| Long-Term Prognostic Value of Free Triiodothyronine in Hypertrophic CardiomyopathyThyroid hormones profile acts as a fundamental regulator in cardiovascular homeostasis in both physiological condition and pathological process.Our previous study,together with other clinical evidence,indicates that thyroid hormone levels,particularly the level of free triiodothyronine,correlate with exacerbated cardiac function and hypothyroid status was an independent risk factor of adverse events in patients with cardiovascular diseases.Hypertrophic cardiomyopathy(HCM)is a genetic heart disease characterized by cardiomyocyte hypertrophy,disarray and interstitial fibrosis with ventricular muscle being thickened,which mainly involves the inter-ventricular septum and left ventricle.Patients with HCM suffer a much higher risk of ventricular arrhythmias and heart failure than normal population,and accumulating evidence suggests that HCM is the leading cause of sudden cardiac death in the young.However,there are limited data regarding thyroid hormone levels and the prognosis of patients with HCM.Objective: Myocardial fibrosis can independently predict the cardiovascular events in patients with hypertrophic cardiomyopathy(HCM).The present study aims to determine whether the value of thyroid hormone(TH)level is also an independent and incremental predictor of adverse events in HCM.Methods: Thyroid function testing in 982 consecutive patients with HCM were examined at the National Center for Cardiovascular Diseases(China)from October2009 to December 2013.From the first visit to the hospital and the diagnosis of HCM,the patients were followed up for the first time.Telephone follow-up and the electronic medical record inquiry system of Fuwai Hospital recorded the adverse events.The end-time of follow-up was December 2016.Patients were divided into three groups according to the free triiodothyronine(FT3): FT3<2.79pg/m L(n=335),2.79pg/m L≤FT3≤3.10 pg/m L(n=310),FT3>3.10 pg/m L(n=337).Results: After a median follow-up of 54 months,39 patients(4%)with all-cause mortality or cardiac transplantation,with rates of 7.8%,2.9% and 1.2% in patients with FT3<2.79pg/m L,2.79pg/m L≤FT3≤3.10 pg/m L and FT3>3.10 pg/m L status,respectively.Multivariable Cox regression analysis identi?ed FT3<2.79 pg/m L as a signi?cant independent predictor of all-cause mortality or cardiac transplantation(HR:8.83,95% CI: 1.115,69.905,p=0.039).Conclusions: The level of FT3 provides clinically relevant information for assessing the risk of long-term adverse events in patients with HCM.Association between thyroid dysfunction and incidence of atrial fibrillation in patients with hypertrophic cardiomyopathyObjective: To explore the correlation between incidence of atrial fibrillation(AF)and thyroid dysfunction in patients with hypertrophic cardiomyopathy(HCM).Methods: Thyroid function testing in 982 consecutive patients with HCM were examined at the National Center for Cardiovascular Diseases(China)from October2009 to December 2013 and followed up through December 2016.Patients were divided into four groups according to the TSH levels: TSH<0.55 m IU/L(n=51)、0.55~2.49 m IU/L(n=611)、2.50~9.9 m IU/L(n=300)and >10.00 m IU/L(n=20).Results : Tota I of 173 patients were diagnosed with AF(17.6%).(1)Compare to HCM patients without AF,HCM patients with AF had older age(P<0.001),higher NT-pro BNP(P=0.002),higher Cr(P=0.005),larger left atrial diameter(P<0.001),higher TSH(P=0.009),lower FT3(P=0.003),lower FT4(P=0.043).(2)In the four groups according to the TSH levels: TSH<0.55 m IU/L、0.55~2.49 m IU/L、2.50~9.9m IU/L and ≥10.00 m IU/L,the incidence of AF were 19.6 %(10/51),14.9%(91/611),21.7%(65/300),and 35%(7/20),respectively.Both high and low TSH levels were associated with an increased incidence of AF.After adjustment for common risk factor(age,NT-pro BNP and so on),stepwise multiple logistic regression analysis revealed that TSH levels were significantly related with the incidence of AF.Compared to patients with TSH 0.55~2.49 ml U/L,the adjusted odds ratio of AF for TSH<0.55,2.50~9.99,≥10.00 m IU/L were 1.044(95% CI 0.407~2.676,P=0.929),2.099(95%CI 1.297~3.397,p=0.003),2.454(95%CI 0.521~11.558,P=0.256),respectively.Conclusion: Our results suggested that thyroid dysfunction was associated with an increased risk of AF in patients with HCM. |
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