Clinical and pathogenetic role of immunoinflammatory activation and endothelial dysfunction in patients with coronary heart disease associated with hypothyroidism based on the results of cognitive modeling
DOI:
https://doi.org/10.14739/2310-1210.2017.1.91585Keywords:
coronary disease, hypothyroidism, biological markers, lipids, cardiac remodeling, myocardial ischemia, statistical modelAbstract
Objective: to study the relationship between the level of thyroid hormones and clinical, autonomic, structural and functional characteristics of heart affections, activity of immune inflammation markers, endothelial dysfunction by means of cognitive modeling.
Methods: 60 patients with coronary heart disease with concomitant hypothyroidism were examined (the average level of TSH 13.05 ± 3.30 mU/ml, the average level of FT4 11.45 ± 0.72 pmol L, the average age of patients – 60.5 (54.0; 64.5) years, among them 16 (27 %) were men and 44 (73 %) women. The complex clinical examination including clinical, biochemical, immune-enzyme and instrumental methods of examination, correlation and regression analysis of the data was carried out.
Results: The correlation analysis showed that in patients with coronary heart disease, comorbid with hypothyroidism, the reduction of left ventricular ejection fraction was mostly associated with the increasing levels of neopterin and tumor necrosis factor-α (r = -0.37 and r = -0.38 respectively; p < 0.05); condition of myocardial stiffness correlated with the concentration of C-reactive protein (r = +0,56; p < 0,05); level of total cholesterol (TС) – with concentration of neopterin (r = +0.39; p < 0.05) and plasminogen activator inhibitor-1 (PAI-1) (r= +0.50; p < 0.05); heart rate variability parameters and indicators of myocardial ischemic changes correlated with the level of neopterin and endothelin-1. The value of FT4 had a correlation with the concentration of neopterin (r = -0.34; p < 0.05) and PAI-1 (r = -0.52; p < 0.05), left ventricular myocardium mass index (LVMI) (r =-0.44; p < 0.05), early and late diastolic filling velocities of the left ventricle and their ratio (r = +0.50, r = -0,42 and r = -0.41, respectively, p <0.05), standard deviation of normal-to-normal intervals (SDNN) in the active (r = +0.45; p < 0.05) and passive (r = +0.36; p < 0.05) periods, ТС (r = -0.33; p < 0.05). The performed regression analysis confirmed the direction of relations, also allowed to build the cognitive model of the clinical course of ischemic heart disease in patients with hypothyroidism, where the FT4 acts as a connecting link.
Conclusions: The cognitive model developed on the basis of correlation and regression analyzes demonstrates clinical and pathogenetic role of immune inflammation markers and endothelial dysfunction in the progression of structural and functional heart disorders, ischemic and autonomic changes in CHD patients with concomitant hypothyroidism, where FT4 level acts as a connecting link.
References
Kovalenko, V. M., & Kornatskyi, V. M. (2016). Problemy zdorov’ia i medychnoi dopomohy ta model pokrashchennia v suchasnykh umovakh [Problems of health and medical care and improved model in modern conditions]. Kyiv. [in Ukrainian].
Mitchenko, O. I., Logvinenko, A. O., & Romanov, V. Yu. (2010). Optymizatsiia likuvannia dyslipidemii ta porushen vuhlevodnoho obminiv u khvorykh z metabolichnym syndromom ta dysfunktsiieiu shchytopodibnoi zalozy [The optimisation of lipid and carbohydrate exchange correction in patients with metabolic syndrome and thyroid dysfunction]. Ukrainskyi kardiolohichnyi zhurnal, 1, 73–80. [in Ukrainian].
Didushko, O. M. (2014). Hiperleptynemiia yak odyn iz chynnykiv porushennia funktsii nyrok u khvorykh na hipotyreoz [Hyperleptinemia as one of the factors for renal dysfunction in patients with hypothyroidism]. Mezhdunarodnyj e´ndokrinologicheskij zhurnal, 6(62), 29–32. [in Ukrainian].
Meena, C., Meena, R., Nawal, R., Meena, V., Bharti, A., & Meena, L. (2012). Assessment of Left Ventricular Diastolic Dysfunction in Sub-clinical Hypothyroidism. Acta Informatica Medica, 20(4), 218. doi: 10.5455/aim.2012.20.21-218-220.
Biondi, B. (2012). MECHANISMS IN ENDOCRINOLOGY: Heart failure and thyroid dysfunction. European Journal of Endocrinology, 167(5), 609–618. doi: 10.1530/EJE-12-0627.
Shved, M., & Prypkhan, I. (2015). Osoblyvosti klinichnykh oznak, zmin natriiuretychnoho pro peptydu NT-pro BNP, diastolichnoi funktsii livoho shlunochka ta variabelnosti rytmu sertsia u khvorykh na stabilnu stenokardiiu navantazhennia u poiednanni z hipofunktsiieiu shchytopodibnoi zalozy [Features of the Clinical Signs, Changes of the Natriuretic Propeptide (NT-proBNP), Left Ventricular Diastolic Function and Heart Rate Variability in the Patients with the Stable Angina Pectoris Combined with Thyroid Hypofunction]. Lvivskyi klinichnyi visnyk, 1(9), 8–13. [in Ukrainian].
Dal Lin, C., Tona, F., & Osto, E. (2015). Coronary Microvascular Function and Beyond: The Crosstalk between Hormones, Cytokines, and Neurotransmitters. International Journal of Endocrinology, 2015, 1–17. doi: 10.1155/2015/312848.
Nakaz Ministerstva okhorony zdorovia Ukrainy «Pro zatverdzhennia protokoliv nadannia medychnoi dopomohy za spetsialnistiu “Kardiolohiia”» vid 3 lypnia 2006 №436 [Order of the Ministry of Health of Ukraine On approving the protocols of care, specialty 'Cardiology' July, 3. 2006, №436]. Retrieved from: http://www.moz.gov.ua/ua/portal/dn_20060703_436.html [Accessed 25 Dec. 2016]. [in Ukrainian].
Tronko, M. D. (Ed) (2007). Standarty diahnostyky ta likuvannia endokrynnykh zakhvoriuvan [Standards for the diagnosis and treatment of endocrine diseases]. Kyiv. [in Ukrainian].
Jonklaas, J., Bianco, A., Bauer, A., Burman, K., Cappola, A., Celi, F., et al. (2014). Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement. Thyroid, 24(12), 1670–1751. doi: 10.1089/thy.2014.0028.
Mykhailovska, N. S., Oleynik, T. V., & Mykhailovskiy, Y. M. (2015). Osoblyvosti zmin vehetatyvnoho statusu u patsiientiv z ishemichnoiu khvoroboiu sertsia ta hipotyreozom u vzaiemozv’iazku z hormonamy hipofizarno-tyreoidnoi systemy [Features of autonomic status changes in patients with coronary heart disease and hypothyroidism in relation to the hormones of the pituitary, thyroid system]. Semeinaia medytsyna, 4(60), 106–109. [in Ukrainian].
Mykhailovska, N. S., & Oleynik, T. V. (2015). Osoblyvosti remodeliuvannia miokarda u khvorykh na ishemichnu khvorobu sertsia zalezhno vid funktsionalnoho stanu shchytopodibnoi zalozy [Features of myocardial remodeling in patients with coronary heart disease depending on thyroid function]. Pathologia, 2(34), 17–21. doi: http://dx.doi.org/10.14739/2310-1237.2015.2.48619. [in Ukrainian].
Mykhailovska, N. S., & Oliinyk, T. V. (2015). Osoblyvosti imunozapalnoi aktyvatsii ta funktsionalnoho stanu endoteliiu u khvorykh na ishemichnu khvorobu sertsia, asotsiiovanu z hipotyreozom [Features of immunoinflammatory activation and endothelial functional status in patients with coronary heart disease associated with hypothyroidism]. Problemy endokrynnoi patolohii, 4, 37–43. [in Ukrainian].
Blankova, Z. N., Ageev, F. T., Seredenina, E. M., Ryabceva, O. Yu., Svirida, O. N., & Iryuganov, N. Sch. (2014). Gipotireoz i serdechno-sosudistye zabolevaniya [Hypothyroidism and cardiovascular disease]. Russkij medicinskij zhurnal, 13, 980–987. [in Russian].
Valgimigli, M., Percoco, G., Malagutti, P., Campo, G., Ferrari, F., Barbieri, D., et al. (2005). Tirofiban and Sirolimus-Eluting Stent vs Abciximab and Bare-Metal Stent for Acute Myocardial Infarction. JAMA, 293(17), 2109. doi: 10.1001/jama.293.17.2109.
Kopitsa, N. P., Lytvyn, O. I., Petyunina, O. V., Tytarenko, N. V., & Petenyova, L. L. (2006). Rol´ neopterina v prognozirovanii serdechnoj nedostatochnosti u bol´nykh, perenesshikh infarkt miokarda [The role of neopterin in prognosing of heart failure in patiens after myocardial infarction]. Ukrainskyi terapevtychnyi zhurnal, 4, 19–22. [in Ukrainian].
Ruzhencova, U. Yu. (2016). Vzaimosvyaz´ mezhdu simpaticheskoj nervnoj sistemoj i e´ndotelinom-1 v kapillyarnom krovotoke u bol´nykh ishemicheskoj bolezn´yu serdca – znachenie GNB3 S825T polimorfizma [The relationship between the sympathetic nervous system and endothelin-1 in the capillary blood flow in patients with coronary heart disease - the value GNB3 S825T polymorphism]. Lechaschij vrach, 1, 87–92. [in Russian].
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