The features of “low T3” syndrome definition in a heart failure and its effect on a course of the disease
DOI:
https://doi.org/10.14739/2310-1210.2019.4.173178Keywords:
euthyroid sick syndromes, thyrotropin, ROC curve, risk, dilatation, heart ventricles, reverse triiodothyronine, echocardiography, heart failureAbstract
Heart failure (HF) is an important issue in cardiology. Some patients with HF have the low T3 syndrome (LT3S). There is no consensus regarding the criteria for determining LT3S.
The purpose is to study the features of LT3S determination in HF and its relationship with the disease course.
Materials and methods. A total of 157-patients with HF and postinfarction cardiosclerosis were examined. At the I stage, all patients were divided into 2 groups: I – 122 patients with normal level of free T3f, Т4f and thyroid-stimulating hormone (TSH); II – 35 patients with LT3S (Т3f≤2.5 pmol/l and normal levels of T4f and TSH). At the II stage, 129 patients without LT3S were included into group I and 28 patients with LT3S (Т3f ≤2.07 pmol/l) – into group II. Serum levels of TSH, T3f, T4f, reverse T3 (T3r) were determined. Echocardiography was performed. HF course was studied during 2 years.
Results. The frequency of LT3S (T3f <2.5 pmol/l) among patients with HF is 22.3 %. The risk of rehospitalization of patients according to ROC-analysis increases at the intersection of the point Т3f ≤2.07 pmol/l (P = 0.0017). At Т3f ≤2.07 pmol/l the frequency of LT3S is 17.8 %. Patients with LT3S (T3f ≤2.07 pmol/l) are younger (2.5 years younger; P = 0.039), have larger end-diastolic size (by 4.8 %; р P = 0.010) and volume (by 10.2 %; P = 0.012), end-systolic size (by 8.8 %; P = 0.003) and volume (by 20.1 %; P = 0.006), lower left ventricle (LV) ejection fraction (by 9.5 %; P = 0.033), than the patients without LT3S. The relative risk of rehospitalization in patients with LT3S (Т3f ≤2.07 pmol/l) is 2.224 (P < 0.05).
Conclusions. The frequency of LT3S (T3f <2.5 pmol/l) among patients with HF is 22.3 % at level of T3f ≤2.07 pmol/l – 17.8 %. The risk of rehospitalization in patients with HF increases at intersection of the point Т3f ≤2.07 pmol/l. Patients with LT3S (T3f ≤2.07 pmol/l) are younger, have larger LV dilatation and lower ejection fraction, higher frequency of coronary intervention and rehospitalization risk than the patients without LT3S.
References
Voronkov, L. G., Ilnytska, M. R., & Babich, P. M. (2015) Prohnoz patsiientiv iz khronichnoiu sertsevoiu nedostatnistiu ta systolichnoiu dysfunktsiieiu livoho shlunochka zalezhno vid danykh neinvazyvnykh metodiv obstezhennia [The prognosis of patintes with chronic heart failure and left ventricular systolic dysfunction depending on the data noninvasive method examination]. Ukrainskyi terapevtychnyi zhurnal, 1, 24–31. [in Ukrainian].
Voronkov, L. G., Dzyak, G. V., Amosova, E. N., Bagrij, A. E'., Volkov, V. I., & Lutaj, M. I. (2015). Obosnovanie, dizajn i rezul'taty ukrainskogo mnogocentrovogo issledovaniya KORIOLAN (KORIOL – Al'ternativa nasosnoj Nedostatochnosti serdca). [Rationale, design, and the results of Ukrainian multicenter study KORIOLAN (KORIOL – Alternative pumping Heart Failure)]. Sertseva nedostatníst, 2, 28–33. [in Russian].
Rudyk, Yu. S., Pyvovar, S. N., & Beletskaja, O. M. (2013). Kardioprotektivnye mekhanizmy gormonov shchitovidnoj zhelezy [The cardioprotective mechanisms of thyroid hormones]. Ukrayinskyi terapevtychnyi zhurnal, 3, 95–102. [in Russian].
Schultz, M., Faber, J., Kistorp, C., Jarløv, A., Pedersen, F., Wiinberg, N., & Hildebrandt, P. (2004). N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) in different thyroid function states. Clin Endocrinol (Oxf), 60(1), 54–59. doi: 10.1111/j.1365-2265.2004.01941.x
Gerdes, A. M., & Ojamaa, K. (2016). Thyroid hormone and cardioprotection. Compr Physiol., 6(3), 1199–1219. doi: 10.1002/ cphy. c150012
Hayashi, T., Hasegawa, T., Kanzaki, H., Funada, A., Amaki, M., Takahama, H., et al. (2016). Subclinical hypothyroidism is an independent predictor of adverse cardiovascular outcomes in patients with acute decompensated heart failure. ESC Heart Failure., 3(3), 168–176. doi: 10.1002/ehf2.12084
Rothberger, G. D., Gadhvi, S., Michelakis, N., Kumar, A., Calixte, R., & Shapiro, L. E. (2017). Usefulness of Serum Triiodothyronine (T3) to Predict Outcomes in Patients Hospitalized With Acute Heart Failure. Am J Cardiol., 119(4), 599–603. doi: 10.1016/j.amjcard.2016.10.045
Ponikowski, P., Voors, A., Anker, D., Bueno, H., Cleland, J. G. F., Coats, A. J. S., et al. (2016). 2016. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal., 37(27), 2129–2200. doi: 10.1093/ eurheartj/ ehw128
Larsen, P. R., & Zavacki, A. M. (2012). Role of the Iodothyronine Deiodinases in the Physiology and Pathophysiology of Thyroid Hormone Action. Eur Thyroid J., 1(4), 232–242. doi: 10.1159/000343922
De Groot, L. J. (2006). Non-thyroidal illness syndrome is a manifestation of hypothalamic-pituitary dysfunction, and in view of current evidence, should be treated with appropriate replacement therapies. Crit Care Clin., 22(1), 57–86. doi: 10.1016/j.ccc.2005.10.001
Gao, R., Liang, J. H., Wang, L., Zhu, H. Y., Wu, W., Wu, J. Z., et al. (2017). Low T3 syndrome is a strong prognostic predictor in diffuse large B cell lymphoma. British Journal of Haematology., 177(1), 95–105. doi: 10.1111/bjh.14528
Iervasi, G., & Nicolini, G. (2013). Thyroid hormone and cardiovascular system: from basic concepts to clinical application. Intern Emerg Med., 8. Suppl 1, S.71-4. doi: 10.1007/s11739-013-0911-4
Cantisani, M. C., Parascandolo, A., Perala, M., Allocca, C., Fey, V., Sahlberg, N., et al. (2016). A loss-of-function genetic screening identifies novel mediators of thyroid cancer cell viability. Oncotarget, 7(19), 28510–28522. doi: 10.18632/oncotarget.8577
Danzi, S., & Klein, I. (2014). Thyroid disease and the cardiovascular system. Endocrinol Metab Clin North Am., 43(2), 517–28. doi: 10.1016/j.ecl.2014.02.005
Amin, A., Chitsazan, M., Taghavi, S., & Ardeshiri M. (2015). Effects of triiodothyronine replacement therapy in patients with chronic stable heart failure and low-triiodothyronine syndrome: a randomized, double-blind, placebo-controlled study. ESC heart failure, 2(1), 5–11. doi: 10.1002/ehf2.12025
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