Published Online
on January 20, 2003

A more recent version of this article appeared on February 11, 2003

This Article Full Text (PDF) All Versions of this Article: 107/5/708    most recent 01.CIR.0000048124.64204.3Fv1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Iervasi, G. Articles by Donato, L. Search for Related Content PubMed PubMed Citation Articles by Iervasi, G. Articles by Donato, L. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Heart Disease in Women Heart Diseases Hazardous Substances DB LEVOTHYROXINE LIOTHYRONINE Related Collections Secondary prevention Other diagnostic testing Epidemiology

Submitted on September 26, 2002
Accepted on October 17, 2002

Low-T3 Syndrome. A Strong Prognostic Predictor of Death in Patients With Heart Disease

Giorgio Iervasi MD^*, Alessandro Pingitore MD, PhD, Patrizia Landi BSc, Mauro Raciti BSc, Andrea Ripoli PhD, Maria Scarlattini BSc, Antonio L'Abbate MD, and Luigi Donato MD

From C.N.R. Clinical Physiology Institute and Scuola Superiore di Studi Univeritari S. Anna (A.L.A.), Pisa, Italy.

^* To whom correspondence should be addressed. E-mail: iervasi{at}ifc.cnr.it.

Background--Clinical and experimental data have suggested a potential negative impact of low-T3 state on the prognosis of cardiac diseases. The aim of the present prospective study was to assess the role of thyroid hormones in the prognosis of patient population with heart disease.

Methods and Results--A total of 573 consecutive cardiac patients underwent thyroid function profile evaluation. They were divided in two subgroups: group I, 173 patients with low T3, ie, with free T3 (fT3) <3.1 pmol/L, and group II, 400 patients with normal fT3 (3.1 pmol/L). We considered cumulative and cardiac death events. During the 1-year follow-up, there were 25 cumulative deaths in group I and 12 in group II (14.4% versus 3%, P<0.0001); cardiac deaths were 13 in group I and 6 in group II (7.5% versus 1.5%, P=0.0006). According to the Cox model, fT3 was the most important predictor of cumulative death (hazard ratio [HR] 3.582, P<0.0001), followed by dyslipidemia (HR 2.955, P=0.023), age (HR 1.051, P<0.005), and left ventricular ejection fraction (HR 1.037, P=0.006). At the logistic multivariate analysis, fT3 was the highest independent predictor of death (HR 0.395, P=0.003). A prevalence of low fT3 levels was found in patients with NYHA class III-IV illness compared with patients with NYHA class I-II (² 5.65, P=0.019).

Conclusions--Low-T3 syndrome is a strong predictor of death in cardiac patients and might be directly implicated in the poor prognosis of cardiac patients.

Key words: thyroid • heart diseases • prognosis

This article has been cited by other articles:

				I. Klein and S. Danzi Thyroid Hormone Treatment to Mend a Broken Heart J. Clin. Endocrinol. Metab., April 1, 2008; 93(4): 1172 - 1174. [Full Text] [PDF]

				A. Pingitore, E. Galli, A. Barison, A. Iervasi, M. Scarlattini, D. Nucci, A. L'Abbate, R. Mariotti, and G. Iervasi Acute Effects of Triiodothyronine (T3) Replacement Therapy in Patients with Chronic Heart Failure and Low-T3 Syndrome: A Randomized, Placebo-Controlled Study J. Clin. Endocrinol. Metab., April 1, 2008; 93(4): 1351 - 1358. [Abstract] [Full Text] [PDF]

				P. Stenvinkel, J. J. Carrero, J. Axelsson, B. Lindholm, O. Heimburger, and Z. Massy Emerging Biomarkers for Evaluating Cardiovascular Risk in the Chronic Kidney Disease Patient: How Do New Pieces Fit into the Uremic Puzzle? Clin. J. Am. Soc. Nephrol., March 1, 2008; 3(2): 505 - 521. [Abstract] [Full Text] [PDF]

				M. S. Carneiro-Ramos, G. P. Diniz, J. Almeida, R. L. P. Vieira, S. V. B. Pinheiro, R. A. Santos, and M. L. M. Barreto-Chaves Cardiac angiotensin II type I and type II receptors are increased in rats submitted to experimental hypothyroidism J. Physiol., August 15, 2007; 583(1): 213 - 223. [Abstract] [Full Text] [PDF]

				C. Pantos, I. Mourouzis, K. Markakis, A. Dimopoulos, C. Xinaris, A. D. Kokkinos, M. Panagiotou, and D. V. Cokkinos Thyroid hormone attenuates cardiac remodeling and improves hemodynamics early after acute myocardial infarction in rats Eur. J. Cardiothorac. Surg., August 1, 2007; 32(2): 333 - 339. [Abstract] [Full Text] [PDF]

				G. Iervasi, S. Molinaro, P. Landi, M. C. Taddei, E. Galli, F. Mariani, A. L'Abbate, and A. Pingitore Association Between Increased Mortality and Mild Thyroid Dysfunction in Cardiac Patients Arch Intern Med, July 23, 2007; 167(14): 1526 - 1532. [Abstract] [Full Text] [PDF]

				C. Pantos, I. Mourouzis, C. Xinaris, A. D Kokkinos, K. Markakis, A. Dimopoulos, M. Panagiotou, T. Saranteas, G. Kostopanagiotou, and D. V Cokkinos Time-dependent changes in the expression of thyroid hormone receptor {alpha}1 in the myocardium after acute myocardial infarction: possible implications in cardiac remodelling Eur. J. Endocrinol., April 1, 2007; 156(4): 415 - 424. [Abstract] [Full Text] [PDF]

				J. Yu and R. J. Koenig Induction of Type 1 Iodothyronine Deiodinase to Prevent the Nonthyroidal Illness Syndrome in Mice Endocrinology, July 1, 2006; 147(7): 3580 - 3585. [Abstract] [Full Text] [PDF]

				M. G. Trivieri, G. Y. Oudit, R. Sah, B.-G. Kerfant, H. Sun, A. O. Gramolini, Y. Pan, A. D. Wickenden, W. Croteau, G. Morreale de Escobar, et al. Cardiac-specific elevations in thyroid hormone enhance contractility and prevent pressure overload-induced cardiac dysfunction PNAS, April 11, 2006; 103(15): 6043 - 6048. [Abstract] [Full Text] [PDF]

				W. I. Khalife, Y.-D. Tang, J. A. Kuzman, T. A. Thomas, B. E. Anderson, S. Said, P. Tille, E. H. Schlenker, and A. M. Gerdes Treatment of subclinical hypothyroidism reverses ischemia and prevents myocyte loss and progressive LV dysfunction in hamsters with dilated cardiomyopathy Am J Physiol Heart Circ Physiol, December 1, 2005; 289(6): H2409 - H2415. [Abstract] [Full Text] [PDF]

				Y.-D. Tang, J. A. Kuzman, S. Said, B. E. Anderson, X. Wang, and A. M. Gerdes Low Thyroid Function Leads to Cardiac Atrophy With Chamber Dilatation, Impaired Myocardial Blood Flow, Loss of Arterioles, and Severe Systolic Dysfunction Circulation, November 15, 2005; 112(20): 3122 - 3130. [Abstract] [Full Text] [PDF]

				C. Zoccali, G. Tripepi, S. Cutrupi, P. Pizzini, and F. Mallamaci Low Triiodothyronine: A New Facet of Inflammation in End-Stage Renal Disease J. Am. Soc. Nephrol., September 1, 2005; 16(9): 2789 - 2795. [Abstract] [Full Text] [PDF]

				A. Ripoli, A. Pingitore, B. Favilli, A. Bottoni, S. Turchi, N. F. Osman, D. De Marchi, M. Lombardi, A. L'Abbate, and G. Iervasi Does subclinical hypothyroidism affect cardiac pump performance?: Evidence from a magnetic resonance imaging study J. Am. Coll. Cardiol., February 1, 2005; 45(3): 439 - 445. [Abstract] [Full Text] [PDF]

				J. Gussekloo, E. van Exel, A. J. M. de Craen, A. E. Meinders, M. Frolich, and R. G. J. Westendorp Thyroid Status, Disability and Cognitive Function, and Survival in Old Age JAMA, December 1, 2004; 292(21): 2591 - 2599. [Abstract] [Full Text] [PDF]

				M. Emdin, C. Marini, C. Passino, D. Giuggioli, B. Formichi, C. Ferri, J. Khabirinejad, R. Poletti, C. Prontera, A. Iervasi, et al. Right ventricular overload and cardiovascular neuroendocrine derangement in systemic sclerosis Eur. Heart J. Suppl., November 1, 2004; 6(suppl_F): F68 - F73. [Abstract] [Full Text] [PDF]

				A. G. Cerillo, S. Bevilacqua, S. Storti, M. Mariani, E. Kallushi, A. Ripoli, A. Clerico, and M. Glauber Free triiodothyronine: a novel predictor of postoperative atrial fibrillation Eur. J. Cardiothorac. Surg., October 1, 2003; 24(4): 487 - 492. [Abstract] [Full Text] [PDF]

				G. Tripepi, C. Zoccali, J. Auer, T. Weber, B. Eber, G. Iervasi, A. Pingitore, P. Landi, M. Raciti, A. Ripoli, et al. Low Triiodothyronine and Cardiovascular Disease * Low Triiodothyronine and Cardiovascular Disease * Response Circulation, July 29, 2003; 108 (4): e29 - e30. [Full Text] [PDF]