Prevalence And Risk Factors Of Left Ventricular Diastolic Dysfunction In Patients With Hyperthyroidism

Background:Left ventricular(LV)diastolic dysfunction has been demonstrated to be an independent predictor of the future heart failure.Heart failure is one of the severe complications caused by overt hyperthyroidism and seriously affect the patients' quality and duration of life.However,the effects of overt hyperthyroidism on diastolic dysfunction are conflicting,and little is known about the prevalence and risk factors of the diastolic dysfunction in patients with overt hyperthyroidism.Methods:A total of 388 patients with overt hyperthyroidism were included between May2018 and May 2019 in the inpatient of endocrinology department of our hospital and compared with 388 age-and gender-matched euthyroid control subjects.LV diastolic function was evaluated by traditional and tissue-doppler echocardiography,and the study subjects were divided into normal left ventricular diastolic function group and left ventricular diastolic dysfunction group.Routine clinical medical data and echocardiographic parameters were recorded for analysis.Results:The prevalence of LV diastolic dysfunction was 35.1% among hyperthyroid patients and significantly higher than control subjects whose prevalence was 25.5%(P= 0.003),and it increased with age and body mass index(BMI)in patients with overt hyperthyroidism.The possible risk factors for LV diastolic dysfunction,such as hypertension,diabetes,decreased estimated glomerular filtration rate(e GFR),and increased level of thyroid hormones weren't associated with LV diastolic dysfunction.However,overweight or obese were significantly associated with LV diastolic dysfunction(OR = 3.024,95% CI = 1.517-6.027,P = 0.002)compared with normal BMI.When compared with age <40 years old group,40-50 years old group,50-60 years old group and ?60 years old group were significantly associated with LV diastolic dysfunction,with ORs of 2.976(95% CI = 1.744-5.019),12.424(95% CI =4.934-31.283),24.966(95% CI = 5.975-104.321),respectively.However,the results of subgroup analysis showed that serum FT3 level was significantly associated with LV diastolic dysfunction in the age <40 years old group and underweight group,while there were no significant correlation in the age ?40 years old group,normal BMI group and overweight or obese group.Conclusion:LV diastolic dysfunction was very common,in particular,in older and overweight or obese patients with overt hyperthyroidism.Additionally,age and BMI were independent risk factors for LV diastolic dysfunction.The serum FT3 level was an independent risk factor for LV diastolic dysfunction in hyperthyroidism patients with age <40 years old and underweight.Therefore,besides the LV systolic function,we also need focus on the diastolic function in patients with overt hyperthyroidism in clinical work,especially the older and overweight or obese patients.BackgroundLeft ventricular(LV)diastolic dysfunction is an independent predictor of future cardiovascular events including congestive heart failure,stroke,atrial fibrillation,and death.At present,more and more attention has been paid.Early detection of patients with LV diastolic dysfunction can improve clinical outcomes through active monitoring and management.However,the assessment of LV diastolic function is very complicated,and there are currently lack of effective biomarkers which can be used to assess the risk and clinical diagnosis of LV diastolic dysfunction.Connective tissue growth factor(CTGF),a secreted extracellular protein,plays a significant role in cardiac remodeling and dysfunction.We aimed to investigate the associations between plasma CTGF level and the risk of LV diastolic dysfunction in this study and judge its effectiveness in diagnosing LV diastolic dysfunction.MethodsA total of 169 patients with overt hyperthyroidism were included between May2018 and May 2019 in the inpatient of our hospital.LV diastolic function was evaluated by traditional and tissue-doppler echocardiography,and the study subjects were divided into normal LV diastolic function group and LV diastolic dysfunction group,including 118 subjects with normal LV diastolic function and 51 subjects with LV diastolic dysfunction.Routine clinical medical data,biochemical data,thyroid related parameters and echocardiographic parameters were recorded for analysis.Spearman correlation analysis was used to investigate the association between plasma CTGF level and thyroid-related examination indicators or cardiac-related echocardiography parameters.Logistic regression analysis was used to explore the relationship between plasma CTGF level and LV diastolic dysfunction in patients with hyperthyroidism.Additionally,the receiver-operating characteristic curves of plasma CTGF level,serum BNP level and the ratio of BNP/CTGF to diagnose the LV diastolic dysfunction was conducted.ResultsCompared with subjects with normal LV diastolic function,subjects in the LV diastolic dysfunction group had higher age and BMI,as well as lower heart rate,lower serum albumin,lower e GFR,higher serum Tg Ab and BNP level,and the incidences of hypertension were also higher(all P < 0.05).Circulating plasma CTGF levels in the LV diastolic dysfunction group were significantly higher than those in the normal group(normal LV diastolic function group: 7.026 [5.567-8.895],LV diastolic dysfunction group: 8.290 [7.054-9.225]ng/ml,median [(Interquartile range)],P =0.004);Compared with the lowest quartile group,the crude odds ratios(OR)of LV diastolic dysfunction in the second,third,and fourth quartile group were 3.207,5.032 and 4.554,respectively(all P < 0.05).After adjustment for the potentially confounding variables,such as age,gender,BMI,systolic blood pressure,diastolic blood pressure,heart rate,and glomerular filtration rate,the adjusted OR values of the third and fourth quartile group for LV diastolic dysfunction had no obvious change,which were 7.199 and 5.299 respectively,and they were still statistically significant.The results of ROC analysis showed that the plasma CTGF had the largest area under the ROC curve,and the value was 0.659(P = 0.005).ConclusionIn patients with overt hyperthyroidism,compared with subjects with normal LV diastolic function,the level of circulating plasma CTGF in the LV diastolic dysfunction group was significantly increased.Plasma CTGF level is an independent risk factor for LV diastolic dysfunction.Compared with serum BNP level,the plasma CTGF level may have auxiliary diagnostic value for LV diastolic dysfunction.