Mechanisms and Management of Thyroid Disease and Atrial Fibrillation: Impact of Atrial Electrical Remodeling and Cardiac Fibrosis

Takawale, Abhijit; Aguilar, Martín; Bouchrit, Yasmina; Hiram, Roddy

doi:10.3390/cells11244047

Cited by 17 publications

(5 citation statements)

References 129 publications

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“…The thyroid regulates cardiac structural, functional, and electrical remodeling, as shown in experimental studies at the cellular level and in animal models of thyroid disease. [19,20] The thyroid affects atrial physiology through both endocrine and paracrine mechanisms, rendering the atrial myocardium more sensitive, promoting atrial fibrosis, and increasing the propensity for atrial fibrillation. [21,22] Thyrotoxicosis is a reversible precipitant of atrial fibrillation, with evidence showing that approximately 2-thirds of individuals with thyrotoxicosis experience a spontaneous return to sinus rhythm following the restoration of thyroid hormone levels.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Reversible acute heart failure induced by thyrotoxic cardiomyopathy: A case report

Shi,

Meng,

Yin

et al. 2024

Medicine

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Rationale: Thyrotoxic cardiomyopathy is a rare but severe complication of thyrotoxicosis, leading to episodes of acute heart failure. This case report highlights a rare presentation of thyrotoxic cardiomyopathy with low-output heart failure, emphasizing the importance of early diagnosis and comprehensive management. The report aims to increase awareness among clinicians about the potential reversibility of this condition and the effective strategies for managing such complex cases. Patient concerns: This patient presented with dyspnea and chest constriction, without any antecedent predisposing factors. Subsequently, the patient abruptly manifested symptoms indicative of acute heart failure during outpatient consultation. Electrocardiography revealed rapid atrial fibrillation with type A preexcitation syndrome, whereas cardiac ultrasonography demonstrated global cardiac enlargement with a diminished ejection fraction (EF). Diagnoses: After a comprehensive evaluation, the patient was diagnosed with thyrotoxic cardiomyopathy, acute heart failure, and atrial fibrillation with preexcitation syndrome. Interventions: Immediate interventions comprised diuretic administration, oxygen therapy, and antiarrhythmic agents, addressing acute heart failure concomitant with preexcitation syndrome. Following a fortnight of comprehensive therapeutic measures, the patient was discharged with a prescription for oral medications, notably methimazole. Outcomes: Following the intervention, the patient showed significant improvement with the resolution of heart failure symptoms and dyspnea, restoration of sinus rhythm, improved left ventricular ejection fraction (LVEF improved from 36% to 45%), and normalization of thyroid function. These outcomes underscore the efficacy of the intervention strategy and offer a hopeful prognosis for similar cases. Lessons: Thyrotoxicosis may cause cardiomyopathy in patients with heart failure that manifests as dilated cardiac chambers. Clinicians should carefully screen patients for this reversible condition. Diagnosis requires a comprehensive assessment of various tests, and the therapeutic goal is to restore normal thyroid function.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Reversible acute heart failure induced by thyrotoxic cardiomyopathy: A case report

Shi,

Meng,

Yin

et al. 2024

Medicine

View full text Add to dashboard Cite

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“…According to reports, atrial brosis, ectopy, chronic in ammation, and impaired conduction are all key factors in the pathophysiology of AF [44]. It is increasingly evidenced that chronic in ammation is a characteristic of AF.…”

Section: Discussionmentioning

confidence: 99%

Differential gene expression analysis reveals common biomarkers for systemic lupus erythematosus and atrial fibrillation

Wang,

Liu,

Zhang

et al. 2023

Preprint

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Background Atrial fibrillation (AF) is a significant outcome of systemic lupus erythematosus (SLE), increasing the chances of experiencing blood clotting events and unforeseen mortality. As the underlying mechanism of SLE companied with AF is still unknown, this study sought to uncover potential biomarkers that could be of significant value for individuals dealing with SLE and AF, employing thorough bioinformatics research as the primary approach. Methods The NCBI Gene Expression Omnibus database (GEO) was employed to retrieve a collection of five microarray datasets (GSE50772, GSE41177, GSE79768, GSE81622, and GSE2240). By employing the online analytical tool GEO2R, we conducted an analysis of GSE50772 to pinpoint genes that exhibited differential expression. Significant module genes were discovered by WGCNA (weighted gene co-expression network analysis). To identify DEGs in AF, the 'Limma' package was utilized. Function of the common DEGs was found by functional enrichment analysis. The candidate biomarkers were discovered by applying a machine learning technique. The investigation involved the utilization of Single Sample Gene Set Enrichment Analysis (ssGSEA) scores to perform functional enrichment analysis on the identified candidate biomarkers. To predict the risk of AF in individuals with SLE, a nomogram and a ROC curve were created. The analysis focused on examining the presence of immune cells infiltrating the training datasets of SLE and AF, while also conducting a consensus cluster analysis specifically for SLE. Results 29 common DEGs were identified between SLE and AF. The identification and utilization of five potential biomarkers-ANKRD36B, SLC4A4, ANKRD12, MTUS1 and DSC1-led to the creation of a nomogram with area under the receiver operating characteristic curve 0.900-0.981 across all datasets. The dysregulated immune cell infiltration was associated with the biomarkers. Based on the consensus clustering analysis, it was concluded that three subtypes were the most suitable in terms of quantity. The biomarkers exhibited different expression patterns among the subtypes. Regarding immunological infiltration, each subtype possessed unique traits. Conclusion By employing various bioinformatics research approaches and machine learning techniques, our study identified five candidate biomarkers (ANKRD36B, SLC4A4, ANKRD12, MTUS1, DSC1). Additionally, a nomogram capable of predicting the likelihood of both SLE and AF was developed. The results of our study provide a foundation for future investigations on potential important genes for AF in individuals with SLE. Moreover, it was discovered that AF and SLE exhibited abnormal compositions of immune cells.

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“…51,56 Nearly two-thirds of patients return to normal sinus rhythm 8-10 weeks after achieving a euthyroid state. 57 In those patients with persistent atrial fibrillation despite achieving a euthyroid state, rhythm control may be an option. However, as in the general population with atrial fibrillation, rate control is generally initially preferred.…”

Section: Uncontrolled Hyperthyroidismmentioning

confidence: 99%

Thyrotoxic Cardiomyopathy: State of the Art

Quiroz-Aldave¹,

Durand-Vásquez²,

Lobato-Jeri³

et al. 2023

European Endocrinology

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Thyroid hormones, mainly triiodothyronine, have genomic and non-genomic effects on cardiomyocytes related to the contractile function of the heart. Thyrotoxicosis, which is the set of signs and symptoms derived from the excess of circulating thyroid hormones, leads to increased cardiac output and decreased systemic vascular resistance, increasing the volume of circulating blood and causing systolic hypertension. In addition, the shortening of the refractory period of cardiomyocytes produces sinus tachycardia and atrial fibrillation. This leads to heart failure. Approximately 1% of patients with thyrotoxicosis develop thyrotoxic cardiomyopathy, a rare but potentially fatal form of dilated cardiomyopathy. Thyrotoxic cardiomyopathy represents a diagnosis of exclusion, and prompt identification is crucial as it is a reversible cause of heart failure, and heart function can be recovered after achieving a euthyroid state using antithyroid drugs. Radioactive iodine therapy and surgery are not the best initial therapeutic approach. Moreover, it is important to manage cardiovascular symptoms, for which beta blockers are the first-line therapeutic option.

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Mechanisms and Management of Thyroid Disease and Atrial Fibrillation: Impact of Atrial Electrical Remodeling and Cardiac Fibrosis

Cited by 17 publications

References 129 publications

Reversible acute heart failure induced by thyrotoxic cardiomyopathy: A case report

Reversible acute heart failure induced by thyrotoxic cardiomyopathy: A case report

Differential gene expression analysis reveals common biomarkers for systemic lupus erythematosus and atrial fibrillation

Thyrotoxic Cardiomyopathy: State of the Art

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