Low T3 Syndrome Is Associated With High Mortality in Hospitalized Patients With Heart Failure

Sato, Yu; Yoshihisa, Akiomi; Kimishima, Yusuke; Kiko, Takatoyo; Kanno, Yuki; Yokokawa, Tetsuro; Abe, Satoshi; Misaka, Tomofumi; Sato, Toshio; Oikawa, Masayoshi; Kobayashi, Atsushi; Yamaki, Takashi; Kunii, Hiroyuki; Nakazato, Kazuhiko; Takeishi, Yasuchika

doi:10.1016/j.cardfail.2019.01.007

Cited by 50 publications

(59 citation statements)

References 41 publications

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“…Several studies have shown that low T3 syndrome is associated independently with adverse clinical outcomes in patients with heart failure [6][7][8]10 . However, definitions of low T3 syndrome and the measurement of thyroid function among different studies varied.…”

Section: Discussionmentioning

confidence: 99%

“…Low T3 syndrome is not uncommon in patients with heart failure (10.6-34.5% of such patients) [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

“…Increasing evidence suggests that low T3 syndrome is associated independently with an increased risk of adverse clinical outcomes in patients with acute heart failure (AHF) [6,8,9] and chronic heart failure [10]. Although previous studies have demonstrated the independent prognostic impact of low T3 syndrome, there is lack of study adjust for baseline N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations.…”

Section: Introductionmentioning

confidence: 99%

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Low tri-iodothyronine syndrome improve the risk prediction of mortality in patients with acute heart failure

Zhang

Liao

Cheang

et al. 2019

Preprint

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Background Clinical studies have suggested that low tri-iodothyronine (T3) syndrome negatively affects the clinical outcomes of patients with acute heart failure (AHF). The aim of this prospective cohort study was to evaluate the effect of low T3 syndrome in terms of prognosis and risk predictive potential in AHF.Methods Low T3 syndrome was defined by a low free T3 level (<3.1 pmol/L) accompanied by a normal thyroid-stimulating hormone level. The association between the free T3 level and mortality and the incremental risk prediction were estimated in adjusted models.Results In total, 312 patients with AHF for whom detailed thyroid hormone profiles were available were prospectively enrolled. Seventy-two patients exhibited low T3 syndrome. Over a median follow-up period of 35 months, 121 cumulative deaths occurred. Cardiovascular death was observed in 94 patients. After extensive adjustment for confounders, the low T3 syndrome associated hazard ratio (95% conﬁdence interval) was 1.74 (1.16-2.61, P =0.007) for all-cause mortality and 1.90 (1.21-2.98, P =0.005) for cardiovascular mortality. The regression splines suggested a negative linear relationship between the free T3 level and mortality risk. Considering reclassification, adding low T3 syndrome to the fully adjusted model improved the risk prediction for all-cause mortality (Integrated discrimination improvement [IDI] 2.0%, P = 0.030; net reclassification improvement [NRI] 8.9%, P = 0.232) and cardiovascular mortality (IDI = 2.5%, P = 0.030; NRI 21.3%, P = 0.013).Conclusions Low T3 syndrome reclassified risk prediction for mortality beyond traditional risk factors.

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Section: Discussionmentioning

confidence: 99%

“…Low T3 syndrome is not uncommon in patients with heart failure (10.6-34.5% of such patients) [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Low tri-iodothyronine syndrome improve the risk prediction of mortality in patients with acute heart failure

Zhang

Liao

Cheang

et al. 2019

Preprint

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“…Finally, the chosen age range was variable (37-75 years). Moreover, in the study of Okayama and Sato, patients with normal left ventricular function were also enrolled (14,15). The study of Mahal et al, showing that in hospitalized HF patients with SCH there was no increase in mortality and major morbidity, was a retrospective population study in which the data were obtained from the Nationwide Inpatient Sample (NIS), using validated ICD-9CM (classification of diseases, 9th edition, clinical modification) codes for the identification of patients with HF and other comorbidities (16).…”

Section: Thyroid and Heart Failure In The Clinical Setting: The Prognmentioning

confidence: 99%

“…Moreover, the negative prognostic stratification is improved by combining measurement of brain natriuretic peptide (BNP; a hormone secreted by cardiomyocytes in response to stretching derived by increased ventricular blood volume, and a validated HF biomarker) with the presence of LT3S both in acute decompensated and in chronic compensated HF (23,24). In another study by Sato, LT3S was associated with high cardiac and overall mortality, accompanied by high central venous pressure, lower nutritional status, and impaired exercise capacity (15). Moreover, the prognostic relevance of TH abnormalities may also be influenced by the fact that TH abnormalities occur in co-morbidities frequently observed in HF.…”

Section: Thyroid and Heart Failure In The Clinical Setting: The Prognmentioning

confidence: 99%

Cardioprotection and Thyroid Hormones in the Clinical Setting of Heart Failure

et al. 2020

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Ischemic heart disease is the main cause of morbidity and mortality worldwide and is becoming more widespread with population aging. Cardioprotection is a dynamic process characterized by mechanisms related to myocardial damage and activation of protective factors. Targeting these processes could be attractive as a new therapeutic strategy in the evolution of post-ischemic heart failure (HF). In this context, the role of thyroid hormone (TH)-mediated cardioprotection is supported by a number of findings regarding the modulation of neuroendocrine systems, inflammatory and oxidative stress status, pro-survival intracellular pathways, and epigenetic factors, its effects on cardiac angiogenesis, structure, and function and on the preservation of mitochondrial function and morphology, and its beneficial effects on cell growth and redifferentiation. Moreover, the numerous effects of TH on the heart involve genomic mechanisms, which include cardiac differentiation during the perinatal period and non-genomic action, directed toward the maintenance of cardiovascular homeostasis. This evidence suggests that there is an opportunity to treat HF patients with TH. This review is mainly focused on the clinical evidence of the role of the thyroid system in the complex setting of HF.

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Prognostic role and relationship of thyroid dysfunction and lipid profile in hospitalized heart failure patients

Zhou

Huang

Zhai

et al. 2023

Clinical Cardiology

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Background: Thyroid dysfunction might have a negative impact on the prognosis of patients with heart failure (HF) and affect the lipid metabolism. The aim of our study was to investigate the prognostic role of thyroid dysfunction and its relationship with lipid profile in hospitalized HF patients.Hypothesis: Thyroid dysfunction strongly correlates with prognosis of HF patients and combination with lipid profile improves the prognostic value. Methods:We performed a single-center retrospective cohort study including hospitalized HF patients between March 2009 and June 2018.Results: Among enrolled 3733 patients, low fT3 (hazard ratio [HR] 1.33; 95% CI:

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Low T3 Syndrome Is Associated With High Mortality in Hospitalized Patients With Heart Failure

Cited by 50 publications

References 41 publications

Low tri-iodothyronine syndrome improve the risk prediction of mortality in patients with acute heart failure

Low tri-iodothyronine syndrome improve the risk prediction of mortality in patients with acute heart failure

Cardioprotection and Thyroid Hormones in the Clinical Setting of Heart Failure

Prognostic role and relationship of thyroid dysfunction and lipid profile in hospitalized heart failure patients

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