Yang Zhen-Yu, Zhang Zhi-Yuan, Zhang Wei-Jie, Liu Da, Piao Fu-Shi, Yan Xiangyu, Shi Fang-Tao, Yang Min, Chen Jing, Zhu Sheng-Song, He Hong-Hou, Wu Pei-Hong, Qian Cheng, Lin Min, Feng Jun-Qing, Lai Chun-Jin
Cardiac Surgery Department, The Peoplès Hospital of Anyang City, Anyang, Henan, China.
Department of Plastic and Burn Surgery, National Key Clinical Construction Specialty, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.
Front Cardiovasc Med. 2025 Aug 21;12:1546309. doi: 10.3389/fcvm.2025.1546309. eCollection 2025.
This study sought to identify key prognostic factors in patients with hypertrophic cardiomyopathy (HCM) and heart failure with preserved ejection fraction (HFpEF), emphasizing the prognostic role of free triiodothyronine (FT3) levels.
This retrospective cohort study enrolled 992 HCM-HFpEF patients from two Chinese medical centers between 2009 and 2019, excluding those with thyroid-affecting medications or disorders. Data on demographic and clinical variables, including FT3, were analyzed using univariate and multivariate Cox regression, Kaplan-Meier (KM) survival analysis, and restricted cubic spline (RCS) analysis to explore prognostic factors and FT3's nonlinear predictive value.
Age, atrial fibrillation, and NT-proBNP levels significantly influenced prognosis, while FT3 emerged as an independent predictor of all-cause mortality and cardiac transplantation ( < 0.001). Patients with lower FT3 exhibited poorer long-term outcomes, with RCS identifying a critical threshold of 2.885 pg/ml (-non-linear < 0.05).
FT3 is a robust prognostic marker in HCM-HFpEF patients, supporting its integration into risk stratification. Clinicians should monitor FT3 levels, though intervention efficacy requires further prospective validation.
本研究旨在确定肥厚型心肌病（HCM）和射血分数保留的心力衰竭（HFpEF）患者的关键预后因素，重点强调游离三碘甲状腺原氨酸（FT3）水平的预后作用。
这项回顾性队列研究纳入了2009年至2019年间来自两个中国医疗中心的992例HCM-HFpEF患者，排除了使用影响甲状腺的药物或患有甲状腺疾病的患者。使用单因素和多因素Cox回归、Kaplan-Meier（KM）生存分析以及限制性立方样条（RCS）分析对包括FT3在内的人口统计学和临床变量数据进行分析，以探索预后因素和FT3的非线性预测价值。
年龄、心房颤动和N末端B型利钠肽原（NT-proBNP）水平对预后有显著影响，而FT3成为全因死亡率和心脏移植的独立预测因素（<0.001）。FT3水平较低的患者长期预后较差，RCS确定临界阈值为2.885 pg/ml（非线性<0.05）。
FT3是HCM-HFpEF患者强有力的预后标志物，支持将其纳入风险分层。临床医生应监测FT3水平，不过干预效果需要进一步的前瞻性验证。
