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Triiodothyronine levels for risk stratification of patients with chronic heart failure
Open accessAbstract
Purpose We sought to explore the use of triiodothyronine (T(3)) concentrations as an adjunct to clinical and functional parameters when estimating prognosis in patients with chronic heart failure.Methods We enrolled 281 patients with postischemic (n = 153) or nonischemic (n = 128) dilated cardiomyopathy. Total and free T(3) concentrations, and traditional clinical and functional cardiac parameters, were measured 2 to 5 days after hospital admission. A multivariate model was utilized to predict all-cause and cardiac mortality.Results All-cause mortality was 23% (n = 64) after a mean (+/-SD) of 12 +/- 7 months of follow-up; 47 (73%) of the patients died from cardiac causes. The mean ejection fraction was lower in those patients who died than in those who survived (26% +/- 8% vs. 31% +/- 8%, P < 0.001), as were levels of total T(3) (1.0 +/- 0.4 nmol/L vs. 1.3 +/- 0.3 nmol/L, P < 0.001) and free T(3) (3.2 +/- 1.4 pmol/L vs. 3.7 +/- 1.0 pmol/L, P < 0.001). In a multivariate model, ejection fraction (odds ratio [OR] = 2.0 per 10% decrease; 95% confidence interval [CI]: 1.4 to 2.8 per 10% decrease; P < 0.001) and total T(3) level (OR = 0.3 per 1-nmol/L increase; 95% CI: 0.1 to 0.5 per 1-nmol/L increase; P < 0.001) were the only independent predictors of all-cause mortality. In an alternative model using free T(3) levels, ejection fraction (OR = 1.9; 95% CI: 1.4 to 2.7; P < 0.001) and free T(3) level (OR = 0.6 per 1 pmol/L; 95% CI: 0.5 to 0.8 per 1 pmol/L; P <0.02) were associated with all-cause mortality. When we considered cardiac mortality alone, male sex (OR = 3.5; 95% CI: 1.7 to 13; P < 0.04), ejection fraction (OR = 1.7; 95% CI: 1.2 to 2.5; P < 0.006), and total T(3) level (OR = 0.3; 95% CI: 0.2 to 0.7; P < 0.002) were independent predictors with the multivariate model.Conclusion Low T(3) levels are an independent predictor of mortality in patients with chronic heart failure, adding prognostic information to conventional clinical and functional cardiac parameters.
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“In particular, patients with reduced LV ejection fraction and low T 3 have higher mortality than patients with similar LV ejection fractions, but normal T 3 (134).”
From Thyroid Hormones and Cardiovascular Function and Diseases (2018) · cites this paper as [134]
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ResultInfluentialThyroid hormone, amiodarone therapy, and prognosis in left ventricular systolic dysfunction
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“13,14 In this case report, we delineate a scarcely encountered instance of ascites in the context of severe hypothyroidism, further complicated by cardiac failure.”
BackgroundHeart Failure: From Epidemiology to Pathophysiology
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“Роль концентрації Т3 плазми (трийодтироніну) в якості прогностичного показника оцінювалася в дослідженні 281 пацієнтів із систолічною СН, 122 з яких (43 відсотки) мали плазмову концентрацію загального Т3 нижче нижньої межі норми (≤ 80 нг/дл [1,2 нмоль/л]) [3].”
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Cetin, E. H., Çetin, M. S., Könte, H. C., Ocak, K., Yaman, N. M., Hepşen, S., Özeke, Ö., Temizhan, A., Topaloğlu, S., & Aras, D. (2021) · Biomarkers in Medicine · doi:10.2217/bmm-2020-0425 · Cited by 2
Synthetic Thyroid Hormone and Thyroid Hormone Analogues for Treatment of Heart Failure
Pingitore, A., Lionetti, V., & Forini, F. (2009) · Springer eBooks · doi:10.1007/978-88-470-1143-4_20
Potempa, M., & Jończyk, P. (2015) · Biology and Medicine · doi:10.4172/0974-8369.1000255
“There was an interrelation between reduced both LVEF and total T3, showing higher mortality than in patients having similar LVEF but normal total T3 [110].”
BackgroundPaolino, B. (2015) · Digital Library of Theses and Dissertations (Universidade de São Paulo) · doi:10.11606/t.5.2015.tde-05102015-112923
Insuffisance cardiaque chez l'enfant
Dragulescu, A., & Fraisse, A. (2010) · EMC - Médecine d urgence · doi:10.1016/s1959-5182(10)45574-9
Koenig, R. J. (2009) · Elsevier eBooks · doi:10.1016/b978-1-4160-4745-2.00020-1
Heart Failure, Iodine Intake and Thyroid Hormones
Iervasi, G., & Pingitore, A. (2009) · Elsevier eBooks · doi:10.1016/b978-0-12-374135-6.00110-2
Braithwaite, S. S. (2008) · Elsevier eBooks · doi:10.1016/b978-032304841-5.50063-7
Li, H., Chen, J., Shi, B., Chen, X., Wu, D., & Wang, Y. (2017) · Hematology · doi:10.1080/10245332.2017.1345098
“thelial function [12,30,31], such that lower pretransplant serum FT3 levels are at a higher risk for subsequent microvascular occlusive disorders.”
BackgroundAbbas, N., & Effat, H. (2019) · Research and Opinion in Anesthesia and Intensive Care · doi:10.4103/roaic.roaic_38_18
Thyroid Hormone and Cardiac Repair
Pantos, C. I. (2020) · Springer eBooks · doi:10.1007/978-3-030-36871-5_12
Pingitore, A., & Mastorci, F. (2020) · Springer eBooks · doi:10.1007/978-3-030-36871-5_29
Модель несприятливого перебігу серцевої недостатності з урахуванням тиреоїдного статусу хворих
Pyvovar, S. M. (2020) · Medicine Today and Tomorrow · doi:10.35339/msz.2019.82.01.04
McDermott, M. T. (2009) · Elsevier eBooks · doi:10.1016/b978-0-323-05885-8.00039-8
Relation of Triiodothyronine to Subclinical Myocardial Injury in Patients With Chest Pain
Weltman, N. Y., Pingitore, A., & Iervasi, G. (2013) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2013.05.047
“In fact, we believe that the aforementioned study nicely complements a previous report from our laboratory that demonstrated that serumT3 levels add prognostic information to conventional clinical and functional cardiac parameters in patients with both postischemic and nonischemic dilated cardiomyopathies.(2) However,…”
MethodResultBrain natriuretic peptide (BNP) in euthyroid sick syndrome
Hokkaomeroglu, M. S., Koca, A. O., Ertuğrul, D. T., Dal, K., & Beyan, E. (2021) · Ankara Medical Journal · doi:10.5505/amj.2021.94840
Multisystem Inflammatory Syndrome in Children
(2024) · Frontiers research topics · doi:10.3389/978-2-8325-4694-9
Les nouvelles connaissances sur la génétique d’Oenococcus oeni
Favier, M., Lucas, P., Moine, V., & Renouf, V. (2011) · HAL
Li, Z.-H., Ni, L.-J., Liu, Y.-Q., & Si, D.-Y. (2023) · World Journal of Clinical Cases · doi:10.12998/wjcc.v11.i22.5310
PECULIARITIES OF THE COURSE OF CARDIOVASCULAR PATHOLOGY IN SUBCLINICAL HYPOTHYROIDISM
Kuznetsova, O. E., Kruzhalin, E. E., Кутелев, Г. Г., Cherkashin, D. V., & Nikashin, A. N. (2023) · Translational Medicine · doi:10.18705/2311-4495-2023-10-3-209-222
Akkuş, O., Sen, F., Yasdıbaş, R., Otegen, A. T., Hüzmeli̇, İ., & Akkuş, G. (2024) · Endocrine Metabolic & Immune Disorders - Drug Targets · doi:10.2174/0118715303287732240201122412
Kuz, N. B., & Solomenchuk, T. M. (2024) · Zaporozhye Medical Journal · doi:10.14739/2310-1210.2024.3.300258
Gezer, C., Yıldırım, H., & Maviş, O. (2026) · BMC Cardiovascular Disorders · doi:10.1186/s12872-026-05973-9
Metadata
- Authors
- Pingitore, A., Landi, P., Taddei, M. C., Ripoli, A., L’Abbate, A., & Iervasi, G.
- Affiliations
- Istituto di Fisiologia Clinica (IT)
- Scuola Superiore Sant'Anna (IT)
- Corresponding author
- Pingitore, Alessandro
- Venue
- The American Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 2005-02
- Volume
- 118
- Issue
- 2
- Pages
- 132-136
- ISSN
- 0002-9343 (ISSN-L)
- OpenAlex
- W2171564744
- Cited by
- 192
- References
- 25
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 6 · 2023: 9 · 2022: 5 · 2021: 9 · 2020: 12 · 2019: 11 · 2018: 9 · 2017: 10 · 2016: 10 · 2015: 10 · 2014: 6 · 2013: 9 · 2012: 9
- FWCI
- 7.21
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The American Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- CINECA IRIS Institutional Research Information System (Sant'Anna School of Advanced Studies) (submittedVersion, other-oa)
- JAMA
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Keywords
- triiodothyronine, free triiodothyronine, chronic heart failure, dilated cardiomyopathy, risk stratification, prognosis, all-cause mortality, cardiac mortality, ejection fraction, thyroid hormones, non-ischemic cardiomyopathy, prognostic factors, multivariate risk models, NYHA functional class, NT-proBNP
- MeSH terms
- Aged, Aged, 80 and over, Chronic Disease, Female, Heart Failure, Humans, Male, Middle Aged, Prognosis, Stroke Volume, Triiodothyronine, Biomarkers, Multivariate Analysis, Survival Analysis, Myocardial Ischemia, Risk Assessment
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