Abstract
Background and objectives: Long standing hypothyroidism may impair myocardial relaxation, but its effect on systolic myocardial function is still controversial. The aim of this study was to investigate left ventricular (LV) systolic and diastolic function in patients with hypothyroidism. Materials and Methods: This study included 81 (age 42 ± 13 years, 92% female) patients with hypothyroidism, and 22 age and gender matched controls. All subjects underwent a detailed clinical examination followed by a complete biochemical blood analysis including thyroid function assessment and anthropometric parameters measurements. LV function was assessed by 2-dimensional, M-mode and Tissue-Doppler Doppler echocardiographic examination performed in the same day. Results: Patients had lower waist/hip ratio (p< 0.001), higher urea level (p = 0.002), and lower white blood cells (p = 0.011), compared with controls. All other clinical, biochemical, and anthropometric data did not differ between the two groups. Patients had impaired LV diastolic function (lower E wave [p< 0.001], higher A wave [p = 0.028], lower E/A ratio [p< 0.001], longer E wave deceleration time [p = 0.01], and higher E/e’ ratio [p< 0.001]), compared with controls. Although LV global systolic function did not differ between groups, LV longitudinal systolic function was compromised in patients (lateral mitral annular plane systolic excursion—MAPSE [p = 0.005], as were lateral and septal s’ [p< 0.001 for both]). Conclusions: In patients with hypothyroidism, in addition to compromised LV diastolic function, LV longitudinal systolic function is also impaired compared to healthy subjects of the same age and gender. These findings suggest significant subendocardial function impairment, reflecting potentially micro-circulation disease that requires optimum management.
Highlights
Hypothyroidism is an endocrine disorder, caused by thyroid hormone deficiency, which may affect the heart and the cardiovascular system
The aim of this study was to investigate the effect of hypothyroidism on left ventricular (LV) systolic and diastolic function components using conventional Doppler echocardiography
Our results show that in a modest sample of patients with hypothyroidism and reduced waste/hip ratio, there was significant evidence for compromised LV longitudinal systolic function in the form of long axis amplitude of motion (MAPSE) and its systolic velocity
Summary
Hypothyroidism is an endocrine disorder, caused by thyroid hormone deficiency, which may affect the heart and the cardiovascular system. It has a direct effect on cardiac function through changes in myocyte—specific gene expression [2,3] It does affect the arterial system, even at the endothelial level, causing dysfunction and impaired vascular smooth muscle (VSM) relaxation, leading to increased systemic vascular resistance and diastolic hypertension, which has been reported in approximately 30% of such patients [4]. Conclusions: In patients with hypothyroidism, in addition to compromised LV diastolic function, LV longitudinal systolic function is impaired compared to healthy subjects of the same age and gender. These findings suggest significant subendocardial function impairment, reflecting potentially micro-circulation disease that requires optimum management
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