Prognostic value of total triiodothyronine and free thyroxine levels for the heart failure in patients with acute myocardial infarction

Abstract

Background/AimsAlthough a low triiodothyronine (T3) state is closely associated with heart failure (HF), it is uncertain whether total T3 levels on admission is correlated with the clinical outcomes of acute myocardial infarction (AMI). The aim of this study is to investigate the prognostic value of total T3 levels for major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with AMI undergone percutaneous coronary intervention (PCI).MethodsA total of 765 PCI-treated AMI patients (65.4 ± 12.6 years old, 215 women) between January 2012 and July 2014 were included and 1-year MACCEs were analyzed. We assessed the correlation of total T3 and free thyroxine (fT4) with prevalence of 1-year MACCEs and the predictive values of total T3, fT4, and the ratio of total T3 to fT4 (T3/fT4), especially for HF requiring re-hospitalization.ResultsThirty patients (3.9%) were re-hospitalized within 12 months to control HF symptoms. Total T3 levels were lower in the HF group than in the non-HF group (84.32 ± 21.04 ng/dL vs. 101.20 ± 20.30 ng/dL, p < 0.001). Receiver operating characteristic curve analysis showed the cut-offs of total T3 levels (≤ 85 ng/dL) and T3/fT4 (≤ 60) for HF (area under curve [AUC] = 0.734, p < 0.001; AUC = 0.774, p < 0.001, respectively). In multivariate analysis, lower T3/fT4 was an independent predictor for 1-year HF in PCI-treated AMI patients (odds ratio, 1.035; 95% confidential interval, 1.007 to 1.064; p = 0.015).ConclusionsLower levels of total T3 were well correlated with 1-year HF in PCI-treated AMI patients. The T3/fT4 levels can be an additional marker to predict HF.

Prognostic Value of Thyroid Hormone FT3 in General Patients Admitted to the Intensive Care Unit

“…A decreased thyroid level has a great influence on the function of the heart and circulation [ 19 ]. Changes in thyroid hormone levels are evident in myocardial infarction, heart failure, and other diseases and can thus be considered a predictor of multiple prognostic indicators [ 7 , 8 , 20 ]. Furthermore, other studies [ 21 , 22 ] also suggested that the selective application of thyroid hormone in patients with myocardial infarction and extracorporeal circulation can improve the survival rates.…”

“…This syndrome is possibly associated with decreased 5′-deiodinase activity and increased 5-deiodination that results in more inactivation of thyroid hormone and the production of 3T3 caused by various factors activated by a systemic inflammatory reaction, decreasing the metabolism of T4 into active T3 [ 5 , 6 ], but the mechanism remains unclear [ 3 ]. Studies have shown that NTIS is associated with an adverse prognosis in acute myocardial infarction [ 7 ], heart failure [ 8 ], sepsis [ 9 ], severe trauma [ 10 ], and acute respiratory distress syndrome [ 11 ]. T3 or free T3 (FT3) can be considered a prognostic indicator in myocardial infarction and heart failure [ 7 , 8 ].…”

“…Studies have shown that NTIS is associated with an adverse prognosis in acute myocardial infarction [ 7 ], heart failure [ 8 ], sepsis [ 9 ], severe trauma [ 10 ], and acute respiratory distress syndrome [ 11 ]. T3 or free T3 (FT3) can be considered a prognostic indicator in myocardial infarction and heart failure [ 7 , 8 ]. It was also found that there was an association between the decrease in T3 or FT3 levels and mortality in intensive care unit (ICU) patients [ 9 , 11 – 13 ].…”

Free triiodothyronine and global registry of acute coronary events risk score on predicting long-term major adverse cardiac events in STEMI patients undergoing primary PCI

“…Zhou et al also reported that a strong association of fT3 levels within the normal range with Gensini score among CAD patients, concluding that fT3 levels could independently predicted the presence and severity of CAD [ 25 ]. The report by Gyu Kang et al showed that levels of fT3 were decreased and the fT3 levels at admission were correlated with 1-year heart failure in PCI-treated acute myocardial infarction (AMI) patients [ 26 ]. Similar to the previous studies, the present study has also revealed a relationship between low serum fT3 levels and the poor prognostic of STEMI patients who underwent PCI.…”

Levothyroxine and the Heart

“…Many observational studies have evaluated cardiovascular function in people with hypothyroidism and Table 1 summarises the results of some large, recent studies [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. The findings of these studies were variable, probably because of differences between populations in terms of the severity of hypothyroidism, the age of the patients, and the presence of comorbidities.…”