Evaluation of left ventricular systolic asynchrony in patients with subclinical hypothyroidism

Öztürk, Serkan; Alçelik, Aytekin; Özyaşar, Mehmet; Dikbaş, Oğuz; Ayhan, Selim; Özlü, Fatih; Erdem, Alim; Tosun, Mehmet; Baltaci, Davut; Yazıcı, Mehmet

doi:10.5603/cj.2012.0068

Cited by 13 publications

(9 citation statements)

References 30 publications

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“…At baseline, echocardiographic parameters of LV function were not significantly different between the control and the ScH group, which were similar with results from other studies (15,(24)(25)(26)(27)(28). Five months of levothyroxine therapy statistically significantly increased the EF.…”

Section: Discussionsupporting

confidence: 89%

The effect of levothyroxine treatment on left ventricular function in subclinical hypothyroidism

Nakova¹,

Krstevska²,

Kostovska³

et al. 2018

Archives of Endocrinology and Metabolism

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Objective: Treatment of subclinical hypothyroidism (ScH), especially the mild form of ScH, is controversial because thyroid hormones influence cardiac function. We investigate left ventricular systolic and diastolic function in ScH and evaluate the effect of 5-month levothyroxine treatment. Subjects and methods: Fifty-four patients with newly diagnosed mild ScH (4.2 < TSH < 10.0 mU/L) and 30 euthyroid subjects matched by age were analysed. Laboratory analyses and an echocardiography study were done at the first visit and after 5 months in euthyroid stage in patients with ScH. Results: Compared to healthy controls, patients with ScH had a lower E/A ratio (1.03 ± 0.29 vs. 1.26 ± 0.36, p < 0.01), higher E/e' sep. ratio (7.62 ± 2.29 vs. 6.04 ± 1.64, p < 0.01), higher myocardial performance index (MPI) (0.47 ± 0.08 vs. 0.43 ± 0.07, p < 0.05), lower global longitudinal strain (GLS) (-19.5 ± 2.3 vs.-20.9 ± 1.7%, p < 0.05), and lower S wave derived by tissue Doppler imaging (0.077 ± 0.013 vs. 0.092 ± 0.011 m/s, p < 0.01). Levothyroxine treatment in patients with ScH contributed to higher EF (62.9 ± 3.9 vs. 61.6 ± 4.4%, p < 0.05), lower E/e' sep. ratio (6.60 ± 2.06 vs. 7.62 ± 2.29, p < 0.01), lower MPI (0.43 ± 0.07 vs. 0.47 ± 0.08%, p < 0.01), and improved GLS (-20.07 ± 2.7 vs.-19.55 ± 2.3%, p < 0.05) compared to values in ScH patients at baseline. Furthermore, in all study populations (ScH patients before and after levothyroxine therapy and controls), TSH levels significantly negatively correlated with EF (r =-0.15, p < 0.05), E/A (r =-0.14, p < 0.05), GLS (r =-0.26, p < 0.001), and S/TDI (r =-0.22, p < 0.01) and positively correlated with E/e' sep. (r = 0.14, p < 0.05). Conclusion: Patients with subclinical hypothyroidism versus healthy individuals had subtle changes in certain parameters that indicate involvement of systolic and diastolic function of the left ventricle. Although the values of the parameters were in normal range, they were significantly different compared to ScH and the control group at baseline, as well as to the ScH groups before and after treatment. The results of our study suggest that patients with ScH must be followed up during treatment to assess improvement of the disease. Some of the echocardiography obtained parameters were reversible after levothyroxine therapy.

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Section: Discussionsupporting

confidence: 89%

The effect of levothyroxine treatment on left ventricular function in subclinical hypothyroidism

Nakova¹,

Krstevska²,

Kostovska³

et al. 2018

Archives of Endocrinology and Metabolism

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“…LV systolic function is marginally subnormal, with slightly lower ejection fraction and stroke volume values. 29,30 Preload is reduced, with a subnormal cardiac output. High cholesterol levels are an additional risk for the development of atherosclerosis.…”

Section: Mechanisms Of Th Action On the Cardiovascular Systemmentioning

confidence: 98%

Effects of thyroid hormones on the heart

Vargas‐Uricoechea

Bonelo-Perdomo

Sierra‐Torres

2014

Clínica e Investigación en Arteriosclerosis

115

101

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“…Reduced availability of intracellular calcium results in a dysfunctional systole and diastole, leading to poor contractility and ventricular filling [11]. Other possible hemodynamic changes include an increased systemic vascular resistance, pericardial effusion, endothelial dysfunction, impaired relaxation and increased ventricular filling time, ventricular asynchrony, QT prolongation with risk of Torsades de Pointes, heart failure, and cardiogenic shock [13,[16][17][18]. The development of overt heart failure is rare, however, owing to decreased oxygen consumption in cardiac myocytes during the hypothyroid state [14].…”

Section: Discussionmentioning

confidence: 99%

Differential reversibility in heart failure due to hypothyroidism: A series of contrasting cases with review of literature

Roberto¹,

Aung²,

Agarwal³

et al. 2016

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations.IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor. Website: www.ijcasereportsandimages.comDifferential reversibility in heart failure due to hypothyroidism:A series of contrasting cases with review of literature E. Samuel Roberto, Thein Aung, Ajay Agarwal, Roberto J. Colón ABSTRACT Introduction: Ranking third as a leading cause of heart failure in the United States, dilated cardiomyopathy (DCMP) affects 5 in 100,00 adults with an eight-year mortality rate between 70-80%. In the setting of hypothyroidism, DCMP is unique due to its potential reversibility with medical therapy. Thyroid hormone affects cardiac physiology and intracellular calcium regulation via SERCA2 and phospholamban, with concentrations of phospholamban most numerous in the ventricles. Administration of thyroid hormone can restore contractile function. However, the relationship between disease timeline and reversibility in DCMP due to hypothyroidism has not been previously described. Case Series: A 65-year-old Caucasian male presented with new onset severe dyspnea and fatigue. Thyroid-stimulating hormone was markedly elevated. Following levothyroxine therapy, his dilated cardiomyopathy reversed and returned to normal within six months. LVEF improved from 15-45% with decreased chamber dilation. A 60-year-old Caucasian female presented minimally responsive in overt heart failure due to myxedema coma. History revealed chronically uncontrolled hypothyroidism. TSH was significantly elevated. Following prolonged hospitalization and intravenous levothyroxine therapy, her clinical status began to reverse. LVEF improved from 10-25%, with decreased chamber dilation. Conclusion:Once the underlying mechanism of heart failure was addressed, the cases displayed varying recovery of contractility following thyroid hormone replacement. This may suggest that with longer duration of uncontrolled disease and consequent cardiac structural remodeling, the reversibility diminishes into irreversibility. These cases underscore the need to identify and treat early any contributing hypothyroidism in the setting of new onset dilated cardiomyopathy, as reversibility may be at stake.

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Evaluation of left ventricular systolic asynchrony in patients with subclinical hypothyroidism

Cited by 13 publications

References 30 publications

The effect of levothyroxine treatment on left ventricular function in subclinical hypothyroidism

The effect of levothyroxine treatment on left ventricular function in subclinical hypothyroidism

Effects of thyroid hormones on the heart

Differential reversibility in heart failure due to hypothyroidism: A series of contrasting cases with review of literature

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