The Characteristic Changes Of Serum Thyroid Hormone In Patients With Chronic Heart Failure(CHF) And The Related Clinical Research Of The CHF Patients With Euthyroid Sick Syndrome(ESS)

Objectives:To study the characteristic changes of serum thyroid hormone in patients withchronic heart failure(CHF).To examine the changes of echocardiographic parametersand the levels of plasma N-Terminal-proBNP (NT-proBNP) in the CHF patients witheuthyroid sick syndrome(ESS), and the heart failure patient with preserved ejectionfraction(HFpEF) with ESS. To explore the clinical significance.Methods:206CHF patients (NYHA Ⅱ62cases,NYHA III99cases,NYHA IV45cases)and60health control (NYHA I) was selected. We measured the levels of serumthyroid hormone(FT3,FT4,sTSH), the plasma NT-proBNP, the echocardiographicparameters(LVEF,LVEDD, and the value of E,A,E/A ratio,Em,Am,Em/Amratio,E/Em ratio). We compared the difference of the parameters between differentheart function groups, the ESS and non-ESS groups in the CHF patients, the HFpEFand non-HFpEF group in the CHF patients, the ESS and non-ESS group in theHFpEF patients, respectively. The clinical significance was analyzed.Results:1.When the chronic heart failure increased, the levels of FT3and LVEFdecreased significantly (p<0.05), the detection rates of ESS and the levels oflgNT-proBNP increased dramatically (p<0.05). The levels of FT4decreased, whichwas only observed in NYHA class IV CHF patients. The levels of FT3and LVEFdecreased significantly in CHF group when compared with health control group,while the detection rates of ESS and the levels of lgNT-proBNP increasedsignificantly(p<0.05).2.In the ESS group of CHF patients, the degree of chronic heart failure, thelevels of lgNT-proBNP and heart rate increased significantly while LVEF decreased(p<0.05), LVEDD has no detectable changes(p>0.05) when compared with thenon-ESS group in the CHF patients.3.As compared with the contorl group, the detection rates of ESS and the levels of lgNT-proBNP increased significantly, and the levels of FT3,FT4decreased (p<0.05)in the HFpEF and non-HFpEF group in the CHF patients. There was no significantdifferences in the levels of FT3,FT4,sTSH,lgNT-proBNP and the detection rates ofESS between the HFpEF and non-HFpEF group in the CHF patients(p>0.05).4.To compare the differences between the ESS group and non-ESS group in theHFpEF patients,the degree of chronic heart failure, the levels of lgNT-proBNP, thevalue of E and E/Em increased significantly while the value of Em and Em/Amdecreased significantly(p<0.05).5.FT3was positively correlated with LVEF but negatively correlated withlgNT-proBNP in the CHF patients(P＜0.05).6.FT3was positively correlated with the value of Em,Em/Am but negativelycorrelated with lgNT-proBNP and the value of E/Em in the HFpEF patients(P＜0.05).Conclusion:1.The patients with chronic heart failure usually have the complication ofchanges in the thyroid hormone plasma level, which was characterized by thedecreased total serum T3. The levels of FT3decreased while the severity of chronicheart failure and the detection rates of ESS increased. CHF has a close relationshipwith ESS, and they influence each other. The cause-result relationship of CHF andESS needs further studies.2.The hemodynamics abnormity and the neuroendocrine activity might be moresevere in the ESS than in the non-ESS group in the CHF patients. The detraction ofdiastolic function might be more severe in the ESS group than the non-ESS group inthe HFpEF patients.The decreased thyroid hormone plasma levels might not onlyaffect cardiac systolic function but also likely have an impact on cardiac diastolicfunction.3.The combined detection of the levels of serum thyroid hormone, plasmaNT-proBNP, and the echocardiographic parameters was valuable for diagnosingpatients with CHF.