The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Prognostic value of total triiodothyronine and free thyroxine levels for the heart failure in patients with acute myocardial infarction

  • Kang, Min Gyu (Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Hahm, Jong Ryeal (Division of Endocrinology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Kim, Kye-Hwan (Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Park, Hyun-Woong (Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Koh, Jin-Sin (Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Hwang, Seok-Jae (Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Hwang, Jin-Yong (Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Ahn, Jong Hwa (Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine) ;
  • Park, Yongwhi (Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine) ;
  • Jeong, Young-Hoon (Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine) ;
  • Park, Jeong Rang (Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Kwak, Choong Hwan (Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine)
  • Received : 2016.09.09
  • Accepted : 2016.12.25
  • Published : 2018.05.01
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Abstract

Background/Aims: Although a low triiodothyronine (T3) state is closely associated with heart failure (HF), it is uncertain whether total T3 levels on admission is correlated with the clinical outcomes of acute myocardial infarction (AMI). The aim of this study is to investigate the prognostic value of total T3 levels for major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with AMI undergone percutaneous coronary intervention (PCI). Methods: A total of 765 PCI-treated AMI patients ($65.4{\pm}12.6years$ old, 215 women) between January 2012 and July 2014 were included and 1-year MACCEs were analyzed. We assessed the correlation of total T3 and free thyroxine (fT4) with prevalence of 1-year MACCEs and the predictive values of total T3, fT4, and the ratio of total T3 to fT4 (T3/fT4), especially for HF requiring re-hospitalization. Results: Thirty patients (3.9%) were re-hospitalized within 12 months to control HF symptoms. Total T3 levels were lower in the HF group than in the non-HF group ($84.32{\pm}21.04ng/dL$ vs. $101.20{\pm}20.30ng/dL$, p < 0.001). Receiver operating characteristic curve analysis showed the cut-offs of total T3 levels (${\leq}85ng/dL$) and T3/fT4 (${\leq}60$) for HF (area under curve [AUC] = 0.734, p < 0.001; AUC = 0.774, p < 0.001, respectively). In multivariate analysis, lower T3/fT4 was an independent predictor for 1-year HF in PCI-treated AMI patients (odds ratio, 1.035; 95% confidential interval, 1.007 to 1.064; p = 0.015). Conclusions: Lower levels of total T3 were well correlated with 1-year HF in PCI-treated AMI patients. The T3/fT4 levels can be an additional marker to predict HF.

Keywords

Acknowledgement

Supported by : National Research Foundation (NRF), Gyeongsang National University

References

  1. Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. N Engl J Med 2001;344:501-509. https://doi.org/10.1056/NEJM200102153440707
  2. Klein I, Danzi S. Thyroid disease and the heart. Circulation 2007;116:1725-1735. https://doi.org/10.1161/CIRCULATIONAHA.106.678326
  3. Friberg L, Drvota V, Bjelak AH, Eggertsen G, Ahnve S. Association between increased levels of reverse triiodothyronine and mortality after acute myocardial infarction. Am J Med 2001;111:699-703. https://doi.org/10.1016/S0002-9343(01)00980-9
  4. Mancini A, Di Segni C, Raimondo S, et al. Thyroid hormones, oxidative stress, and inflammation. Mediators Inflamm 2016;2016:6757154.
  5. Iervasi G, Pingitore A, Landi P, et al. Low-T3 syndrome: a strong prognostic predictor of death in patients with heart disease. Circulation 2003;107:708-713. https://doi.org/10.1161/01.CIR.0000048124.64204.3F
  6. Zhang B, Peng W, Wang C, Li W, Xu Y. A low fT3 level as a prognostic marker in patients with acute myocardial infarctions. Intern Med 2012;51:3009-3015. https://doi.org/10.2169/internalmedicine.51.7902
  7. Lazzeri C, Sori A, Picariello C, Chiostri M, Gensini GF, Valente S. Nonthyroidal illness syndrome in ST-elevation myocardial infarction treated with mechanical revascularization. Int J Cardiol 2012;158:103-104. https://doi.org/10.1016/j.ijcard.2012.03.100
  8. Levine GN, Bates ER, Blankenship JC, et al. 2015 ACC/AHA/SCAI focused update on primary percutaneous coronary intervention for patients with ST-elevation myocardial infarction: an update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention and the 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 2016;133:1135-1147. https://doi.org/10.1161/CIR.0000000000000336
  9. de Vries EM, Fliers E, Boelen A. The molecular basis of the non-thyroidal illness syndrome. J Endocrinol 2015;225:R67-R81. https://doi.org/10.1530/JOE-15-0133
  10. Lymvaios I, Mourouzis I, Cokkinos DV, Dimopoulos MA, Toumanidis ST, Pantos C. Thyroid hormone and recovery of cardiac function in patients with acute myocardial infarction: a strong association? Eur J Endocrinol 2011;165:107-114. https://doi.org/10.1530/EJE-11-0062
  11. Selvaraj S, Klein I, Danzi S, Akhter N, Bonow RO, Shah SJ. Association of serum triiodothyronine with B-type natriuretic peptide and severe left ventricular diastolic dysfunction in heart failure with preserved ejection fraction. Am J Cardiol 2012;110:234-239. https://doi.org/10.1016/j.amjcard.2012.02.068
  12. Ascheim DD, Hryniewicz K. Thyroid hormone metabolism in patients with congestive heart failure: the low triiodothyronine state. Thyroid 2002;12:511-515. https://doi.org/10.1089/105072502760143908
  13. Pingitore A, Landi P, Taddei MC, Ripoli A, L'Abbate A, Iervasi G. Triiodothyronine levels for risk stratification of patients with chronic heart failure. Am J Med 2005;118:132-136. https://doi.org/10.1016/j.amjmed.2004.07.052
  14. Liu Y, Sherer BA, Redetzke RA, Gerdes AM. Regulation of arteriolar density in adult myocardium during low thyroid conditions. Vascul Pharmacol 2010;52:146-150. https://doi.org/10.1016/j.vph.2009.10.003
  15. Franklyn JA, Gammage MD, Ramsden DB, Sheppard MC. Thyroid status in patients after acute myocardial infarction. Clin Sci (Lond) 1984;67:585-590. https://doi.org/10.1042/cs0670585
  16. Pimentel RC, Cardoso GP, Escosteguy CC, Abreu LM. Thyroid hormone profile in acute coronary syndromes. Arq Bras Cardiol 2006;87:688-694.
  17. Ojamaa K, Kenessey A, Shenoy R, Klein I. Thyroid hormone metabolism and cardiac gene expression after acute myocardial infarction in the rat. Am J Physiol Endocrinol Metab 2000;279:E1319-E1324. https://doi.org/10.1152/ajpendo.2000.279.6.E1319
  18. Olivares EL, Marassi MP, Fortunato RS, et al. Thyroid function disturbance and type 3 iodothyronine deiodinase induction after myocardial infarction in rats a time course study. Endocrinology 2007;148:4786-4792. https://doi.org/10.1210/en.2007-0043
  19. Wang WY, Tang YD, Yang M, et al. Free triiodothyronine level indicates the degree of myocardial injury in patients with acute ST-elevation myocardial infarction. Chin Med J (Engl) 2013;126:3926-3929.
  20. Van den Berghe G. Non-thyroidal illness in the ICU: a syndrome with different faces. Thyroid 2014;24:1456-1465. https://doi.org/10.1089/thy.2014.0201
  21. Wilcox RB, Nelson JC, Tomei RT. Heterogeneity in affinities of serum proteins for thyroxine among patients with non-thyroidal illness as indicated by the serum free thyroxine response to serum dilution. Eur J Endocrinol 1994;131:9-13. https://doi.org/10.1530/eje.0.1310009
  22. Kaptein EM, Kaptein JS, Chang EI, Egodage PM, Nicoloff JT, Massry SG. Thyroxine transfer and distribution in critical nonthyroidal illnesses, chronic renal failure, and chronic ethanol abuse. J Clin Endocrinol Metab 1987;65:606-616. https://doi.org/10.1210/jcem-65-4-606
  23. McIver B, Gorman CA. Euthyroid sick syndrome: an overview. Thyroid 1997;7:125-132. https://doi.org/10.1089/thy.1997.7.125

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