ECE2017 Guided Posters Thyroid 2 (11 abstracts)
Background: It has been previously demonstrated that thyroid hormone deficiency is associated with a worse outcome in patients affected by chronic heart failure (CHF). However, few data are available about the effects of thyroid replacement therapy on the prognosis of patients.
Aim of the study: The aim of the study was to evaluate the relationship among thyroid replacement therapy, correction of thyroid stimulating hormone (TSH) serum levels and outcome of a series of CHF outpatients.
Methods: We screened CHF outpatients in stable clinical conditions (>1 month) and in conventional therapy. All patients underwent a baseline clinical evaluation, a 12-lead ECG, an echocardiogram and routine blood tests. Thyroid hormones were assessed at the enrolment and routinely during follow-up (every 34 months or every 68 weeks if TSH level was altered at the previous control). All patients with history or newly diagnosed hypothyroidism were managed by endocrinologists. We considered hypothyroidism corrected when TSH serum levels were normalized by thyroid replacement therapy (levothyroxine).
Results: Hypothyroidism was diagnosed in 180 patients (121 males, 67±12 years, left ventricular ejection fraction, LVEF, 33±10%, NYHA class 2.5±0.5, NTproBNP 2125±2975 pg/ml, GFR-EPI 64±22 ml/min*1.73 m2) out of 712 patients. Twenty-four patients were excluded because they were lost at follow-up or died within the first 3 months or because endocrinologists did not prescribe levothyroxine for TSH values not high enough. Among the remaining 156 patients in which levothyroxine was prescribed, in 111 patients a normal TSH value was obtained. During a mean follow-up of 38 months, 29 patients died (25 for cardiovascular causes) and 62 experienced at least one admission for acute decompensated heart failure. The failure in TSH correction was associated with an increased risk of all cause of death (HR: 3.31; 95% CI: 1.596.86; P: 0.001) and of heart failure hospitalization (HR: 2.27; 95% CI: 1.363.79; P: 0.002). At Cox multivariate analysis the failure in TSH correction remained associated with all cause mortality (HR: 2.57; 95% CI: 1.205.51; P: 0.002) and with heart failure hospitalization (HR: 1.78; 95% CI: 1.053.01; P: 0.03) after correction for NYHA class 3, LVEF<35%, NTproBNP>1000, systolic blood pressure <100 mmHg and GFR-EPI<60.
Conclusion: Our results support the possibility that hypothyroidism correction could improve the prognosis of CHF patients, although randomized controlled trials should be designed in order to demonstrate this hypothesis.
20 May 2017 - 23 May 2017