Alfredo Giuseppe Cerillo1, Simona Storti2, Enkel Kallushi3, Dorela Haxhiademi4, Antonio Miceli3, Michele Murzi3, Sergio Berti5, Mattia Glauber3, Aldo Clerico2, Giorgio Iervasi6. 1. Operative Unit of Cardiac Surgery, "G. Pasquinucci" Hospital, "G. Monasterio" Foundation, Massa, Italy. Electronic address: acerillo@yahoo.com. 2. Clinical Chemistry Laboratory, "G. Pasquinucci" Hospital, "G. Monasterio" Foundation, Massa, Italy. 3. Operative Unit of Cardiac Surgery, "G. Pasquinucci" Hospital, "G. Monasterio" Foundation, Massa, Italy. 4. Anesthesia and Intensive Care, "G. Pasquinucci" Hospital, "G. Monasterio" Foundation, Massa, Italy. 5. Cardiology, "G. Pasquinucci" Hospital, "G. Monasterio" Foundation, Massa, Italy. 6. Operative Unit of Cardiovascular Endocrinology and Metabolism, "G. Monasterio" Foundation, Istituto di Fisiologia Clinica del Consiglio Nazionale delle Ricerche, Pisa, Italy.
Abstract
BACKGROUND: There is strong clinical and experimental evidence that altered thyroid homeostasis negatively affects survival in cardiac patients, but a negative effect of the low triiodothyronine (T3) syndrome on the outcome of coronary artery bypass grafting (CABG) has not been demonstrated. This study was designed to evaluate the prognostic significance of low T3 syndrome in patients undergoing CABG. METHODS: The thyroid profile was evaluated at hospital admission in 806 consecutive CABG patients. Known thyroid disease, severe systemic illness, and use of drugs interfering with thyroid metabolism were considered exclusion criteria. The effect of the baseline free T3 (fT3) concentration and of preoperative low T3 syndrome (fT3 <2.23 pmol/L) on the risk of low cardiac output (CO) and death was analyzed in a logistic regression model. RESULTS: There were 19 (2.3%) deaths, and 64 (7.8%) patients experienced major complications. After univariate analysis, fT3, low T3, New York Heart Association class greater than II, low left ventricular ejection fraction (LVEF), and emergency were associated with low CO and hospital death. History of atrial fibrillation, cardiopulmonary bypass time, and peripheral vascular disease were associated only with low CO. At multivariate analysis, only fT3, low T3, emergency, and LVEF were associated with low CO, and fT3 (odds ratio, 0.172, 95% confidence interval, 0.078 to 0.379; p < 0.0001) and LVEF (odds ratio, 0.934, 95% confidence interval, 0.894 to 0.987; p = 0.03) were the only independent predictors of death. CONCLUSIONS: Our study demonstrates that low T3 is a strong predictor of death and low CO in CABG patients. For this reason, the thyroid profile should be evaluated before CABG, and patients with low T3 should be considered at higher risk and treated accordingly.
BACKGROUND: There is strong clinical and experimental evidence that altered thyroid homeostasis negatively affects survival in cardiac patients, but a negative effect of the low triiodothyronine (T3) syndrome on the outcome of coronary artery bypass grafting (CABG) has not been demonstrated. This study was designed to evaluate the prognostic significance of low T3 syndrome in patients undergoing CABG. METHODS: The thyroid profile was evaluated at hospital admission in 806 consecutive CABG patients. Known thyroid disease, severe systemic illness, and use of drugs interfering with thyroid metabolism were considered exclusion criteria. The effect of the baseline free T3 (fT3) concentration and of preoperative low T3 syndrome (fT3 <2.23 pmol/L) on the risk of low cardiac output (CO) and death was analyzed in a logistic regression model. RESULTS: There were 19 (2.3%) deaths, and 64 (7.8%) patients experienced major complications. After univariate analysis, fT3, low T3, New York Heart Association class greater than II, low left ventricular ejection fraction (LVEF), and emergency were associated with low CO and hospital death. History of atrial fibrillation, cardiopulmonary bypass time, and peripheral vascular disease were associated only with low CO. At multivariate analysis, only fT3, low T3, emergency, and LVEF were associated with low CO, and fT3 (odds ratio, 0.172, 95% confidence interval, 0.078 to 0.379; p < 0.0001) and LVEF (odds ratio, 0.934, 95% confidence interval, 0.894 to 0.987; p = 0.03) were the only independent predictors of death. CONCLUSIONS: Our study demonstrates that low T3 is a strong predictor of death and low CO in CABG patients. For this reason, the thyroid profile should be evaluated before CABG, and patients with low T3 should be considered at higher risk and treated accordingly.
Authors: Edita Jankauskienė; Paulius Orda; Greta Barauskienė; Narseta Mickuvienė; Julija Brožaitienė; Jolanta Justina Vaškelytė; Robertas Bunevičius Journal: Intern Emerg Med Date: 2015-12-21 Impact factor: 3.397
Authors: Viswanathan Rajagopalan; Youhua Zhang; Christine Pol; Clifford Costello; Samantha Seitter; Ann Lehto; Olga V Savinova; Yue-Feng Chen; A Martin Gerdes Journal: Front Physiol Date: 2017-04-12 Impact factor: 4.566