| Part Ⅰ Risk factors of low T3 syndrome in patients with acute coronary syndrome and the relationship with cardiac structure and functionBackground and objectivesAlthough all advance in pharmacotherapy and myocardial reperfusion strategies,the short-term and long-term mortality of patients suffering an acute coronary syndrome remains substantial.Patients with acute coronary syndrome,whose T4 to T3 conversion disorder causes the occurrence of low T3 syndrome.Low T3 syndrome is related to the area of myocardial infarction and cardiac function in patients with acute myocardial infarction,and it is also one of the predictors of short-term and long-term prognosis.The main purpose of this study is to analyze the risk factors of low T3 syndrome in patients with acute coronary syndrome,and the changes in cardiac structure and function in patients with acute coronary syndrome combined with low T3 syndrome.Methods809 patients with acute coronary syndrome were enrolled.According to thyroid hormone levels,they were divided into a group with low T3 syndrome(179 patients)and the other group without low T3 syndrome(630 patients).The differences in the characteristics of patients and echocardiogram-related indicators between the two groups were analyzed,and the risk factors of low T3 syndrome in patients with acute coronary syndrome were analyzed by logistic regression.Used ROC curve to analyze the predictive ability of related risk factors for acute coronary syndrome with low T3 syndrome,and calculated the best cut-off.ResultsPatients with low T3 syndrome exhibited older age,higher female ratio,and higher glycosylated hemoglobin(HbA1c),while BMI,hemoglobin,and albumin are lower(all P<0.05).Morever,in those patients the thickness of the ventricular septum(P=0.003)and the left ventricular ejection fraction are lower(P=0.0001),the percentage of diffuse ventricular wall motion abnormality(P=0.012)and the ventricular diastolic dysfunction(P=0.001)are higher.Multivariate logistic regression analysis found that female(OR:2.170,95%CI:1.277-3.689,P=0.004),HbAlc(OR:1.239,95%Cl:1.087-1.413,P=0.001)and low albumin(OR:0.832,95CI%:0.778-0.886,P=0.0001)is independently related to the occurrence of low T3 syndrome in patients with acute coronary syndrome.ROC curve analysis results indicate that the area under the curve(AUC)of female,HbAlc and albumin are 0.593(95%CI:0.545-0.641,P<0.0001),0.609(95%CI:0.557-0.660,P<0.0001)and 0.732(95CI:0.691-0.733,P<0.0001),respectively.The optimal cut-off of HbAlc and albumin are≥7.40%and≤37.5g/l,respectively.ConclusionFemale,HbAlc and low albumin increase the risk of low T3 syndrome in patients with acute coronary syndrome.Compared with patients without low T3 syndrome,acute coronary syndrome with low T3 syndrome has an higher proportion of ventricular systolic and diastolic dysfunction.Part Ⅱ Effect of FT4/FT3 on the condition and prognosis of aged patients with acute coronary syndromeBackground and objectivesThyroid hormones are related to the incidence of coronary heart disease,the degree of coronary artery stenosis and the short-term and long-term prognosis of patients with acute coronary syndrome.In patients with acute coronary syndrome,the serum T3 level would decrease because of the impaired conversion of T4 to T3.In addition,as the age increases,T3 gradually decreases.Part of mechanisms of T3 decrease in acute coronary syndrome is the same as the physiological changes of the elderly.However,whether the changes of thyroid hormones in the aged patients with acute coronary syndrome are still closely related to the condition and prognosis is still unclear.Based on the above background,the purpose of this study is to explore the effect of FT4/FT3 on the condition and prognosis of the aged patients with acute coronary syndrome.Methods487 aged patients with acute coronary syndrome were enrolled.Patients were divided into four groups according to the index of FT4/FT3:group 1(FT4/FT3≤4.14,n=122),group 2(4.14<FT4/FT3≤4.91,n=122),group 3(4.91<FT4/FT3<6.23,n=121),group 4(FT4/FT3≥6.23,n=122).Compared the differences in baseline and in-hospital mortality between the four groups.Spearman correlation was used to analyze the relationship between FT4/FT3 and inflammation,myocardial damage and cardiac function.Kaplan-Meire survival analysis and Cox regression analysis were used to analyze the effect of FT4/T3 on in-hospital death in aged patients with acute coronary syndrome.ResultsThe proportion of STEMI,heart rate at admission,NLR,CRP,lgcTnT,GRACE score and the proportion of in-hospital deaths in group 4 were higher;LVEF was lower(all P<0.05).FT4/FT3 was negatively correlated with systolic(rs=-.0221)and diastolic blood pressure(rs=-0.136)(all P<0.05),and positively correlated with heart rate(rs=0.303),cTnT(rs=0.422),CK-MB(rs=0.337),BNP(rs=0.500),LVEF(rs=0.398),CRP(rs=0.494),creatinine(rs=0.248)and GRACE scores(rs=0.398)(all P<0.05).Compared with the other three groups,the cumulative survival rate of group 4 was lower(long-rank P<0.05).Cox multivariate regression analysis found that FT4/FT3(OR:1.207,95%Cl:1.008-1.445,P=0.040)and GRACE scores(OR:1.115,95%Cl:1.038-1.197,P=0.003)were independent predictor of in-hospital death for aged patients with acute coronary syndrome.ConclusionsIn aged patients with acute coronary syndrome,FT4/FT3 is related to inflammation,myocardial damage,and cardiac function.Except for GRACE score,FT4/FT3 is also an independent predictor of in-hospital death in aged patients with acute coronary syndrome. |
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