Relation between thyroid function and mortality in patients with chronic heart failure

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
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cleland, Professor John
Creator Roles:
Cleland, J. G.F.Writing – review and editing, Supervision
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 > Institute of Health and 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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