Effect Of Subclinical Hypothyroidism On Inflammatory Factors And Prognosis In Patients With Heart Failure

Objective:By comparing the inflammatory mediators TNF-α,IL-6,IL-1,and cardiac ultrasound parameters in patients with heart failure complicated with subclinical hypothyroidism with those in heart failure alone,and by studying the correlation between TSH and TNF-α,IL-6,IL-1,and cardiac ultrasound parameters,we can further assess the differences in the occurrence of endpoint events between patients with heart failure complicated with subclinical hypothyroidism and those with heart failure,and the effect of TSH on the incidence of endpoint events in heart failure This will provide data to support the need for individualized treatment in patients with heart failure complicated with subclinical hypothyroidism.Methods:Consecutive included patients with heart failure admitted to the Cardiovascular Medicine Department of Hunan Provincial People’s Hospital from January 1,2019 to March 1,2020,with New York cardiac function class II to IV.Baseline data such as age,gender,current medical history and cardiac function classification were recorded and compared between the two groups,and various indexes such as inflammatory mediators TNF-α,IL-6,IL-1,FT3,FT4 and TSH in serum and cardiac ultrasound parameters were compared between the two groups,and to analyze the correlation between TSH and various indexes.Patients in both groups were followed up for 1 year,and to recorde the number of heart failure endpoint events in the two groups.and the Kaplan-Meier survival curve analysis was applied to compare the incidence of endpoint events(cardiovascular death and heart failure readmission)in the two groups,and the area under the curve and cut-off point values were calculated by ROC curve analysis,and grouped according to the TSH cut-off point values,and the predictors of endpoint events in heart failure patients were further evaluated using COX proportional risk regression analysis.Result:1.NT-pro BNP,TNF-α,IL-6,and IL-1 levels were higher in the heart failure complicated with subclinical hypothyroidism group compared with the heart failure group,and NT-pro BNP(r=0.22,P<0.05),TNF-α(r=0.26,P<0.01),IL-6(r=0.27,P<0.05),and IL-1(r=0.30,P< 0.01)expression were positively correlated with TSH.2.FT3 and FT4 levels were significantly lower in the heart failure complicated with subclinical hypothyroidism compared with the heart failure group,and the differences were statistically significant(P < 0.05).3.Among cardiac ultrasound parameters,the IVST,LVPWT,A-peak,and E/e values were higher and E-peak,E/A values were lower in the heart failure complicated with subclinical hypothyroidism group compared with the heart failure group(P< 0.05).Correlation analysis showed that LVPWT,A peak,and E/e values were positively correlated with TSH,and E-peak,E/A values was negative correlated with TSH.4.At 1 year follow-up,there were 23 readmissions due to heart failure and2 deaths in the heart failure complicated with subclinical hypothyroidism,and 11 readmissions due to heart failure and 0 deaths in the heart failure group.Kaplan-Meier survival curve analysis showed that a higher incidence of heart failure endpoint events in the heart failure complicated with subclinical hypothyroidism group compared with the heart failure group,and the differences were statistically significant(P < 0.05).5.The ROC curve analysis yielded a critical value of TSH of 4.33 mIU/L,AUC=0.658,95% CI(0.542,0.775),sensitivity: 0.694,specificity: 0.609,and was divided into two groups according to the critical value,with TSH≥4.33 m IU/L as the first group and TSH <4.33 m IU/L as the second group for Kaplan-Meier survival analysis showed that the incidence of heart failure endpoint events was significantly higher in patients with TSH ≥4.33 m IU/L than in patients with TSH <4.33 m IU/L.Further one-way regression analysis showed that the incidence of heart failure endpoint events was 2.8 times higher in patients with TSH ≥4.33 m IU/L than in patients with TSH <4.33 m IU/L.6.COX proportional risk regression analysis showed that TSH(HR(95%CI)= 1.11(1.02,1.21),P = 0.01 < 0.05)was an independent risk factor for endpoint events in patients with heart failure.each unit increase in TSH was associated with an 11% increase in the risk of endpoint events in patients with heart failure.Conclusion:1.The heart failure complicated with subclinical hypothyroidism group had higher expression of inflammatory mediators,lower FT3,higher NT-pro BNP,more pronounced diastolic insufficiency and myocardial fibrosis compared with the heart failure group,and all were associated with TSH.2.Patients in the heart failure complicated with subclinical hypothy roidism group had a higher rate of heart failure endpoint events compared with the heart failure group,and patients with heart failure had a worse prognosis as TSH levels increased.TSH was positively associated with heart failure mortality and readmission rates,and was an independent risk factor for readmission and death in heart failure patients.