Subclinical Hypothyroidism Might Increase the Risk of Postoperative Atrial Fibrillation after Aortic Valve Replacement

Martínez‐Comendador, José Manuel; Vidal, J.M. Marcos; Gualis, Javier; Martín, Cristina; Martín, E.; Otero, Javier; Castaño, Mario

doi:10.1055/s-0035-1555753

Cited by 18 publications

(22 citation statements)

References 25 publications

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“…Although a recent study revealed a possible association of subclinical hypothyroidism with AF/AFL [66], our study, consistent with another study using the Framingham Heart Study participants [67], did not show such an association. Inconsistent with previous studies [68, 69], we did not find a significant association between hypothyroidism or sleep apnea and AF.…”

Section: Discussionsupporting

confidence: 88%

Risk of Atrial Fibrillation or Flutter Associated with Periodontitis: A Nationwide, Population-Based, Cohort Study

et al. 2016

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ObjectiveTo investigate the risk of atrial fibrillation or atrial flutter in patients with periodontitis (PD) in comparison with individuals without PD.MethodsWe used the 1999–2010 Taiwanese National Health Insurance Research Database to identify cases of PD in the year 2000 matching (1:1) with persons without PD during 1999–2000 according to sex and individual age as the control group. Using Cox proportional regression analysis adjusting for potential confounders, including age, sex, and comorbidities at baseline, and average annual number of ambulatory visits and dental scaling frequency during the follow-up period, we estimated hazard ratios (HRs) with 95% confidence intervals (CIs) to examine the risk of atrial fibrillation or flutter in PD patients in comparison with the control group. Subgroup analyses according to age, gender, or comorbidities were conducted to study the robustness of the association and investigate possible interaction effects.ResultsWe enrolled 393,745 patients with PD and 393,745 non-PD individuals. The incidence rates of atrial fibrillation or flutter were 200 per 105 years among the PD group and 181 per 105 years in the non-PD group (incidence rate ratio, 1.10; 95% CI, 1.06–1.14). After adjusting for potential confounders, we found an increased risk of atrial fibrillation or flutter in the PD group compared with the non-PD group (HR, 1.31; 95% CI, 1.25–1.36). The greater risk of atrial fibrillation or flutter in the PD group remained significant across all disease subgroups except hyperthyroidism and sleep apnea.ConclusionThe present study results indicate an increased risk of atrial fibrillation or flutter in patients with PD. Lack of individual information about alcohol consumption, obesity, and tobacco use was a major limitation.

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Section: Discussionsupporting

confidence: 88%

Risk of Atrial Fibrillation or Flutter Associated with Periodontitis: A Nationwide, Population-Based, Cohort Study

et al. 2016

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“…In HVS patients, the mortality rates were similar regardless of TSH levels, providing further supporting that the risk associated with higher TSH levels was not related to cardiac surgery, but to conditions associated with high cardiovascular risk. Regarding the associations of thyroid dysfunction in patients undergoing HVS, Martinez-Comendador et al [ 18 ] reported that SCH was associated with an increased risk of postoperative Afib in patients undergoing aortic valve replacement, but there were limited data on the long-term outcomes of HVS patients according to thyroid function. We did not find any significant effects of SCH on postoperative outcomes in the HVS group, although the number of subjects might not have been sufficient to fully elucidate the impact of SCH on the long-term prognosis in patients with HVS.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, we did not confirm whether the poor outcomes of SCH patients were specific to CABG or would be similar after other cardiac surgical procedures in patients whose cardiovascular risk is not as high. A previous study showed increased postoperative Afib in SCH patients after aortic valve replacement surgery [ 18 ], although they did not present long-term outcomes after surgery.…”

Section: Introductionmentioning

confidence: 96%

Subclinical Hypothyroidism Affects the Long-Term Outcomes of Patients Who Undergo Coronary Artery Bypass Grafting Surgery but Not Heart Valve Surgery

et al. 2020

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Background The aim of this study was to determine the associations between subclinical hypothyroidism (SCH) and long-term cardiovascular outcomes after coronary artery bypass grafting (CABG) or heart valve surgery (HVS). Methods We retrospectively reviewed and compared all-cause mortality, cardiovascular mortality, and cardiovascular events in 461 patients who underwent CABG and 104 patients who underwent HVS. Results During a mean±standard deviation follow-up duration of 7.6±3.8 years, there were 187 all-cause deaths, 97 cardiovascular deaths, 127 major adverse cardiovascular events (MACE), 11 myocardial infarctions, one unstable angina, 70 strokes, 30 hospitalizations due to heart failure, 101 atrial fibrillation, and 33 coronary revascularizations. The incidence of all-cause mortality after CABG was significantly higher in patients with SCH ( n =36, 55.4%) than in euthyroid patients ( n =120, 30.3%), with a hazard ratio of 1.70 (95% confidence interval, 1.10 to 2.63; P =0.018) after adjustment for age, sex, current smoking status, body mass index, underlying diseases, left ventricular dysfunction, and emergency operation. Interestingly, low total triiodothyronine (T3) levels in euthyroid patients who underwent CABG were significantly associated with increased risks of all-cause mortality, cardiovascular mortality, and MACE, but those associations were not observed in HVS patients. Both free thyroxine and thyroid-stimulating hormone levels in euthyroid patients were not related with any cardiovascular outcomes in either the CABG or HVS group. Conclusion SCH or low total T3 might be associated with a poor prognosis after CABG, but not after HVS, implying that preoperative thyroid hormonal status may be important in ischemic heart disease patients.

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“…Atrial enlargement may occur as a consequence of AF (37,38), and LA enlargement preceding AF or higher LAD may lead to an increased risk of incidence and recurrence of AF (39)(40)(41)(42). Additionally, overt and subclinical hypothyroidism has been demonstrated to increase the risk of postoperative AF in the patients underwent cardiac surgery (43)(44)(45). However, our study matched AF in the PS analyses, which indicated that the difference of LAD between hypothyroidism and euthyroid groups was independent of AF.…”

Section: Discussionmentioning

confidence: 57%

Impact of Hypothyroidism on Echocardiographic Characteristics of Patients With Heart Valve Disease: A Single-Center Propensity Score-Based Study

et al. 2020

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Background: Hypothyroidism is known to be correlated with multiple heart diseases. However, the influence of hypothyroidism on the patients with heart valve disease (HVD) is still unclear. The purpose of our study was to investigate the impact of hypothyroidism on echocardiographic characteristics of patients with heart valve disease. Methods: We conducted a retrospective cohort study which included 2,128 patients with HVD, and they were divided into euthyroid, subclinical hypothyroidism (SCHypoT), and overt hypothyroidism (OHypoT) group. Echocardiographic characteristics before and after valve surgery between groups were compared by using propensity score (PS) analysis. Kaplan-Meier analysis was used to compare the percent of recovery of left atrial (LA) enlargement between groups. Results: Overall, 463 patients had hypothyroidism (404 SCHypoT patients and 59 OHypoT patients), and 1,665 patients were euthyroid. At baseline, hypothyroidism was associated with significantly higher left atrial diameter (LAD), interventricular septum thickness, left ventricular posterior wall thickness, pulmonary artery systolic pressure, and lower left ventricular ejection fraction. After valve surgery, only LAD remained significantly higher in the patients with hypothyroidism. Additionally, patients with hypothyroidism had a significantly lower recovery rate of LA enlargement after valve surgery compared with euthyroid patients. Conclusion: Hypothyroidism was associated with a larger LAD in patients with HVD before and after surgery, which may suggest that hypothyroidism is a risk factor of LA enlargement of HVD. Besides, hypothyroidism was associated with a significantly lower recovery rate of LA enlargement after valve surgery.

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Subclinical Hypothyroidism Might Increase the Risk of Postoperative Atrial Fibrillation after Aortic Valve Replacement

Cited by 18 publications

References 25 publications

Risk of Atrial Fibrillation or Flutter Associated with Periodontitis: A Nationwide, Population-Based, Cohort Study

Risk of Atrial Fibrillation or Flutter Associated with Periodontitis: A Nationwide, Population-Based, Cohort Study

Subclinical Hypothyroidism Affects the Long-Term Outcomes of Patients Who Undergo Coronary Artery Bypass Grafting Surgery but Not Heart Valve Surgery

Impact of Hypothyroidism on Echocardiographic Characteristics of Patients With Heart Valve Disease: A Single-Center Propensity Score-Based Study

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