Title:TSH Variations in Chronic Heart Failure Outpatients: Clinical Correlates and Outcomes
Volume: 21
Issue: 10
Author(s): Paola Terlizzese, Miriam Albanese, Dario Grande, Giuseppe Parisi, Margherita Ilaria Gioia, Natale Daniele Brunetti, Francesco Lisi, Giuseppe Lisco, Francesca Di Serio, Marco Matteo Ciccone, Vincenzo Triggiani*Massimo Iacoviello
Affiliation:
- Interdisciplinary Department of Medicine – Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari, Piazza Giulio Cesare 11, Policlinico of Bari, Bari, Apulia,Italy
Keywords:
Chronic heart failure, hypothyroidism, prognosis, biomarkers, echocardiography, ventricular dysfunction.
Abstract:
Background: Hypothyroidism is a frequently observed comorbidity in patients with
chronic heart failure (CHF), possibly giving rise to unfavorable outcomes.
Aim: The aim of the study was to evaluate the impact of TSH changes over time on cardiac function
and prognosis of outpatients with CHF.
Methods: Patients underwent clinical, electrocardiographic, and echocardiographic evaluations at
baseline and after 12 months. Moreover, blood chemistry tests were performed to evaluate renal
function, cardiac biomarkers, fT3, fT4, and TSH levels. Based on TSH serum levels, patients were
retrospectively classified into four categories: Group 1, patients with improved thyroid function at
one-year follow up vs. baseline; Group 2, patients with stable and mildly high TSH values (3.74 –
10 mUI/L); Group 3, patients with worsening thyroid function; Euthyroid patients Group, TSH levels
within the normal range of reference at baseline as well as at 12 months follow-up. We considered
as end-points: one-year changes of laboratory and echocardiographic parameters; hospitalizations
due to worsening of HF (acute decompensated heart failure - ADHF); death for all causes.
Results: Among 257 patients, 174 (67.7%) were euthyroid at baseline and after 12 months. Group
1 patients (n. 22, 8.6%) showed a significant improvement in systolic and diastolic function, filling
pressures, NT-proBNP and Galectin-3. Group 2 patients (n. 34, 13.2%) did not exhibit significant
modifications in studied parameters. Group 3 patients (n. 27, 10.5%) showed worsening of diastolic
function and NT-proBNP and a greater risk of ADHF (HR: 2.12; 95%CI: 1.20-3.74; p: 0.009)
and death (HR: 4.05; 95%CI: 2.01-8.15; p<0.001).
Conclusion: In patients with CHF, changes in thyroid function over time influenced echocardiographic
parameters and biomarkers reflecting modifications of cardiac function and prognosis, thus
suggesting the clinical relevance of thyroid deficiency screening and correction.
