Abstract
The study included 218 patients with heart failure (HF) on the background of post-infarction cardiosclerosis who had non-toxic goiter (NG). 109 (50.0 %) patients received levothyroxine (LT) in connection with NG. Whether the levels of TSH, T3f, T4f, T3r were determined. Echocardioscopy and ultrasound examination of the thyroid gland were conducted. We studied the course of heart failure for 2 years. Patients who used LT, comparing with patients without this drug, had smaller dimensions (EDD and ESD) and volumes (ESV and EDV) of left ventricle (LV) and 22.9 % greater LV ejection fraction (EF) (p = 0.0001), as well as higher low serum NT-proBNP level (26.3 %, p = 0.009). In the subgroup of patients taking LT at a dose of 0.1 to 0.69 μg/kg, LVEF did not differ from patients without this tritment. At a dose of 0.7-1.19 μg/kg, LVEF is higher compared with that of patients who did not take LT (by 37.9%) and patients who took LT at a dose 0.1−0.33 mcg/kg (36.9 %). LVEF was the highest in patients taking LT at a dose of > 1.20 mcg/kg. The use of LT for 2 years reduces the risk of re-hospitalization (RH) due to decompensation of heart failure (Odds ratio = 0.490 (0.281−0.857), p = 0.018) and a tendentious decrease in the risk of combined endpiont achieving (by 27.9 %, p = 0.074). The ROC analysis showed that the risk of RH in patients with heart failure due to decompensation of the disease decreases with the use of LT at a dose of > 0.53 μg/kg (sensitivity − 56.62 %, specificity − 60.98 %, p = 0.016). The use of LT in patients has a dose-dependent positive effect on LVEF. The largest LVEF is observed in patients taking the drug at a dose of> 1.2 mcg/kg. The use of an LT dose of > 0.53 mcg/kg leads to a significant decrease in the frequency of re-hospitalization due to decompensation of heart failure during 2 years.
Highlights
109 (50 %) patients (group I) with non-toxic goiter received LT at the time of inclusion in the study (of them 23 (21,1 %) had subclinical hypothyreosis, the remaining patients had laboratory evidence of autoimmune thyroiditis)
Several clinical studies have demonstra ted the potential benefits of using thyroid hormones in patients with acute Heart failure (HF) [7], the TH treatment reduced the postoperative atrial fibrillation, improved hemodynamic parameters, reducing the need for inotropic drugs and reducing troponin I level [8, 9]
The results of this study showed a slight increase in the incidence of arrhythmia and mortality [13]
Summary
109 (50 %) patients (group I) with non-toxic goiter received LT at the time of inclusion in the study (of them 23 (21,1 %) had subclinical hypothyreosis, the remaining patients had laboratory evidence of autoimmune thyroiditis). For comparison of LV EF values in the groups of patients taking different doses of LT a one-way ANOVA was performed with posterior multiple comparison by the Sheffe method. The effect of the use of levothyroxine in non-toxic goiter on the course of heart failure (n = 218)
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