Samuel, N. A., Cuthbert, J. J., Brown, O. I., Kazmi, S., Cleland, J. G.F. , Rigby, A. S. and Clark, A. L. (2021) Relation between thyroid function and mortality in patients with chronic heart failure. American Journal of Cardiology, 139, pp. 57-63. (doi: 10.1016/j.amjcard.2020.10.034) (PMID:33115640)
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Abstract
Thyroid dysfunction is common in patients with chronic heart failure (CHF), but there is conflicting evidence regarding its prognostic significance. We investigated the relation between thyroid function and prognosis in a large, well characterized cohort of ambulatory patients with CHF. Heart failure was defined as signs and symptoms of the disease and either left ventricular systolic dysfunction (LVSD) mild or worse (heart failure with reduced ejection fraction [HFrEF]), or no LVSD and raised amino-terminal pro-B-type natriuretic peptide (NT-proBNP) levels (>125 ng/L; heart failure with normal ejection fraction [HFnEF]). Euthyroid state was defined as a thyroid-stimulating hormone (TSH) level between 0.35 and 4.70 mIU/l, hypothyroidism as TSH >4.70 mIU/l, and hyperthyroidism as TSH <0.35 mIU/l. 2997 patients had HFrEF and 1995 patients had HFnEF. 4491 (90%) patients were euthyroid, 312 (6%) were hypothyroid, and 189 (4%) were hyperthyroid. In univariable analysis, both hypothyroid patients (hazard ratio [HR] 1.25, 95% confidence interval [CI] 1.08 to 1.45) and hyperthyroid patients (HR 1.21, 95% CI 1.01 to 1.46) had a greater risk of death compared with euthyroid patients. There was a U-shaped relation between TSH and outcome. Increasing TSH was a predictor of mortality in univariable analysis (HR 1.02, 95% CI 1.01 to 1.03), but the association disappeared in multivariable analysis. The three strongest predictors of adverse outcome were increasing age, increasing NT-proBNP, and higher NYHA class. In conclusion, although thyroid dysfunction is associated with worse survival in patients with CHF, it is not an independent predictor of mortality.
Item Type: | Articles |
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Status: | Published |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | Cleland, Professor John |
Creator Roles: | |
Authors: | Samuel, N. A., Cuthbert, J. J., Brown, O. I., Kazmi, S., Cleland, J. G.F., Rigby, A. S., and Clark, A. L. |
Subjects: | R Medicine > R Medicine (General) |
College/School: | College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre |
Journal Name: | American Journal of Cardiology |
Publisher: | Elsevier |
ISSN: | 0002-9149 |
ISSN (Online): | 1879-1913 |
Published Online: | 25 October 2020 |
Copyright Holders: | Copyright © 2020 Elsevier Inc. |
First Published: | First published in American Journal of Cardiology 139: 57-63 |
Publisher Policy: | Reproduced in accordance with the publisher copyright policy |
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