ECE2017 Guided Posters Thyroid 2 (11 abstracts)
Hypothyroidism and heart failure outcome: a study with a long-term follow-up
V Triggiani 1 , B Licchelli 1 , C Rizzo 2 , D Grande 2 , P Terlizzese 2 , T Leopizzi 2 , I Gioia 2 , VA Giagulli 1 , E Guastamacchia 1 & M Iacoviello 3
1Endocrinology and Metabolic Diseases Unit, Interdisciplinary Medicine Department, University of Bari, Bari, Italy; 2School of Cardiology, University of Bari, Bari, Italy; 3Cardiology Unit, Cardiothoracic Department, Polyclinic Hospital of Bari, Bari, Italy.
Background: Hypothyroidism (HT) has been demonstrated to be associated to heart failure (HF) progression.
Aim of the study: To evaluate the impact of HT on the progression of HF during a long-term follow-up.
Methods: From 2006 to 2015, we evaluated 675 consecutive CHF outpatients (523 males, 64±13 years) in stable clinical conditions (>1 month) and in conventional therapy. They underwent a clinical evaluation, 12-lead ECG, echocardiogram, blood pressure measurement and a routine chemistry. They have been carefully evaluated for the presence of thyroid diseases. The follow-up was extended on a median value of 47 months, for a maximum of 123 months. Thyroid function has been evaluated every 4 months, more frequent (every 6 weeks) for patients receiving levothyroxine. The onset of HT during follow-up was defined as detection of TSH values above the upper limit. When HT was detected, thyroid replacement therapy was started according to guidelines. During follow-up were also evaluated hospitalizations related to exacerbation of HF and death.
Results: Four hundred and fifty-five patients (67.7%) were euthyroid at the enrolment and showed a normal thyroid function during the follow-up; in 80 patients (11.8%) there was a previous diagnosis of HT; in 40 patients (5.9%) the HT was detected at the time of enrolment; 52 patients (7.7%) developed HT during the follow-up. To avoid confounding factors, we compared patients in euthyroid status at the enrolment and during follow-up and patients with HT at the enrolment. At univariate Cox regression analysis, a significant association between HT and the events, i.e. mortality for all causes (HR: 1.60; 95% CI: 1.08–2.38; P:0.019) and hospitalization for HF worsening (HR: 2.13; 95% CI: 1.54–2.96; P:<0.001) was found. At multivariate Cox regression analyses, HT remained associated only with HF hospitalization (HR: 1.58; 95% CI: 1.09–2.29; P:0.015), but not with mortality (HR: 1.05;95% CI:0.67–1.65; P:0.819), after correction to LVEF<35%, GFR<60 ml/min/m2, NTproBNP>1000 pg/ml, NYHAIII, PA 95 mmHg.
Conclusion: In a long-term follow-up, HT is independently associated with hospitalization due to HF worsening, but not with mortality. We hypothesise that HT is able to induce hemodynamic instability leading to hospitalization, but, probably, its correction with thyroid hormone therapy could in part blunt its impact on patients’ survival.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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