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TSH Variations in Chronic Heart Failure Outpatients: Clinical Correlates and Outcomes

Author(s):

Paola Terlizzese, Miriam Albanese, Dario Grande, Giuseppe Parisi, Margherita Ilaria Gioia, Natale Daniele Brunetti, Francesco Lisi, Giuseppe Lisco, Francesca Di Serio, Marco Matteo Ciccone, Vincenzo Triggiani* and Massimo Iacoviello   Pages 1 - 8 ( 8 )

Abstract:


Background: Hypothyroidism is a frequently observed comorbidity in patients with chronic heart failure (CHF), possibly giving rise to unfavorable outcomes.

Aim: The aim of the study was to evaluate the impact of TSH changes over time on cardiac function and prognosis of outpatients with CHF.

Methods: Patients underwent clinical, electrocardiographic, and echocardiographic evaluations at baseline and after 12 months. Moreover, blood chemistry tests were performed to evaluate renal function, cardiac biomarkers, fT3, fT4, and TSH levels. Based on TSH serum levels, patients were retrospectively classified into four categories: Group 1, patients with improved thyroid function at one-year follow up vs. baseline; Group 2, patients with stable and mildly high TSH values (3.74 – 10 mUI/L); Group 3, patients with worsening thyroid function; Euthyroid patients Group, TSH levels within the normal range of reference at baseline as well as at 12 months follow-up. We considered as end-points: one-year changes of laboratory and echocardiographic parameters; hospitalizations due to worsening of HF (acute decompensated heart failure - ADHF); death for all causes.

Results: Among 257 patients, 174 (67.7%) were euthyroid at baseline and after 12 months. Group 1 patients (n. 22, 8.6%) showed a significant improvement in systolic and diastolic function, filling pressures, NT-proBNP and Galectin-3. Group 2 patients (n. 34, 13.2%) did not exhibit significant modifications in studied parameters. Group 3 patients (n. 27, 10.5%) showed worsening of diastolic function and NT-proBNP and a greater risk of ADHF (HR: 2.12; 95%CI: 1.20-3.74; p: 0.009) and death (HR: 4.05; 95%CI: 2.01-8.15; p<0.001).

Conclusion: In patients with CHF, changes in thyroid function over time influenced echocardiographic parameters and biomarkers reflecting modifications of cardiac function and prognosis, thus suggesting the clinical relevance of thyroid deficiency screening and correction.

Keywords:

Chronic heart failure, hypothyroidism, prognosis, biomarkers, echocardiography, ventricular dysfunction.

Affiliation:

Cardiology Unit, Bolognini Hospital, Seriate, Bergamo, School of Cardiology, “A. Moro” University of Bari, Bari, Cardiology Unit, “Sarcone” Hospital, Terlizzi, Cardiology Unit, “Sarcone” Hospital, Terlizzi, Cardiology Unit, “Perrino” Hospital, Brindisi, Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, University of Bari, Department of Emergency and Organ Transplantation (DETO), School of Cardiology, Cardiovascular Diseases Section, Bari, Interdisciplinary Department of Medicine – Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases. School of Medicine, University of Bari, Piazza Giulio Cesare 11, Policlinico of Bari, Bari, Apulia, Clinical Pathology Unit, University Policlinic Hospital of Bari, Bari, School of Cardiology, “A. Moro” University of Bari, Bari, Interdisciplinary Department of Medicine – Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases. School of Medicine, University of Bari, Piazza Giulio Cesare 11, Policlinico of Bari, Bari, Apulia, Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia



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