Thyroid-stimulating hormone within the normal range and risk of major adverse cardiovascular events in non-ischemic dilated cardiomyopathy patients with severe left ventricular dysfunction.
Clin Cardiol. 2018 Nov 17;:
Authors: Li X, Yao Y, Chen Z, Fan S, Hua W, Zhang S, Fan X
BACKGROUND: The association between thyroid-stimulating-hormone(TSH) and prognosis of nonischemic dilated cardiomyopathy(NIDCM) in patients with normal thyroid function remains unclear.
OBJECTIVE: The present study investigated whether TSH is associated with major adverse cardiovascular events in euthyroid NIDCM patients.
METHODS: The original cohort consisted of 216 consecutive euthyroid NIDCM patients, with left ventricular ejection fraction(LVEF) ≤ 35%, who were observed from 2010 to 2013. Patients with persistent ventricular arrhythmia (VA) histories, amiodarone taken for VA prevention, or on heart transplant list within one year were excluded. A follow-up evaluation was performed, and VA events, heart failure(HF) exacerbation/heart transplant, cardiac death or death from any cause were separately evaluated.
RESULTS: A total of 184 patients were enrolled, and 97.8% (180/184) ultimately received follow-up evaluations. During the median 4.6-year follow-up, 24 VA events, 28 cardiac deaths, 30 all-cause deaths, 40 HF exacerbations and 11 heart transplant events occurred. Serum TSH levels showed good predictive efficacies for VA events(AUC=0.702, 95% CI: 0.629-0.767), and the risk of VA events increased, according to serum TSH quarters, as determined by Kaplan-Meier analysis (2.2% vs 13.4% vs 21.0% vs 30.0%, Q1-Q4, P=0.011). Multivariable Cox analysis showed that patients at the Q4 level of serum TSH(>2.67 mIU/L) suffered an increased risk of VA events, compared with those at the Q1 level of TSH(HR=15.88, 95%CI:2.01-65.15) or those at the other three quarters(HR=3.17, 95%CI:1.38-7.26). However, the Q4 TSH level was not associated with other adverse cardiac events.
CONCLUSION: An association between TSH levels and the risk of VA events may exist in euthyroid NIDCM patients.
PMID: 30447088 [PubMed – as supplied by publisher]