.
Databases including PubMed, Cochrane Library, Embase, CNKI, and Sinomed for clinical studies of hypothyroidism on cardiac function changes. Databases were searched from the earliest data to 15 June 2023. Two authors retrieved studies and evaluated their quality. Review Manager 5.4.1 and Stata18 were used to analyze the data. This study is registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY), 202440114.
Six studies were selected for further analysis. Five of them reported differences in cardiac function measures between patients with hypothyroidism and healthy controls, and three studies reported cardiac function parameters after treatment in patients with hypothyroidism. The fixed-effect model combined WMD values for left ventricular ejection fraction (LVEF) had a pooled effect size of -1.98 (95% CI -3.50 to -0.44], =0.01), implying that LVEF was lower in patients with hypothyroidism than in healthy people. Analysis of heterogeneity found moderate heterogeneity ( = 0.08, ² = 50%). WMD values for stroke volume (SV), cardiac index (CI), left ventricular end-diastolic volume index(LVEDVI), left ventricular end-systolic volume (LESVI), and left ventricular mass index(LVMI) were also analyzed, and pooled effect sizes showed the CI and LVEDVI of patients with hypothyroidism ware significantly decrease (WMD=-0.47, 95% CI [-0.93 to -0.00], =0.05, WMD=-7.99, 95%CI [-14.01 to -1.96], =0.009, respectively). Patients with hypothyroidism tended to recover cardiac function after treatment [LVEF (WMD = 6.37, 95%CI [2.05, 10.69], =0.004), SV (WMD = 7.67, 95%CI [1.61, 13.74], =0.01), CI (WMD = 0.40, 95%CI [0.01, 0.79], =0.05)], and there was no difference from the healthy controls.
Hypothyroidism could affect cardiac function, although this does not cause significant heart failure. It may be an adaptation of the heart to the hypothyroid state. There was a risk that this adaptation may turn into myocardial damage. Cardiac function could be restored after treatment in patients with hypothyroidism. Aggressive levothyroxine replacement therapy should be used to reverse cardiac function.
https://inplasy.com, identifier (INPLASY202440114).
本荟萃分析旨在通过心脏磁共振探讨甲状腺功能减退症患者的心脏适应性。
检索包括 PubMed、Cochrane Library、Embase、中国知网（CNKI）和中国生物医学文献数据库（Sinomed）在内的数据库，以获取有关甲状腺功能对心脏功能变化影响的临床研究。从最早的数据到 2023 年 6 月 15 日对数据库进行了搜索。两名作者检索了研究并评估了其质量。使用 Review Manager 5.4.1 和 Stata18 分析数据。本研究在国际注册系统评价和荟萃分析方案平台（INPLASY）上注册，编号为 202440114。
选择了 6 项研究进行进一步分析。其中 5 项研究报告了甲状腺功能减退症患者与健康对照组之间心脏功能测量值的差异，3 项研究报告了甲状腺功能减退症患者治疗后的心脏功能参数。左心室射血分数（LVEF）的固定效应模型合并 WMD 值的汇总效应大小为-1.98（95%CI-3.50 至-0.44]，=0.01），表明甲状腺功能减退症患者的 LVEF 低于健康人。异质性分析发现存在中度异质性（=0.08，²=50%）。还分析了每搏输出量（SV）、心指数（CI）、左心室舒张末期容积指数（LVEDVI）、左心室收缩末期容积（LESVI）和左心室质量指数（LVMI）的 WMD 值，汇总效应大小显示甲状腺功能减退症患者的 CI 和 LVEDVI 显著降低（WMD=-0.47，95%CI[-0.93 至-0.00]，=0.05，WMD=-7.99，95%CI[-14.01 至-1.96]，=0.009）。甲状腺功能减退症患者在治疗后心脏功能趋于恢复[LVEF（WMD=6.37，95%CI[2.05，10.69]，=0.004），SV（WMD=7.67，95%CI[1.61，13.74]，=0.01），CI（WMD=0.40，95%CI[0.01，0.79]，=0.05）]，与健康对照组无差异。
甲状腺功能减退症可能会影响心脏功能，尽管这不会导致明显的心力衰竭。这可能是心脏对甲状腺功能减退状态的一种适应。这种适应可能会转变为心肌损伤，风险存在。甲状腺功能减退症患者经治疗后心脏功能可恢复。应使用积极的左甲状腺素替代疗法来逆转心脏功能。
