Thyroid dysfunction in heart failure with preserved ejection fraction: A systematic review and meta-analysis

Despite controversial findings regarding the association between thyroid hormones and heart failure with preserved ejection fraction (HFpEF), thyroid dysfunction is widely assumed to be independently associated with this condition. Herein, we sought to systematically review the existing literature and estimate the prevalence of thyroid dysfunction in patients with HFpEF.

We conducted a comprehensive search in PubMed, Scopus, Web of Science, Embase, and ProQuest up to the end of November 2024. Observational studies assessing thyroid dysfunction prevalence in patients with HFpEF were included in this study. The prevalence of overt thyroid dysfunction, low T3 syndrome, and subclinical hypothyroidism (SCH) was pooled using a random-effects model. Duval and Tweedie's Trim and Fill test, funnel plot, and Egger's test were utilized for publication bias assessment. All analyses were conducted with R Version 4.5.1 and Comprehensive Meta-Analysis Version 3 software.

Fourteen studies involving 3,931 subjects with HFpEF were included in this analysis. The pooled prevalence of overt thyroid dysfunction, based on six studies, was 15% (95% CI: 7%-29%). The pooled prevalence of low T3 syndrome was 22% (95% CI: 20%-25%), and for SCH, it was 15% (95% CI: 1%-68%).

Despite heterogeneity among the included studies, our findings suggest that thyroid dysfunction is relatively common in patients with HFpEF and may be associated with more severe symptoms and worse outcomes.