The Effects Of Nonthyroidal Illness Syndrome And Low EGFR On Mortality In Patients With Coronary Artery Disease

Part1:The effects of nonthyroidal illness syndrome and low e GFR on mortality in patients with heart failure caused by coronary artery diseaseObjectives To determine the prognostic significance of NTIS and low e GFR on long-term all-cause and cardiovascular mortality in patients with heart failure caused by coronary artery disease(CAD).Methods From April 2006 to April 2013, 1169 patients with CAD enrolled in the Department of Cardiology of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital and were divided into normal group(n=552), NTIS group(n=122), low e GFR group(n=361)and combined group(n=131). NTIS was defined as FT3 levels below the lower limit of the reference interval accompanied with FT4 and TSH in or below the reference range. The cut-off value of low e GFR was 60 ml·min-1·(1.73m2)-1. The patients were followed up for 1 to 8 years. Death was defined as the study outcome. The relationship of long-term all-cause and cardiovascular mortality of four group was investigated by Kaplan-Meier curves and multivariate Cox regression analysis.Results After controlling for age and sex, LVEF was significantly lower in the NTIS group(53 ± 10%,p=0.009), the low e GFR group(54 ± 10%,p=0.014)than in the normal group(57± 9%);LVEF was futher lower in the combined group(49 ± 11%,all p<0.05)than in the NTIS group and the low e GFR group. Both all-cause mortality and cardiovascular mortality increased in the NTIS group(11.3% and 7.5%, p<0.05),and the low e GFR group(12.0% and 7.5%, all p<0.05),which was higher than that in the normal group(5.5% and 3.0%). Compared to the NTIS group and the low e GFR group, the combined group(21.7% and 18.0%)further increased all-cause mortality and cardiovascular mortality. Compared to the normal group, the NTIS group had 1.867 times and 1.877 times the risk of all-cause mortality and cardiovascular mortality( 95% CI : 1.042-3.700, p=0.048; 95% CI : 1.085-3.580, p=0.045); the low e GFR group had 2.179 times the risk of overall mortality and 2.379 times the risk of cardiovascular mortality(95% CI:1.298-3.658; p= 0.003;95% CI:1.016-5.568, p=0.046). Compared with the NTIS group and the low e GFR group, the combined group represented significantly higher risks of all-cause mortality(HR: 1.890, 95% CI: 1.110-3.216, p=0.019; HR: 1.592, 95% CI: 1.029-2.463, p=0.037,respectively), and cardiovascular mortality(HR:2.017,95% CI: 1.059-3.845, p=0.033;HR:1.779,95% CI: 1.023-3.093, p=0.041,respectively).Conclusion NTIS and renal insufficiency reduce cardiac function and are associated with increased mortality risk.The coexistence of NTIS and renal insufficiency further reduces cardiac function and exacerbated morality.Part2:The effects of nonthyroidal illness syndrome and low e GFR on mortality in patients with acute myocardial infarctionAims Both NTIS and low e GFR are associated with increased mortality risk in AMI. However, it is unclear whether combined NTIS and low e GFR further increases mortality risk in patients with AMI. Our aim is to investigate whether combined NTIS and low e GFR further increases mortality risk in patients with AMI.Methods From June 2005 to March 2013, 1309 patients with AMI were enrolled in the Department of Cardiology of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital. Based on the diagnosis of NTIS and low e GFR,they were divided into normal group(n=708), NTIS group(n=137), low e GFR group(n=304), and combined NTIS and low e GFR group(n=160). Heart function were compared among the four groups. The patients were followed up for 1 to 8.5 years. Death was defined as the study outcome. In-hospital, all-cause and cardiovascular mortality were compared among the four groups by binary logistic regression and multivariate Cox regression analysis.Results After adjustment for age and sex,LVEF was significantly lower in the NTIS group(52 ± 10%,p=0.023)and the low e GFR group(52 ± 9%,p=0.024)than in the normal group(56 ± 8%,p all<0.05);LVEF was futher lower in the combined group(48 ± 11%)than in the NTIS group and the low e GFR group. Compared to normal group(1.4%, 12.6%, and 7.2%),the NTIS group(10.2%, 24.1%, and 12.9%, respectively, all p<0.05)and the low e GFR group(7.6%, 21.7%, and 13.5%, respectively, all p<0.05) had higher in-hospital, all-cause and cardiovascular mortality. In-hospital, all-cause and cardiovascular mortality in the combined group were 21.9%, 39.1% and 27.8%, respectively, which were significantly higher than in the NTIS group and the low e GFR group(all p<0.05). Compared with the normal group,the NTIS group and the low e GFR group showed an obviously increased risk for in-hospital death(OR: 3.674, 95% CI: 1.164-11.603, p=0.027;and OR: 3.165, 95% CI: 1.054-9.505, p=0.040, respectively),all-cause mortality(HR:2.166,95% CI: 1.250-3.753,p=0.006;HR:2.080,95% CI: 1.289- 3.354, p=0.003),and cardiovascular mortality(HR: 2.175, 95% CI: 1.048- 4.514, p=0.037; HR: 2.287, 95% CI: 1.239- 4.222, p=0.008). Compared with the NTIS group and the low e GFR group, the combined group represented increased higher risks of in-hospital mortality(OR:2.856, 95% CI:1.109 to 7.357, p=0.030; OR:2.486, 95% CI:1.063 to 5.814, p=0.036, respectively), all-cause mortality(HR:1.939, 95% CI:1.139-3.304, p=0.015;HR:2.020, 95% CI:1.300-3.140,p=0.002, respectively), and cardiovascular mortality(HR:2.420, 95% CI:1.239 to 4.725, p=0.010; HR: 2.302, 95% CI:1.372 to 3.860, p=0.002, respectively).Conclusions The patients with NTIS and low e GFR decrease cardiac function and have obviously increased mortality risk in AMI. The coexistence of NTIS and low e GFR presents further reduced heart function,and predicts further increased mortality risk in AMI.