Disfuncția tiroidiană la pacientul cu sindrom coronarian acut

Abstract

Purpose. The study aims to determine the impact of dystyroidism on the type of acute coronary syndrome, on vascular function and coronary impairment, as well as on the myocardium and last but not least the general biological resonance of these hormones, emphasizing the role of thyroid hormones in the cardiovascular system. Methods. We introduced in the study 100 patients recently diagnosed with acute coronary syndrome, without history of ischemic heart disease or thyroid disease, hospitalized in the Cardiology Clinic of the Emergency Clinical Hospital Bagdasar-Arseni Bucharest, for the interventional treatment of acute coronary syndrome. The studied patients were hospitalized between November 2014 - April 2015, with follow-up up to 5 years, evaluated clinically, bio-humorally, by echocardiography, coronary angiography with SYNTAX score calculation and electrocardiogram and pulse wave. The obtained data were integrated in Excel sheets and statistically processed with the Python program. Results. The prevalence of dystyroidism in the study group was 44% (44 patients). Hypothyroidism is predominant (34 patients; 77%), and subclinical hypothyroidism occurs in 20 (59%) of subjects with hypothyroidism. Unstable angina is the predominant type of acute coronary syndrome, both in the whole group (54 patients; 54%) and in the group of patients with hyperthyroidism (7 patients; 70%), while acute myocardial infarction without ST-segment elevation was the type majority of presentation in patients with hypothyroidism (19 patients, 56%). Coronary heart disease varied as follows: in the total group unicoronary lesion (31 subjects; 31%), in patients with hyperthyroidism unicoronary lesion (5 subjects; 50%), in patients with hypothyroidism bicoronary lesion (10 subjects; 29%). And the calculated SYNTAX score is higher in the group of patients with dysthyroidism compared to the group of patients with euthyroidism. Discussions. Unstable angina (p = 0.006) and ventricular wall hypertrophy (p = 0.008) are predictive factors for dysthyroidism. Hypothyroidism correlates with high LDL-cholesterol levels (p = 0.0176) and hyposideremia (p = 0.0083), while hyperthyroidism correlates with thrombocytosis (p = 0.0122) and a significant nonspecific inflammatory syndrome (p = 0.0043). Dystyroidism has a direct correlation with the presence of kinetic disorders (Person correlation coefficient 0.21). Conclusion. Thyroid disease, with hypothyroidism or hyperthyroidism, can also be a risk factor for cardiovascular disease, and especially for ischemic heart disease.