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Thyroid Disorders and Prognosis in Chronic Heart Failure: A Long-Term Follow-Up Study

Massimo Iacoviello¹, Giuseppe Parisi², Margherita I Gioia²

¹University Cardiology Unit, Cardiothoracic Department, Policlinic University Hospital, Bari, Italy.

Endocrine, Metabolic & Immune Disorders Drug Targets

|October 29, 2019

Insights

Hypothyroidism in chronic heart failure patients significantly increases hospitalization risk and, with elevated TSH levels, also increases mortality risk. Hyperthyroidism does not appear to worsen outcomes in these patients.

Area of Science:

Cardiology
Endocrinology
Internal Medicine

Background:

Thyroid disorders can negatively impact the prognosis of patients with chronic heart failure (CHF).
Understanding the prognostic role of thyroid dysfunction in CHF is crucial for patient management.

Purpose of the Study:

To investigate the long-term prognostic significance of various thyroid disorders in a large cohort of outpatients with chronic heart failure.
To determine the association between hypothyroidism, low T3 syndrome, and hyperthyroidism with mortality and heart failure hospitalizations.

Main Methods:

Prospective evaluation of thyroid function (TSH, fT4, T3) in 762 CHF outpatients.
Classification of patients into euthyroid, hypothyroidism, low T3 syndrome, and hyperthyroidism groups.
Assessment of all-cause mortality and heart failure hospitalization as primary and secondary endpoints over a mean follow-up of 5.1 years.

Main Results:

Hypothyroidism (190 patients) was associated with increased risk of death and hospitalization for heart failure.
Low T3 syndrome (15 patients) was independently linked to both heart failure hospitalization and death.
Hyperthyroidism (59 patients) showed no significant association with adverse outcomes.

Conclusions:

Hypothyroidism is a significant predictor of worse prognosis in chronic heart failure patients.
The association of hypothyroidism with hospitalization is independent of TSH levels, while the link to mortality is significant only when TSH exceeds 10 mIU/L.
Hyperthyroidism does not appear to influence the prognosis of chronic heart failure.

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Abstract

Background:

Thyroid disorders may have a negative impact on the prognosis of patients affected by chronic heart failure (CHF).

Objective:

The aim of the current study was to evaluate the prognostic role of all thyroid disorders over a long term follow-up in a single centre large sample of CHF outpatients.

Methods:

In all patients, the function of the thyroid was evaluated at the enrolment and during the follow- up. On the basis of free triiodothyronine (T3), free thyroxine (fT4) and thyroid-stimulating hormone (TSH) serum levels, patients were classified into one of the following four categories: euthyroid subjects, patients affected by hypothyroidism, low T3 (LT3) syndrome and hyperthyroidism. During the follow-up, death for all causes was assessed as primary end-point, whereas time to the first hospitalization for heart failure worsening was the secondary end-point analyzed.

Results:

Among 762 patients, 190 patients were affected by hypothyroidism (Hypo). LT3 syndrome was diagnosed in 15 patients and 59 patients were affected by hyperthyroidism (Hyper). During a long term follow-up (5.1±3.7 years), 303 patients died. Patients with Hypo showed an increased risk of death as well as of hospitalization due to heart failure worsening at univariate regression analysis. At multivariate regression analysis, Hypo remained associated with hospitalization after correction for age >75 years, ischemic aetiology, diabetes, therapy with ACE-inhibitors or ARBs, therapy with betablockers and with aldosterone antagonists, NYHA class 3, systolic arterial pressure <95 mmHg, left ventricular ejection fraction <30%, estimated glomerular filtration rate <60 ml/min, hyponatremia and NTproBNP> 1000 pg/ml. At multivariate analysis, the independent association with death was significant only for the subgroup of patients with TSH >10 mIU/L. LT3 was independently associated with both heart failure hospitalization and death, whereas Hyper was not associated with any of the two considered end-points.

Conclusion:

Hypo is associated with a worse prognosis over a long-term follow-up. The association with heart failure hospitalization is not dependent on the baseline TSH levels, whereas the association with death is significant only when TSH >10 mIU/L. Finally, Hyper does not have any association with a worse prognosis.

Keywords:

Hypothyroidism chronic heart failure hyperthyroidism low T3 Syndrome prognosis thyroid hormones.

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