Zhou Haiqing, Wang Qi, Liu Zhiquan, Wu Guohong, Zhou Wenqing, Yang Dongmei, Chen Kangyu
Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, China.
Department of Echocardiography, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
Intern Emerg Med. 2025 Mar;20(2):481-488. doi: 10.1007/s11739-024-03827-w. Epub 2024 Dec 17.
Heart failure (HF) with improved ejection fraction (HFimpEF) has gradually attracted widespread attention in recent years for its better clinical prognosis. In this study, we attempted to investigate the relationship between subclinical hypothyroidism (SCH) and HFimpEF. This study retrospectively collected clinical data on patients with HF with reduced ejection fraction (HFrEF) hospitalized at the First Affiliated Hospital of USTC from March 2015 to September 2023, and divided into two groups as euthyroidism or SCH according to the baseline thyroid function. Then patients were further categorized into HFimpEF (follow-up LVEF > 40% and absolute increase ≥ 10%) and persistent HFrEF based on their LVEF on the echocardiograms during the follow-up period. Afterward, logistic regression was used to estimate the effect of SCH on HFimpEF. A total of 916 patients with HFrEF met the inclusion and exclusion criteria, and 396 patients (43.2%) progressed to HFimpEF status during the follow-up period. Compared with HFrEF patients, the prevalence of SCH is lower in HFimpEF patients (9.3% vs. 14.4%, P = 0.020). Univariate logistic regression analysis indicates that SCH was a potential predictor for HFimpEF (OR: 0.612 [95% CI 0.403-0.928], P = 0.021). After adjusting for multiple factors in logistic regression, the odds ratios of HFrEF patients with SCH progressing to HFimpEF decreased by 37.8% (OR: 0.622 [95% CI 0.397-0.974], P = 0.038) compared with patients with euthyroidism. This study suggests that thyroid function affects the improvement of cardiac function in patients with HFrEF and SCH is an independent predictor for HFimpEF.
近年来，射血分数改善的心力衰竭（HFimpEF）因其较好的临床预后逐渐受到广泛关注。在本研究中，我们试图探究亚临床甲状腺功能减退（SCH）与HFimpEF之间的关系。本研究回顾性收集了2015年3月至2023年9月在中国科学技术大学附属第一医院住院的射血分数降低的心力衰竭（HFrEF）患者的临床资料，并根据基线甲状腺功能分为甲状腺功能正常或SCH两组。然后根据随访期间超声心动图的左心室射血分数（LVEF），将患者进一步分为HFimpEF（随访LVEF＞40%且绝对增加≥10%）和持续性HFrEF。之后，采用逻辑回归分析来评估SCH对HFimpEF的影响。共有916例HFrEF患者符合纳入和排除标准，其中396例患者（43.2%）在随访期间进展为HFimpEF状态。与HFrEF患者相比，HFimpEF患者中SCH的患病率较低（9.3%对14.4%，P = 0.020）。单因素逻辑回归分析表明，SCH是HFimpEF的潜在预测因素（OR：0.612 [95%CI 0.403 - 0.928]，P = 0.021）。在逻辑回归中对多个因素进行调整后，与甲状腺功能正常的患者相比，患有SCH的HFrEF患者进展为HFimpEF的优势比降低了37.8%（OR：0.622 [95%CI 0.397 - 0.974]，P = 0.038）。本研究表明，甲状腺功能影响HFrEF患者的心功能改善，且SCH是HFimpEF的独立预测因素。
