Abstract 13233: Impact of Thyroid Function on Patients Admitted for Acute Decompensated Heart Failure
Although it is recommended to assess thyroid function as part of the evaluation of patients (pts) with heart failure, this recommendation is based on consensus agreement rather than on evidence from large randomized placebo-controlled clinical trials.
OBJETIVE: To evaluate the relationship between thyroid function and hospital outcome in pts admitted for acute decompensated heart failure (ADHF).
METHODS: Two hundred and twenty eight consecutive pts were prospectively included in the analysis. Thyroid tests were measured at baseline. Hypothyroidism was defined as thyroid-stimulating hormone >4.64 UI/ml; low T3 (LT3) syndrome as T3 <0.79 ng/ml with normal values of thyroid-stimulating hormone and Free T4.
RESULTS: We detected hypothyroidism in 20.2% of pts and LT3 syndrome in 49%. There were no significant differences among groups in demographic characteristics and treatment at admission. Mean left ventricular ejection fraction was similar regardless thyroid function at baseline. Those pts with LT3 syndrome had more hospitalizations during the previous year (53.7% vs 38.0%; p<0.05). At admission, pts with LT3 syndrome had lower systolic blood pressure (SBP<110 mmHg) (31.3% vs 16.1%; p<0.05). Previous treatment with amiodarone was associated with hypothyroidism (35.1% vs 14.6%; p<0.01).
All-cause mortality rate was higher among pts with LT3 syndrome than in the other groups (13.7% vs 5.1%; p<0.05).
LT3 syndrome was associated with increased risk of death in pts admitted for ADHF, after controlling for other known mortality predictors (OR: 5.41; CI 95% 1.22-24.05; p<0.05).
Other independent variables linked to all-cause hospital mortality were age (inversely related, OR 0.92; CI95% 0.88-0.97; p<0.001); NYHA functional classes III-IV (OR: 4.63; CI 95% 1.23-17.34; p<0.05) and SBP<110 mmHg at admission (OR: 3.55; CI 95% 1.02-12.43; p<0.05).
CONCLUSIONS: Abnormal thyroid function was prevalent in our population admitted for acute decompensated heart failure, mostly as low T3 syndrome. This syndrome was frequent in more severly ill patients regardless left ventricular function. Low T3 syndrome was an independent predictor of all-cause mortality during hospitalization.
- © 2013 by American Heart Association, Inc.