Left Ventricular Longitudinal Myocardial Function in Overt Hypothyroidism: A Tissue Doppler Echocardiographic Study

Tiryakioğlu, Selma Kenar; Tiryakioğlu, Osman; Arı, Hasan; Basel, Mehmet Cem; Özkan, Hakan; Bozat, Tahsin

doi:10.1111/j.1540-8175.2009.01043.x

Cited by 22 publications

(17 citation statements)

References 18 publications

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“…When the duration of this hyperthyroidism is prolonged, the increased protein synthesis in cardiac myocytes can lead to concentric cardiac hypertrophy (1,2,4). A thyroid hormone deficit, in contrast, decreases cardiac contractility and delays diastolic relaxation (4,5). Moreover, structural changes such as asymmetric septal hypertrophy (6), cardiomegaly (2), and pericardial effusion (7) have been reported.…”

Section: Introductionmentioning

confidence: 99%

Thyroid Hormone Levels Within Reference Range Are Associated with Heart Rate, Cardiac Structure, and Function in Middle-Aged Men and Women

Roef

Taes

Kaufman

et al. 2013

Thyroid

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Background: Triiodothyronine (T3) has many effects on the heart, and marked changes in cardiac function and structure occur in patients with (subclinical) thyroid disease. We investigated whether between-subject variation in thyroid hormone levels within the euthyroid range is also associated with heart rate and echocardiographic heart function and structure. Methods: Subjects were selected from the Asklepios study (n = 2524), a population-representative random sample of patients aged between 35 and 55 years, free from overt cardiovascular disease at baseline. Analyses were restricted to 2078 subjects (1013 women and 1065 men), not using antihypertensive or thyroid medication nor having antithyroperoxidase antibody levels above clinical cut-off or thyrotropin (TSH) levels outside the reference range. All subjects were phenotyped in-depth and underwent comprehensive echocardiography, including diastolic evaluation. Thyroid function parameters were determined by automated electrochemiluminescence. Results: Heart rate was robustly positively associated with (quartiles of) free T3 (FT3) and T3, both in subjects with TSH levels within reference (0.27-4.2 lU/L) and in narrow TSH range (0.5-2.5 lU/L; p <0.0001). FT3 and T3 were negatively associated with left ventricular (LV) end-diastolic volume but positively associated with relative wall thickness. Total T3 (TT3) was associated with enhanced ventricular contraction (as assessed by tissue Doppler imaging). Free thyroxine, FT3, and TT3 were positively associated with late ventricular filling, and TT3 was associated with early ventricular filling. Conclusion: We have demonstrated a strong positive association between thyroid hormone levels within the euthyroid range and heart rate, and more subtle effects on cardiac function and structure. More specifically, we suggest a smaller LV cavity size (with increased relative wall thickness), an enhanced atrial and ventricular contraction, and LV relaxation with higher circulating thyroid hormones. These results illustrate that variation in thyroid hormone levels, even within the reference range, exerts effects on the heart.

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Section: Introductionmentioning

confidence: 99%

Thyroid Hormone Levels Within Reference Range Are Associated with Heart Rate, Cardiac Structure, and Function in Middle-Aged Men and Women

Roef

Taes

Kaufman

et al. 2013

Thyroid

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“…Overt hypothyroidism is typically associated with grade 1 diastolic dysfunction, but grade 2 or pseudonormal diastolic dysfunction also may be seen (35). Overt hypothyroidism impairs early and late regional and global diastolic peak longitudinal LV strain rates (35,36).…”

Section: Discussionmentioning

confidence: 98%

“…Overt hypothyroidism impairs early and late regional and global diastolic peak longitudinal LV strain rates (35,36). In addition, tissue Doppler-derived e' and the e'/a' ratios are reduced, and the myocardial performance index may be prolonged (37).…”

Section: Discussionmentioning

confidence: 99%

Effects of Subclinical and Overt Primary Hypothyroidism on the Cardiac Function and their Reversibility under Treatment Using Tissue Doppler Echocardiography

Tanase¹

2014

Acta Endo (Buc)

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Background. The modifications of blood pressure and lipid metabolism, the decrease of heart contractility and the increase of systemic vascular resistance that accompany hypothyroidism are caused by the decreased action of thyroid hormones.Objective. The purpose of this study is to evaluate, using echocardiography, the changes of the heart functional parameters in patients with untreated thyroid dysfunctions.Pacients and Methods. Study group included 348 patients for an evaluation of cardiovascular and thyroid status. The control of the thyroid condition was conducted using measurements of the FT3, FT4 and TSH levels, echocardiographic measurements defining the parameters of the function of the left ventricle.Results. The study group was divided into subclinical hypothyroidism (SH, 75 cases), overt hypothyroidism (OH, 123 patients) and normal thyroid function (C, 150 patients). TSH values decreased (from 5.8±15 mUI/L to 2.28±0.63 mUI/L in SH and from 20.23±17.33 mUI/L to 4.24±0.24 mUI/L in OH) after one year of treatment while fT4 and fT3 increased. The parameters obtained revealed significant decreases of the E/A ratio in both groups with hypothyroidism. The isovolumetric relaxation time was significantly higher in SH and OH as compared to the control group (C: 112.50±35.45 msec, SH: 118.75±16.52 msec p<0.05, OH: 130±41.83 msec p<0.001). In addition, the tissue Doppler revealed significant decreases of the E'/A' ratio, measured septally and laterally in the group with overt and subclinical hypothyroidism.Conclusion. In hypothyroidism the systolic and predominantly diastolic function of the left ventricle are impaired. These dysfunctions are reversible under L-T4 substitutive treatment.

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“…The impact of SHT on the cardiovascular system has been studied using tissue Doppler echocardiography in previous studies Refs. [10,11]. Speckle tracking echocardiography (STE) has recently been introduced to evaluate myocardial mechanics.…”

Section: Introductionmentioning

confidence: 99%

Estimation of Left Ventricular Myocardial Mechanics in Patients with Subclinical Hypothyroidism Using Three-Dimensional Speckle Tracking Echocardiography

Chen¹,

Han²,

Zhang³

et al. 2016

j med imaging hlth inform

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Subclinical hypothyroidism (SHT) is an asymptomatic condition defined by increased serum thyroid stimulating hormone (TSH) with normal free thyroid hormone levels. In this study, global left ventricular (LV) myocardial mechanics in patients with SHT by three-dimensional speckle tracking echocardiography (3D-STE) and the influence of levothyroxine therapy on 3D-STE related parameters was evaluate. We used 32 consecutive patients with untreated SHT (10 males and 22 females, mean age: 50.7 ± 12.7 years) and 30 age-and gender-matched healthy volunteers (10 males and 20 females, mean age: 48.7 ± 14.2 years). Evothyroxine replacement therapy was prescribed to all SHT patients, and the euthyroid state is achieved by levothyroxine therapy the following year. The untreated SHT patients had significantly lower global longitudinal strain (GLS), global circumferential strain (GCS) and global area strain (GAS) values as compared to our controls, and the differences between two groups were statistically significant (P < 0 05). Global mechanical index (GMI) in SHT patients after therapy was significantly higher than that in the SHT patients before therapy [−492.7 ± 6.4 (%× ) vs. −386.3 ± 48.6 (%× , unit of GMI), P < 0 001], whereas GMI was still lower in SHT patients after therapy than the controls [−492.7 ± 6.4 (%× ) vs. −630.8 ± 64.8 (%× ), P < 0 001]. The receiver-operating characteristic (ROC) analysis showed that GMI is the best echocardiographic predictor of patients who developed myocardial dysfunction during the follow-up [AUC = 0.947, 95% CI = 0.900-0.994, with a sensitivity of 84.8% and a specificity of 92.4%, and optimal cut-off value for GMI was 473.2 (%× )]. We showed that 3D-STE and the GMI can be used for early detection of LV myocardial impairment and reversal of impairment in patients with SHT after therapy.

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Left Ventricular Longitudinal Myocardial Function in Overt Hypothyroidism: A Tissue Doppler Echocardiographic Study

Abstract: These results indicate that overt hypothyroidism is associated with early impairment in LV longitudinal myocardial function, and that tissue Doppler echocardiography is useful for the grading of disease and detection of early impairment. (ECHOCARDIOGRAPHY 2010;27:505-511).

Cited by 22 publications

References 18 publications

Thyroid Hormone Levels Within Reference Range Are Associated with Heart Rate, Cardiac Structure, and Function in Middle-Aged Men and Women

Thyroid Hormone Levels Within Reference Range Are Associated with Heart Rate, Cardiac Structure, and Function in Middle-Aged Men and Women

Effects of Subclinical and Overt Primary Hypothyroidism on the Cardiac Function and their Reversibility under Treatment Using Tissue Doppler Echocardiography

Estimation of Left Ventricular Myocardial Mechanics in Patients with Subclinical Hypothyroidism Using Three-Dimensional Speckle Tracking Echocardiography

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