Xiaoping Li1, Xinwei Yang2, Yang Wang3, Ligang Ding2, Jing Wang2, Wei Hua4. 1. Cardiac Arrhythmia Center, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China; Department of Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, People's Republic of China. 2. Cardiac Arrhythmia Center, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China. 3. Biological Information and Statistics Center, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China. 4. Cardiac Arrhythmia Center, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China. Electronic address: drhua@yahoo.cn.
Abstract
BACKGROUND: Subclinical thyroid dysfunction may be a risk factor for mortality in patients with heart failure and may be associated with dilated cardiomyopathy (DCM). This was a cohort study to examine the possible association between subclinical thyroid dysfunction and all-cause mortality in DCM patients, because the current evidence on this association remains elusive. METHODS AND RESULTS: A total of 963 DCM patients were evaluated for thyroid function. Of these patients, 7.1% (n = 68) had subclinical hyperthyroidism (defined as serum thyroid-stimulating hormone [TSH] <0.35 μIU/mL), 84.7% (n = 816) had euthyroidism (TSH 0.35-5.5 μIU/mL), and 8.2% (n = 79) had subclinical hypothyroidism (TSH >5.5 μIU/mL). There was a significant difference in all-cause mortality rates between patients with euthyroidism and patients with subclinical hyper- and hypothyroidism (21%, 38.2%, and 26.6%, respectively; log-rank χ(2) = 13.104; P = .001) with mean follow-up of 3.5 years. After adjustment for other confounding factors at baseline, QRS duration, N-terminal pro-B-type natriuretic peptide, New York Heart Association functional class, left atrial diameter, and subclinical hyperthyroidism (hazard ratio 1.793, 95% CI 1.010-3.183; P = .046) emerged as significant predictors of all-cause mortality. CONCLUSION: DCM patients with subclinical hyper- and hypothyroidism had higher all-cause mortality rates. However, only subclinical hyperthyroidism, not subclinical hypothyroidism, was an independent predictor for increased risk of all-cause mortality.
BACKGROUND: Subclinical thyroid dysfunction may be a risk factor for mortality in patients with heart failure and may be associated with dilated cardiomyopathy (DCM). This was a cohort study to examine the possible association between subclinical thyroid dysfunction and all-cause mortality in DCMpatients, because the current evidence on this association remains elusive. METHODS AND RESULTS: A total of 963 DCMpatients were evaluated for thyroid function. Of these patients, 7.1% (n = 68) had subclinical hyperthyroidism (defined as serum thyroid-stimulating hormone [TSH] <0.35 μIU/mL), 84.7% (n = 816) had euthyroidism (TSH 0.35-5.5 μIU/mL), and 8.2% (n = 79) had subclinical hypothyroidism (TSH >5.5 μIU/mL). There was a significant difference in all-cause mortality rates between patients with euthyroidism and patients with subclinical hyper- and hypothyroidism (21%, 38.2%, and 26.6%, respectively; log-rank χ(2) = 13.104; P = .001) with mean follow-up of 3.5 years. After adjustment for other confounding factors at baseline, QRS duration, N-terminal pro-B-type natriuretic peptide, New York Heart Association functional class, left atrial diameter, and subclinical hyperthyroidism (hazard ratio 1.793, 95% CI 1.010-3.183; P = .046) emerged as significant predictors of all-cause mortality. CONCLUSION:DCMpatients with subclinical hyper- and hypothyroidism had higher all-cause mortality rates. However, only subclinical hyperthyroidism, not subclinical hypothyroidism, was an independent predictor for increased risk of all-cause mortality.
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