Prognostic value of free triiodothyronine in patients with dilated cardiomyopathy

Abstract

Background The association between free triiodothyronine (FT3) and long-term prognosis in dilated cardiomyopathy (DCM) patients has not been evaluated. The purpose of this study was to determine whether the level of FT3 could provide prognostic value in patients with DCM. Methods Data of consecutive patients diagnosed with DCM were collected from October 2009 to December 2014. FT3 was measured by fluoroimmunoassay. Other biochemical markers, such as free thyroxin (FT4), thyroid-stimulating hormone, red blood cell, hemoglobin, blood urea nitrogen, and serum creatinine, were tested at the same time. Follow-up was performed every 3 months. The primary endpoint was all-cause mortality. Pearson analysis was used to evaluate the correlation of FT3 and other lab metrics with DCM patients’ prognosis. The association of long-term mortality in DCM and FT3 was compared using Cox hazards model. Results Data of 176 patients diagnosed with DCM were collected. Of them, 24 patients missed FT3 values and six patients were lost to follow-up. Altogether, data of 146 patients were analyzed. During the median follow-up time of 79.9 (53.5–159.6) months, nine patients lost, 61 patients died (non-survival group), and 85 patients survived (survival group). FT3 was significantly lower in non-survival group than that in survival group (3.65 ± 0.83 pmol/L vs. 4.36 ± 1.91 pmol/L; P = 0.003). FT3 also showed a significantly positive correlation with red blood cell and hemoglobin, negatively correlated with age, blood urea nitrogen and serum creatinine ( P < 0.05), respectively. Patients in the group of lower FT3 levels (FT3 ≤3.49 pmol/L) suffered from a higher risk of all-cause mortality ( P for log-rank = 0.001). In multivariate Cox regression analysis, FT3 level was significantly associated with all-cause mortality (hazard ratio: 0.70, 95% confidence interval 0.52–0.95, P for trend = 0.021). Conclusion Low levels of FT3 were associated with increased all-cause mortality in patients with DCM.

Endoplasmic reticulum stress-related gene expression causes the progression of dilated cardiomyopathy by inducing apoptosis

“…We have previously shown that bisphenol A is closely associated with various cardiovascular diseases, including myocardial infarction, arrhythmia, DCM, atherosclerosis, and hypertension ( Zhang et al, 2020 ); and that the circulating triiodothyronine concentration is also associated with the prognosis of patients with DCM ( Zhao et al, 2020 ). Valproic acid is a deacetylation inhibitor that protects the cardiac function of patients who have experienced myocardial infarction through the Foxm1 pathway, and therefore may also represent a potential therapeutic agent for DCM ( Tian et al, 2019 ).…”

Circulating biomarker- and magnetic resonance-based nomogram predicting long-term outcomes in dilated cardiomyopathy

“…[33] Low thyroid function also contributes to myocardial fibrosis and affects heart function. [34][35][36] Zhao et al [37] and our previous study [11] demonstrated that low fT3 levels were strongly correlated with an increased risk of mortality in DCM patients. fT3 provided an incremental predictive value for mortality risk stratification in addition to LGE.…”

Thyroid Hormones—An Underestimated Player in Dilated Cardiomyopathy?

“…In a recent study, Zhao et al [9] clearly demonstrated that low FT3 was linked to the increased mortality rate in patients with DCM. Moreover, the highest risk was associated with the lowest concentration of FT3, which retained significance after multivariate adjustment.…”

“…DCM patients with thyroid dysfunction have a worse long-term prognosis [6][7][8][9][10][11][12]. Seminal investigations of the role of TH in the course of DCM found that although TH levels remained within the normal range in 111 DCM patients, the concentrations of free triiodothyronine (FT3) levels were lower and free thyroxine (FT4) higher, compared to 30 age-matched healthy controls [6].…”