Abstract
Background: Hypothyroidism is known to be correlated with multiple heart diseases. However, the influence of hypothyroidism on the patients with heart valve disease (HVD) is still unclear. The purpose of our study was to investigate the impact of hypothyroidism on echocardiographic characteristics of patients with heart valve disease.Methods: We conducted a retrospective cohort study which included 2,128 patients with HVD, and they were divided into euthyroid, subclinical hypothyroidism (SCHypoT), and overt hypothyroidism (OHypoT) group. Echocardiographic characteristics before and after valve surgery between groups were compared by using propensity score (PS) analysis. Kaplan–Meier analysis was used to compare the percent of recovery of left atrial (LA) enlargement between groups.Results: Overall, 463 patients had hypothyroidism (404 SCHypoT patients and 59 OHypoT patients), and 1,665 patients were euthyroid. At baseline, hypothyroidism was associated with significantly higher left atrial diameter (LAD), interventricular septum thickness, left ventricular posterior wall thickness, pulmonary artery systolic pressure, and lower left ventricular ejection fraction. After valve surgery, only LAD remained significantly higher in the patients with hypothyroidism. Additionally, patients with hypothyroidism had a significantly lower recovery rate of LA enlargement after valve surgery compared with euthyroid patients.Conclusion: Hypothyroidism was associated with a larger LAD in patients with HVD before and after surgery, which may suggest that hypothyroidism is a risk factor of LA enlargement of HVD. Besides, hypothyroidism was associated with a significantly lower recovery rate of LA enlargement after valve surgery.
Highlights
The cardiovascular system or myocardium is an important target of thyroid hormones, which exert many regulatory effects on heart rate, cardiac output, blood volume, vascular resistance, and tissue oxygen consumption [1]
The adverse effect of hypothyroidism on cardiac structure has been demonstrated by some researchers, such as larger interventricular septum (IVS) thickness, left ventricular posterior wall (LVPW) thickness, and decreased left ventricular ejection fraction (LVEF), and they confirmed the significant improvement after levothyroxine treatment [10,11,12,13,14,15,16,17,18,19,20]
The main finding of our study is that hypothyroidism was associated with larger left atrial diameter (LAD) in patients with heart valve disease (HVD), which may suggest that hypothyroidism is a risk factor of left atrial (LA) enlargement of HVD
Summary
The cardiovascular system or myocardium is an important target of thyroid hormones, which exert many regulatory effects on heart rate, cardiac output, blood volume, vascular resistance, and tissue oxygen consumption [1]. The patients with hypothyroidism were found to display higher QT dispersion, lower heart rate variability (HRV), and aberrant diastolic velocities [6,7,8]; levothyroxine treatment for hypothyroidism may bring cardiac benefits [6, 9]. A retrospective cohort study found that in patients with dilated cardiomyopathy (DCM), patients with subclinical hypothyroidism had larger left ventricular (LV) and left atrial (LA) diameter and higher all-cause mortality [21]. The purpose of our study was to investigate the impact of hypothyroidism on echocardiographic characteristics of patients with heart valve disease
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