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首页> 外文期刊>ESC Heart Failure >Subclinical hypothyroidism is an independent predictor of adverse cardiovascular outcomes in patients with acute decompensated heart failure ?￠????
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Subclinical hypothyroidism is an independent predictor of adverse cardiovascular outcomes in patients with acute decompensated heart failure ?￠????

机译：亚临床甲状腺功能减退是急性失代偿性心力衰竭患者心血管不良后果的独立预测因子。

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Abstract Aims Altered thyroid hormone metabolism characterized by a low triiodothyronine (T3), so-called low-T3 syndrome, is a common finding in patients with severe systemic diseases. Additionally, subclinical thyroid dysfunction, defined as abnormal thyroid stimulating hormone (TSH) and normal thyroxine (T4), causes left ventricular dysfunction. Our objective was to identify the prevalence and prognostic impact of low-T3 syndrome and subclinical thyroid dysfunction in patients with acute decompensated heart failure (ADHF). Methods and results We examined 274 ADHF patients who were not receiving thyroid medication or amiodarone on admission (70 ???± 15 years, 156 male), who underwent thyroid function tests. Euthyroidism was defined as TSH of 0.45 to 4.49 mIU/L; subclinical hypothyroidism as TSH of 4.5 to 19.9 mIU/L; and subclinical hyperthyroidism as TSH < 0.45 mIU/L, with normal free T4 level for the last two. Additionally, low-T3 syndrome was defined as free T3 < 4.0 pmol/L among euthyroidism subjects. On admission, 188 patients (69%) showed euthyroidism, 58 (21%) subclinical hypothyroidism, 5 (2%) subclinical hyperthyroidism, and 95 (35%) low-T3 syndrome. Cox proportional hazards models revealed that higher TSH, but not free T3 and free T4, was independently associated with composite cardiovascular events, including cardiac death and re-hospitalization for heart failure. Indeed, subclinical hypothyroidism was an independent predictor (hazard ratio: 2.31; 95% confidence interval: 1.44 to 3.67; P < 0.001), whereas low-T3 syndrome and subclinical hyperthyroidism were not. Conclusions Subclinical hypothyroidism on admission was an independent predictor of adverse cardiovascular outcomes in ADHF patients, suggesting a possible interaction between thyroid dysfunction and the pathophysiology of ADHF.
机译：摘要目的以重度甲状腺功能低（T3）（即所谓的低T3综合征）为特征的甲状腺激素代谢改变是重症全身疾病患者的常见发现。此外，亚临床甲状腺功能不全（定义为异常的甲状腺刺激激素（TSH）和正常甲状腺素（T4））会导致左心室功能不全。我们的目的是确定急性失代偿性心力衰竭（ADHF）患者的低T3综合征和亚临床甲状腺功能不全的患病率和预后影响。方法和结果我们检查了274例入院时未接受甲状腺药物或胺碘酮治疗的ADHF患者（70±15岁，156例男性），他们接受了甲状腺功能检查。甲状腺功能亢进定义为TSH为0.45至4.49 mIU / L;亚临床甲状腺功能减退症（TSH）为4.5至19.9 mIU / L;和亚临床甲状腺功能亢进症，TSH <0.45 mIU / L，最后两个患者的游离T4水平正常。此外，低T3综合征被定义为甲状腺功能亢进受试者中的游离T3 <4.0 pmol / L。入院时，有188例患者（69％）表现出甲状腺功能正常，58例（21％）亚临床甲状腺功能减退，5例（2％）亚临床甲状腺功能亢进和95例（35％）低T3综合征。 Cox比例风险模型显示，较高的TSH（而非游离的T3和游离的T4）与复合性心血管事件（包括心源性死亡和因心力衰竭而再次住院）独立相关。的确，亚临床甲状腺功能减退症是一个独立的预测因素（危险比：2.31; 95％置信区间：1.44至3.67; P <0.001），而低T3综合征和亚临床甲状腺功能亢进则不是。结论入院时亚临床甲状腺功能减退是ADHF患者不良心血管预后的独立预测因子，提示甲状腺功能障碍与ADHF病理生理之间可能存在相互作用。

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