Subclinical hypothyroidism is an independent predictor of adverse cardiovascular outcomes in patients with acute decompensated heart failure
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Abstract Aims Altered thyroid hormone metabolism characterized by a low triiodothyronine (T3), so-called low-T3 syndrome, is a common finding in patients with severe systemic diseases. Additionally, subclinical thyroid dysfunction, defined as abnormal thyroid stimulating hormone (TSH) and normal thyroxine (T4), causes left ventricular dysfunction. Our objective was to identify the prevalence and prognostic impact of low-T3 syndrome and subclinical thyroid dysfunction in patients with acute decompensated heart failure (ADHF). Methods and results We examined 274 ADHF patients who were not receiving thyroid medication or amiodarone on admission (70 ± 15 years, 156 male), who underwent thyroid function tests. Euthyroidism was defined as TSH of 0.45 to 4.49 mIU/L; subclinical hypothyroidism as TSH of 4.5 to 19.9 mIU/L; and subclinical hyperthyroidism as TSH < 0.45 mIU/L, with normal free T4 level for the last two. Additionally, low-T3 syndrome was defined as free T3 < 4.0 pmol/L among euthyroidism subjects. On admission, 188 patients (69%) showed euthyroidism, 58 (21%) subclinical hypothyroidism, 5 (2%) subclinical hyperthyroidism, and 95 (35%) low-T3 syndrome. Cox proportional hazards models revealed that higher TSH, but not free T3 and free T4, was independently associated with composite cardiovascular events, including cardiac death and re-hospitalization for heart failure. Indeed, subclinical hypothyroidism was an independent predictor (hazard ratio: 2.31; 95% confidence interval: 1.44 to 3.67; P < 0.001), whereas low-T3 syndrome and subclinical hyperthyroidism were not. Conclusions Subclinical hypothyroidism on admission was an independent predictor of adverse cardiovascular outcomes in ADHF patients, suggesting a possible interaction between thyroid dysfunction and the pathophysiology of ADHF.
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Thyroid hormone metabolism alterations are associated with worse prognosis in patients with ischemic and nonischemic left ventricular dysfunction in both acute decompensated and chronic stable heart failure.
“Furthermore, in addition to conventional risk factors, TH metabolism alterations have been associated with a worse prognosis in patients with both ischemic and nonischemic LV dysfunction in both acute decompensated and chronic stable HF (131-133).”
From Thyroid Hormones and Cardiovascular Function and Diseases (2018) · cites this paper as [132]
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- Authors
- Hayashi, T., Hasegawa, T., Kanzaki, H., Funada, A., Amaki, M., Takahama, H., Ohara, T., Sugano, Y., Yasuda, S., Ogawa, H., & Anzai, T.
- Affiliations
- National Cerebral and Cardiovascular Center (JP)
- Corresponding author
- Hasegawa, Takuya
- ORCID
- Venue
- ESC Heart Failure
- Publisher
- Oxford University Press (OUP)
- Published
- 2016-03-24
- Volume
- 3
- Issue
- 3
- Pages
- 168-176
- ISSN
- 2055-5822 (ISSN-L)
- PMC
- PMC5071693
- OpenAlex
- W2304923927
- Cited by
- 71
- References
- 40
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 7 · 2023: 6 · 2022: 5 · 2021: 12 · 2020: 8 · 2019: 11 · 2018: 8 · 2017: 6 · 2016: 1
- FWCI
- 8.71
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- ESC Heart Failure (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Keywords
- subclinical hypothyroidism, acute decompensated heart failure, low T3 syndrome, subclinical hyperthyroidism, thyroid-stimulating hormone, cardiovascular outcomes, heart failure readmission, cardiovascular mortality, thyroid dysfunction, prognostic factors
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