Link between Pericardial Effusion and Attenuation of QRS Voltage in Patients with Hypothyroidism

Abstract

Objectives: To determine the clinical correlates of peri- cardial effusion (PE) and a low-voltage electrocardiogram (ECG) in patients with primary hypothyroidism. Methods: ECG, echocardiography and blood tests, including thyroid function tests, were performed in 64 consecutive patients with primary hypothyroidism. Results: Twenty-four patients (38%) had PE and 16 patients (25%) had low voltage. To determine the important variables present in patients with hypothyroidism that may be related to PE, 3 variables (free T4, pulmonary artery systolic pressure and serum albumin) were used in the multivariate analysis. From the analysis, free T4 (odds ratio = 0.032) and pulmonary artery systolic pressure (odds ratio = 1.085) emerged as significant variables related to PE, whereas when 4 variables (free T4, serum albumin, pulmonary artery systolic pressure and PE) were used to determine the important variables related to low voltage, free T4 (odds ratio = 0.029) and serum albumin (odds ratio = 0.255) were the significant variables, but PE had no significant relation with low voltage (p = 0.424). Conclusions: In addition to its association with more severe thyroid hormone deficiency, the presence of PE was also associated with an increase in pulmonary artery pressure, whereas attenuation of QRS voltage was associated with lower colloid osmotic pressure in patients with hypothyroidism.

Hypothyroidism Associated with Echocardiographic Abnormalities

“…Such a result was inferred from the significant p value (<0.0001) of the relation between the low EF and FT3 levels in the subjected group and the control group [14]. It was also clear that patients whom suffered from cardiomyopathy were also afflicted with arrathymeia establishing a strong correlation between the two disorders and was treated using amaidiorone As shown in previous studies, untreated subclinical hypothyroidism (SH) was commonly associated with pericardial effusion and such an association was also present in our study with the echocardiographic findings presenting how 60% of patients with subclinical hypothyroidism also had cardiomyopathy and pericardial effusion whilst 70% of patients with severe hypothyroidism had cardiomyopathy and pericardial effusion [17,18]. This could be explained by the fact that patients with severe hypothyroidism are much older and the duration of their disease was much longer than those with subclinical hypothyroidism with a significant p value <0.0001.…”

Role of Thyroid Hormones in Different Aspects of Cardiovascular System

“…Deiodinases exert a major metabolic control of intracellular TH concentrations leading to a tissue-specific TH bioavailability. All deiodinases are membrane-anchored proteins of [29][30][31][32][33] kDa that share substantial sequence homology; they catalyze and sequentially remove stereo-specific iodine atoms from T4, generating active and inactive isomers of both T3 and diiodothyronine [T2]. The deiodination of T4, T3, and other iodothyronines is an integral component of TH homeostasis [3,4].…”

“…There is a relationship between hypothyroidism and coronary artery disease, either because of the presence of a negative chronotropic and inotropic state or the presence of hypercholesterolemia and hypertension, with an increased risk of atherogenesis; but otherwise, TH are powerful regulators of vasculature in the adult myocardium; therefore, a low free T3 [fT3] state would inhibit neovascularization in cardiac tissue after acute myocardial infarction, which would accelerate cardiac pathologic remodeling and heart failure, leading to short-term and long-term adverse cardiac events [31,32].…”

Low-Voltage Electrocardiogram in Patients with Hypothyroidism and Pericardial Effusion: Can Serial Comparative Quantitative Electrocardiography Offer More?

“…This difference in incidence may be partially due to the different sensitivity of the modalities used for the diagnosis of PE and pleural effusion, and the difficulty in detecting nonpitting peripheral edema in HYP. Overall the study by Yamanaka et al [1] is of importance for clinicians and investigators alike.…”

“…But let us begin with the paper by Yamanaka et al [1] in this issue of Cardiology , for which this serves as a commentary. Yamanaka et al…”