The bidirectional relationship of thyroid disease and atrial fibrillation: Established knowledge and future considerations

Bekiaridou, Αlexandra; Κάρτας, Αναστάσιος; Moysidis, Dimitrios V.; Papazoglou, Αndreas S.; Baroutidou, Amalia; Papanastasiou, Anastasios D.; Giannakoulas, George

doi:10.1007/s11154-022-09713-0

Cited by 10 publications

(7 citation statements)

References 91 publications

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“…Moreover, this meta-analysis showed that antithyroid drugs restored the hyperthyroidism-induced increase in plasma NT-pro-BNP level. Therefore, aggressive treatment should be used to avoid severe cardiac complications of hyperthyroidism (atrial fibrillation, heart failure, and embolic events) and reduce the risk of cardiovascular death ( 57 , 71 , 72 ).…”

Section: Discussionmentioning

confidence: 99%

Effect of thyroid dysfunction on N-terminal pro-B-type natriuretic peptide levels: A systematic review and meta-analysis

Zhang

et al. 2023

Front. Endocrinol.

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PurposeThyroid hormones (THs) significantly affect the cardiovascular system. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a useful biomarker for diagnosing, evaluating, and predicting outcomes in heart failure (HF). This comprehensive review and meta-analysis aimed to investigate the effects of thyroid dysfunction (hypothyroidism and hyperthyroidism) on NT-proBNP levels.MethodsTwo investigators independently searched PubMed, Embase, Cochrane Library, and Web of Science databases for studies published from inception to July 31, 2022, without any restrictions on language.Results21 studies were included. In participants without HF, NT-proBNP levels may be elevated in those with overt hyperthyroidism (standardized mean difference [SMD] 2.38, 95% confidence interval [CI]:1.0-3.76). Notably, among patients with preexisting HF, significantly higher NT-proBNP levels were found in patients with overt hyperthyroidism, overt hypothyroidism, or subclinical hypothyroidism than in euthyroid subjects (SMD [95%CI] = 0.31[0.01, 0.62], 0.32[0.08, 0.56], and 0.33[0.21, 0.46], respectively). Seven trials compared NT-proBNP levels in patients with thyroid dysfunction before and after therapy, and significant drops in NT-proBNP levels were observed in patients with hyperthyroidism (SMD [95%CI] = -1.53[-2.50, -0.55]) upon achieving a euthyroid state. In contrast, increased NT-proBNP levels were observed in hypothyroid patients after treatment (SMD [95%CI] = 1.07[0.28, 1.85]).ConclusionThyroid dysfunction can significantly affect NT-proBNP levels, which may change upon achieving a euthyroid state. Notably, the effect of thyroid dysfunction on cardiac function may depend on the underlying cardiac status. Thus, timely recognition and effective treatment of cardiac symptoms in patients with thyroid dysfunction are mandatory because the prognosis of HF may be improved with appropriate treatment of thyroid dysfunction.Systematic review registrationhttps://www.crd.york.ac.uk/prospero, identifier CRD42022353700.

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Section: Discussionmentioning

confidence: 99%

Effect of thyroid dysfunction on N-terminal pro-B-type natriuretic peptide levels: A systematic review and meta-analysis

Zhang

et al. 2023

Front. Endocrinol.

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“…Regarding other clinical variables in the multivariate model, a history of thyroid disease, diabetes, and COPD independently predicted the risk of PoAF. The relationship between thyroid disease and the occurrence of atrial fibrillation is well established; moreover, patients with no signs of acute hyperthyroidism but with a history of thyroid disease are also at a higher risk of AF [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Prediction of post-operative atrial fibrillation in patients after cardiac surgery using heart rate variability

Veselá

Osmančík

Heřman

et al. 2023

BMC Cardiovasc Disord

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Purpose Post-operative atrial fibrillation (PoAF) occurs in ~ 30% of patients after cardiac surgery. The etiology of PoAF is complex, but a disbalance in autonomic systems plays an important role. The goal of this study was to assess whether pre-operative heart rate variability analysis can predict the risk of PoAF. Methods Patients without a history of AF with an indication for cardiac surgery were included. Two-hour ECG recordings one day before surgery was used for the HRV analysis. Univariate and multivariate logistic regression, including all HRV parameters, their combination, and clinical variables, were calculated to find the best predictive model for post-operative AF. Results One hundred and thirty-seven patients (33 women) were enrolled in the study. PoAF occurred in 48 patients (35%, AF group); the remaining 89 patients were in the NoAF group. AF patients were significantly older (69.1 ± 8.6 vs. 63.4 ± 10.5 yrs., p = 0.002), and had higher CHA2DS2-VASc score (3 ± 1.4 vs. 2.5 ± 1.3, p = 0.01). In the multivariate regression model, parameters independently associated with higher risk of AF were pNN50, TINN, absolute power VLF, LF and HF, total power, SD2, and the Porta index. A combination of clinical variables with HRV parameters in the ROC analysis achieved an AUC of 0.86, a sensitivity of 0.95, and a specificity of 0.57 and was more effective in PoAF prediction than a combination of clinical variables alone. Conclusion A combination of several HRV parameters is helpful in predicting the risk of PoAF. Attenuation of heart rate variability increases the risk for PoAF.

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“…Oxidative stress and mitochondrial stress can negatively affect atrial myocardial function and contribute to AF [ 50 , 51 , 52 ]. Clinical and experimental studies have showed that altered thyroid states are associated with increased cardiac oxidative stress that is mediated through cell membrane damages, and unsaturated phospholipids accumulation [ 53 , 54 , 55 , 56 ]. Moreover, elevated levels of thyroid hormones induce a hypermetabolic state [ 57 ], which alters the activity of mitochondrial respiratory complexes, promoting the generation of highly reactive superoxide (O 2− ) ions [ 58 ].…”

Section: Mechanisms Of Thyroid Disease-induced Arrhythmogenic Remodelingmentioning

confidence: 99%

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

Takawale

Aguilar

Bouchrit

et al. 2022

Cells

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Atrial fibrillation (AF) is the most common cardiac arrhythmia associated with increased cardiovascular morbidity and mortality. The pathophysiology of AF is characterized by electrical and structural remodeling occurring in the atrial myocardium. As a source of production of various hormones such as angiotensin-2, calcitonin, and atrial natriuretic peptide, the atria are a target for endocrine regulation. Studies have shown that disorders associated with endocrine dysregulation are potential underlying causes of AF. The thyroid gland is an endocrine organ that secretes three hormones: triiodothyronine (T3), thyroxine (T4) and calcitonin. Thyroid dysregulation affects the cardiovascular system. Although there is a well-established relationship between thyroid disease (especially hyperthyroidism) and AF, the underlying biochemical mechanisms leading to atrial fibrosis and atrial arrhythmias are poorly understood in thyrotoxicosis. Various animal models and cellular studies demonstrated that thyroid hormones are involved in promoting AF substrate. This review explores the recent clinical and experimental evidence of the association between thyroid disease and AF. We highlight the current knowledge on the potential mechanisms underlying the pathophysiological impact of thyroid hormones T3 and T4 dysregulation, in the development of the atrial arrhythmogenic substrate. Finally, we review the available therapeutic strategies to treat AF in the context of thyroid disease.

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The bidirectional relationship of thyroid disease and atrial fibrillation: Established knowledge and future considerations

Cited by 10 publications

References 91 publications

Effect of thyroid dysfunction on N-terminal pro-B-type natriuretic peptide levels: A systematic review and meta-analysis

Effect of thyroid dysfunction on N-terminal pro-B-type natriuretic peptide levels: A systematic review and meta-analysis

Prediction of post-operative atrial fibrillation in patients after cardiac surgery using heart rate variability

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

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