亚临床甲状腺机能减退可预测射血分数保留型心力衰竭患者的不良心血管事件

IF 2.8 3区医学 Q1 Pharmacology, Toxicology and Pharmaceutics

Therapeutics and Clinical Risk Management Pub Date : 2024-04-29 DOI:10.2147/tcrm.s433489

Qiang Tan, Ming Chen, Hongmei Yang, Yao Guo, Xiaoyi Zou

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引用次数: 0

摘要

背景：亚临床甲状腺功能减退症（SH）会增加心血管事件的风险，但SH对射血分数保留型心力衰竭（HFpEF）预后的影响尚不完全清楚：在这项前瞻性观察研究中，HFpEF患者被分为甲状腺功能正常组（413人）和甲状腺功能减退组（79人）。对患者进行了至少30个月的随访，以研究SH与HFpEF患者心血管事件之间的关系。主要终点是复合心血管事件（心血管死亡和再次住院）。患者通过超声波测量血流介导的扩张（FMD），以评估内皮功能：结果：SH 组的心血管综合事件发生率高于甲状腺功能正常组（分别为 54.49% 和 26.36%；P < 0.001）。与甲状腺功能亢进组相比，SH 组发生心血管事件的风险更高（分别为 45.56% 和 20.58%；p <0.001），这主要是由于再次住院的风险更高。SH组的心血管病死亡率高于甲状腺功能正常组（分别为13.92%和5.81%；P = 0.017）。Cox 比例危险回归显示，SH（危险比 [HR] 1.921，95% 置信区间 [CI] 1.139-3.240）、TSH 水平（HR 1.025，95% CI 1.010-1.054）、年龄（HR 1.017，95% CI 1.002- 1.034）、LVEF（HR 0.975，95% CI 0.953- 0.996）、心房颤动（HR 1.581，95% CI 1.083- 2.307）、eGFR（HR 0.987，95% CI 0.978- 0.997）和NYHA心功能（HR 2.342，95% CI 1.649- 3.326）是HFpEF患者心血管事件的独立预测因子（所有P均为0.05）：亚临床甲状腺功能减退症与高频心衰患者心血管事件和死亡的增加有关。

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Subclinical Hypothyroidism Predicted Adverse Cardiovascular Events in Patients with Ejection Fraction Preserved Heart Failure

Background: Subclinical hypothyroidism (SH) increases the risk of cardiovascular events, however the influence of SH on prognosis of ejection fraction preserved heart failure (HFpEF) is not fully understood.
Methods: In this prospective observational study, patients with HFpEF were divided into euthyroidism group (n = 413) and SH group (n = 79). Patients were followed up for at least 30 months to examine the association between SH and cardiovascular events in patients with HFpEF. The primary end point was composite cardiovascular events (cardiovascular death and re-hospitalization). The patients underwent flow-mediated dilation (FMD) measurement by ultrasound in order to value endothelial function.
Results: The rate of composite cardiovascular events was higher in SH group than in euthyroidism group (54.49% and 26.36%, respectively; p < 0.001). The higher risk of cardiovascular events in SH group was primarily due to a higher risk of re-hospitalization compared to euthyroidism group (45.56% and 20.58%, respectively; p < 0.001). The rate of cardiovascular death was higher in SH group than in euthyroidism group (13.92% and 5.81%, respectively; p = 0.017). Cox proportional hazards regression showed that SH (hazard ratios [HR] 1.921, 95% confidence interval [CI] 1.139– 3.240), level of TSH (HR 1.025, 95% CI 1.010– 1.054), age (HR 1.017, 95% CI 1.002– 1.034), LVEF (HR 0.975, 95% CI 0.953– 0.996), atrial fibrillation (HR 1.581, 95% CI 1.083– 2.307), eGFR (HR 0.987, 95% CI 0.978– 0.997), and NYHA cardiac function (HR 2.342, 95% CI 1.649– 3.326) were independent predictors of cardiovascular events in patients with HFpEF (all P < 0.05).
Conclusion: Subclinical hypothyroidism was associated with increased cardiovascular events and death in patients with HFpEF.

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来源期刊

Therapeutics and Clinical Risk Management HEALTH CARE SCIENCES & SERVICES-

CiteScore

5.30

自引率

3.60%

发文量

139

审稿时长

16 weeks

期刊介绍： Therapeutics and Clinical Risk Management is an international, peer-reviewed journal of clinical therapeutics and risk management, focusing on concise rapid reporting of clinical studies in all therapeutic areas, outcomes, safety, and programs for the effective, safe, and sustained use of medicines, therapeutic and surgical interventions in all clinical areas. The journal welcomes submissions covering original research, clinical and epidemiological studies, reviews, guidelines, expert opinion and commentary. The journal will consider case reports but only if they make a valuable and original contribution to the literature. As of 18th March 2019, Therapeutics and Clinical Risk Management will no longer consider meta-analyses for publication. The journal does not accept study protocols, animal-based or cell line-based studies.