Endocrine Abstracts

In elderly patients with symptoms of ischemic heart disease (IHD) coronary angiography often fails to reveal significant atherosclerosis. The causes of the absence of significant coronary atherosclerosis (SCA) in these patients have not been determined.

Purpose: To determine predictors of SCA absence in the elderly IHD patients.

Methods: This is a retrospective study of consecutive 10 713 patients who underwent coronary angiography at the Tyumen Cardiology Centre in 1991–2011. We selected 1483 patients with IHD and without SCA: 124 patients 65 years old and older (group I) and 1.359 patients younger than 65 years (group II).

Results: In patients of group I the incidence of hypothyroidism was higher and incidence of myocardial infarction (MI) was lower compared to group II. Echocardiographic indices of left ventricular (LV) posterior wall thickness, aortic root and left atrium in group I patients were higher. LV diastolic dysfunction was more frequent in patients of group I. According to the results of multivariate analysis LV diastolic dysfunction (OR=2.64; 95% CI 1.21–5.77; P=0.001), hypothyroidism (2.35; 1.45–3.81; 0.015), increased indices of LV posterior wall thickness (1.67; 1.45–3.81; 0.019), left atrium (1.31; 1.09–2.55; 0.002), aortic root (1.26; 1.11–1.55; 0.006) and the absence of prior MI (0.34; 0.15–0.79; 0.011) were independent predictors of the SCA absence in elderly patients with IHD.

Conclusions: Hypothyroidism was strong independent predictor of the SCA absence in elderly IHD patients. Hypothyroidism as a cause of microvascular myocardial dysfunction could manifest clinically as IHD in elderly patients with the absence of SCA.