BNP as a New Biomarker of Cardiac Thyroid Hormone Function

Wang, Kaihao; Ojamaa, Kaie; Samuels, Abigail; Gilani, Nimra; Zhang, Kuo; An, Shimin; Zhang, Youhua; Tang, Yi-Da; Askari, Bardia; Gerdes, A. Martin

doi:10.3389/fphys.2020.00729

Cited by 17 publications

(11 citation statements)

References 54 publications

(101 reference statements)

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“…Second, we require additional follow-up data for this group of patients to clarify the prediction of major adverse cardiovascular events by FT4/FT3 ratio. And some new biological cardiac functional markers associated with thyroid function, such as Brain natriuretic peptide (BNP) ( 37 ), could be added in further study to make our results more reliable. Finally, we need to explore the correlation between the FT4/FT3 ratio with different clinical classifications of CMD.…”

Section: Discussionmentioning

confidence: 99%

FT4/FT3 ratio: A novel biomarker predicts coronary microvascular dysfunction (CMD) in euthyroid INOCA patients

et al. 2022

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BackgroundIschemia and no obstructive coronary artery disease (INOCA) patients who presented coronary microvascular dysfunction (CMD) demonstrate a poor prognosis, yet the risk factors for CMD remain unclear. Subtle changes in thyroid hormone levels within the normal range, especially the free thyroxine (FT4)/free triiodothyronine (FT3) ratio, have been shown to regulate the cardiovascular system. This prospective study investigated the correlation between FT4/FT3 ratio and CMD in euthyroid patients with INOCA.MethodsThis prospective study (www.chictr.org.cn/, ChiCTR2000037112) recruited patients with myocardial ischemia symptoms who underwent both coronary angiography (CAG) and myocardial perfusion imaging (MPI) with dynamic single-photon emission computed tomography (D-SPECT). INOCA was defined as coronary stenosis< 50% and CMD was defined as coronary flow reserve (CFR)<2.5. All patients were excluded from abnormal thyroid function and thyroid disease history.ResultsAmong 71 INOCA patients (15 [21.1%] CMD), FT4 and FT4/FT3 ratio in CMD group were significantly higher and both showed significantly moderate correlation with CFR (r=-0.25, p=0.03; r=-0.34, p=0.003, respectively). The ROC curve revealed that FT4/FT3 ratio had the highest efficacy for predicting CMD with an optimized cutoff value>3.39 (AUC 0.78, p<0.001, sensitivity, 80.0%; specificity, 71.4%). Multivariate logistic regression showed that FT4/FT3 ratio was an independent predictor of CMD (OR 7.62, 95% CI 1.12-51.89, p=0.038, P for trend=0.006).ConclusionIn euthyroid INOCA patients, increased FT4/FT3 ratio levels are associated with the occurrence of CMD, presenting a novel biomarker for improving the risk stratification.

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Section: Discussionmentioning

confidence: 99%

FT4/FT3 ratio: A novel biomarker predicts coronary microvascular dysfunction (CMD) in euthyroid INOCA patients

et al. 2022

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“…Recently published data in rats indicated an inverse relationship between myocardial and serum T3 concentration and the atrial natriuretic peptide. These data suggest that the reduction of circuiting natriuretic peptide during T3 supplementation in CHF could be a more reliable biomarker of intramyocardial T3 concentration, and it could be used to manage T3 supplementation better and provide more accurate therapeutic goals in CHF ( 47 ).…”

Section: Discussionmentioning

confidence: 99%

Effect of levothyroxine replacement therapy in patients with subclinical hypothyroidism and chronic heart failure: A systematic review

2022

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BackgroundChronic heart failure (CHF) affects the health care system with high social and economic costs due to recurrent hospital admissions or frequent ambulatory reassessments. Subclinical hypothyroidism (SCH) is commonly observed in patients with CHF and negatively affects myocardial function and remodeling and, ultimately, increases the risk of hospitalizations and all-cause and cardiovascular (CV) mortality. The role of levothyroxine replacement on relevant CV outcomes in patients with SCH and CHF is unclear.ObjectiveTo assess the effect of levothyroxine (compared to placebo or no treatment) on the incidence of all-cause and CV mortality, major adverse CV events, and heart failure in patients with SCH and CHF.MethodsPubMed/MEDLINE, Cochrane Library, and ClinicalTrial.gov were searched for randomized clinical trials, non-randomized observational, multicentric, and comparative studies. No language restrictions were included. After duplicate removal, articles were screened and extracted for the synthesis according to a hierarchical strategy that included title, abstract, and full-text appraisal. The risk of bias was assessed by RoB2 and ROBIN-I tools. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was applied to rate the quality of evidence and grade the strength of recommendations.ResultsTwo trials were included in the systematic review with considerable indirectness and inaccuracy that down-graded the level of evidence.DiscussionNo evidence supports the use of levothyroxine for treating SCH in CHF due to the lack of reliable and well-designed clinical trials.ConclusionCV outcome and dose-response trials are needed to understand better the role of levothyroxine replacement treatment for a safer prescription in this clinical setting.

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“…Different associations could have been found if we had evaluated total thyroid hormones concentration. Furthermore, we did not evaluate the association of surrogate markers of low thyroid hormone tissue levels ( 22 , 70 ) with cardiovascular risk factors. Also, since it was not possible to measure anti-thyroid antibodies in frozen serum samples, we cannot evaluate the influence of thyroid autoimmunity on cardiovascular risk factors.…”

Section: Discussionmentioning

confidence: 99%

“…Lower free triiodothyronine (FT3) levels have been associated with increased risk of cardiovascular mortality in the general population ( 17 ) and in patients with established cardiovascular disease ( 18 – 20 ). In heart failure, low normal FT3 have been associated with higher BNP levels and with increased risk of adverse events ( 21 , 22 ).…”

Section: Introductionmentioning

confidence: 99%

Association of thyroid function, within the euthyroid range, with cardiovascular risk: The EPIPorto study

et al. 2022

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BackgroundThyroid hormones are important modulators of cardiovascular function. Both hypothyroidism and hyperthyroidism are known to contribute to an increased cardiovascular risk. It remains uncertain whether thyroid hormones level within the euthyroid range are associated with cardiometabolic risk. We aimed to evaluate the association between thyroid function levels within the euthyroid range and cardiovascular risk in a population-based cohort.MethodsEight hundred thirty-five subjects aged ≥45 years from the EPIPorto population-based cohort were included. We excluded participants with TSH, free T4 (FT4), or free T3 (FT3) outside of the reference range, or with previous cardiovascular or thyroid disease. The associations between thyroid function, cardiovascular risk factors and the 10-year estimated risk of cardiovascular events (using SCORE2 and SCORE2-OP) were evaluated in linear and logistic regression models, crudely and adjusting for age, sex, BMI, diabetes, and smoking.ResultsThe mean age of the participants was 61.5 (SD 10.5) years and 38.9% were men. Eleven percent of the participants had diabetes, 47.8% had dyslipidemia, and 54.8% had hypertension. The mean body mass index (BMI) was 27.4 (SD 4.6) kg/m2, and the median (percentile25-75) 10-year risk of cardiovascular events was 5.46% (2.92, 10.11). Participants with higher BMI, larger waist circumference and higher hs-CRP had higher levels of FT3 and FT3/FT4 ratio. Lower FT3/FT4 ratio and higher FT4 levels were associated with higher prevalence of diabetes and more adverse lipid profile. Higher TSH, lower FT3 and lower FT3/FT4 ratio were associated with lower eGFR. Lower FT3, lower FT3/FT4 ratio and higher FT4 were associated with an increased 10-year risk of cardiovascular events.ConclusionsIn a population-based study, variations of thyroid function within the euthyroid range were associated with cardiovascular risk factors. On one hand, individuals with higher BMI, larger waist circumference and higher hs-CRP had higher levels of FT3 and FT3/FT4 ratio. On the other hand, a decreased conversion of T4 to T3 (lower FT3, lower FT3/FT4 ratio and/or higher FT4) was associated with a higher prevalence of diabetes, a more adverse lipid profile, a lower eGFR and an increased 10-year risk of cardiovascular events.

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BNP as a New Biomarker of Cardiac Thyroid Hormone Function

Cited by 17 publications

References 54 publications

FT4/FT3 ratio: A novel biomarker predicts coronary microvascular dysfunction (CMD) in euthyroid INOCA patients

FT4/FT3 ratio: A novel biomarker predicts coronary microvascular dysfunction (CMD) in euthyroid INOCA patients

Effect of levothyroxine replacement therapy in patients with subclinical hypothyroidism and chronic heart failure: A systematic review

Association of thyroid function, within the euthyroid range, with cardiovascular risk: The EPIPorto study

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