Analysis Of Risk Factors Of Hyperthyroid Heart Disease And Its Correlation With GDF15

Objective: Hyperthyroid heart disease(HHD)is one of the most common death causes of hyperthyroidism,and the difficulties of early HHD identification still exist.This study is to analyze the clinical characteristics and risk factors of HHD to help the early prevention of HHD.Due to the lack of HHD biomarkers for its early diagnosis and assessment,this study will also explore the correlation between growth differentiation factor 15(Growth differentiation factor 15,GDF15)and HHD.GDF15 is increasingly recognized as a new marker of cardiovascular disease,which is significantly related to the occurrence,development and prognosis of many heart diseases,such as heart failure,cardiac hypertrophy,atrial fibrillation,coronary heart disease,etc.,but now few study has been found on the correlation between GDF15 and HHD.Methods: A total of 454 hyperthyroidism patients intending to 131 I treatment were enrolled from the inpatient department of the Department of Endocrinology of Wuhan Union Hospital during May 2018 and December 2018.The cohort was divided into two groups according to the diagnostic criteria of hyperthyroidism,hyperthyroid heart disease group(HHD,n=303)and non-hyperthyroid heart disease group(non-HHD,n=151).The plasma GDF15 concentration was measured and analyzed in 36 patients with HHD patients(gdf-HHD group)and 30 hyperthyroidism patients without HHD(gdf-non-HHD group).According to the presence of atrial fibrillation,gdf-HHD group was further divided into atrial fibrillation type HHD group(AF-HHD,n=15)and non-atrial fibrillation HHD group(non-AF-HHD,n=21).To understand the correlation between GDF15 and cardiac enlargement,the hyperthyroidism patients with GDF15 concentrations detected were divided into two groups,larger left atrial end diastolic diameter group(LAEDD>3.5cm)and smaller one(LAEDD≤ 3.5cm),according to the increase of left atrial end diastolic diameter(LAEDD),and the GDF15 concentrations of groups were compared and analyzed.Results: 1.The clinical characteristics and risk factors analysis of HHD:(1)Age,duration of hyperthyroidism,systolic blood pressure,body mass index(BMI),waist circumference,total bilirubin,direct bilirubin,cystatin-C,homocysteine,thyroid peroxidase antibody(TPOAb),thyroid stimulating hormone receptor antibody(TRAb)are significantly higher in HHD group than those in non-HHD group,and albumin is lower in HHD group than thatin non-HHD group(all P-value <0.05).(2)The incidences of abnormal echocardiography and electrocardiogram manifestations,including pulmonary hypertension,heart valve insufficiency,left ventricular diastolic dysfunction,left ventricular high voltage,ST-T segment changes,are significantly increased in HHD group(all P-value <0.01).(3)The results of dual Logistic regression analysis of HHD showed that age,duration of hyperthyroidism,systolic blood pressure and BMI,TRAb were risk factors for hyperthyroidism(Table 5).And another dual Logistic regression analysis of HHD showed that abnormal echocardiography and electrocardiogram manifestations,including pulmonary hypertension,heart valve insufficiency,left ventricular diastolic dysfunction,left ventricular high voltage,ST-T segment changes,were closely related to the diagnosis of HHD independent of age,course of hyperthyroidism and BMI(Table 6).2.The correlation analysis between GDF15 and HHD:(1)Our study found that the growth differentiation factor 15(GDF15)concentration in gdf-HHD group was significantly higher than that in gdf-non-HHD group(P-value =0.008).The subgroup analysis indicated that GDF15 concentration was significantly different between AF-HHD and gdf-non-HHD groups(P-value =0.027),but no difference between non-AF-HHD and gdf-non-HHD groups(P-value =0.058)or AF-HHD and non-AF-HHD groups(P-value >0.05).The GDF15 concentration is significantly higher in the larger left atrial end diastolic diameter group(LAEDD >3.5cm)than that in the smaller one(LAEDD ≤3.5cm)(P-value =0.017).(2)Logistic regression analysis with hyperthyroidism heart as the dependent variable showed that GDF15 concentration was associated with the risk of HHD heart occurrence(OR=1.734,95% CI:1.32,2.656,P-value =0.011).And the correlation remained after the adjustment of sex,age,course,BMI,waist circumference(OR=2.214,95% CI:1.263,3.882,P-value =0.006).And in order to show the influence of GDF15 to HHD effectively,we had changed the variable value of GDF15 concentration into GDF15/100 in the model of the logistic regression analysis.Conclusion:(1)Age,duration of hyperthyroidism,systolic blood pressure,BMI,TRAb are risk factors for HHD.Elderly hyperthyroidism patients or patient who has a long history of hyperthyroidism should be paid attention to the prevention of HHD.Hyperthyroidism patients should be paid attention to monitoring and controlling systolic blood pressure and body weight.Hyperthyroidism patients with high TRAb level should be given timely andeffectively treatment.(2)The incidences of abnormal echocardiography and electrocardiogram manifestations,including pulmonary hypertension,heart valve insufficiency,left ventricular diastolic dysfunction,left ventricular high voltage,ST-T segment changes,are significantly increased in HHD group and these abnormal manifestations are closely related to the diagnosis of hyperthyroidism heart.so for hyperthyroidism patient who has appeared above abnormal echocardiography or electrocardiogram manifestations should be paid attention to checking and preventing the happen of HHD.(3)Increased levels of bilirubin,cystatin-C,homocysteine and TPOAb are associated with HHD,which can help the precision for early identification of HHD.(3)GDF15 is an independent risk factor for HHD and is a promising biomarker for early diagnosis and assessment of HHD.