scholarly journals Cardiovascular effects of overt and subclinical hyperthyroidism: focus on differentiated thyroid cancer

2020 ◽  
Author(s):  
Thera P. Links ◽  
Trynke van der Boom ◽  
Wouter T. Zandee ◽  
Joop D Lefrandt
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Rate ◽  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Cardiovascular Effects ◽  
Suppressive Therapy ◽  
Subclinical Hyperthyroidism ◽  
Cardiac Effects ◽  
Cardiac Inotropy

Thyroid hormone stimulates cardiac inotropy and chronotropy via direct genomic and non-genomic mechanisms. Hyperthyroidism magnifies these effects, resulting in an increase in heart rate, ejection fraction and blood volume. Hyperthyroidism also affects thrombogenesis and this may be linked to a probable tendency towards thrombosis in patients with hyperthyroidism. Patients with hyperthyroidism are therefore at higher risk for atrial fibrillation, heart failure and cardiovascular mortality. Similarly, TSH suppressive therapy for differentiated thyroid cancer is associated with increased cardiovascular risk. In this review, we present the latest insights on the cardiac effects of thyroid suppression therapy for the treatment of thyroid cancer. Finally, we will show new clinical data on how to implement this knowledge into the clinical practice of preventive medicine.

scholarly journals Effect of thyrotropin suppressive therapy on heart rate variability and QT dispersion in patients with differentiated thyroid cancer

Medicine ◽  
2020 ◽  
Vol 99 (28) ◽  
pp. e21190
Author(s):  
Chunhua Liu ◽  
Haihong Lv ◽  
Qian Li ◽  
Songbo Fu ◽  
Jiaojiao Tan ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Qt Dispersion ◽  
Suppressive Therapy

scholarly journals Effect suppresive therapy with levothyroxine on the state of the cardiovascular and sympathoadrenal systems

2019 ◽  
Vol 63 (2) ◽  
pp. 207-215
Author(s):  
T. A. Mityukova ◽  
T. A. Leonova ◽  
S. B. Kohan ◽  
A. A. Sivakov ◽  
O. E. Polulyach
Keyword(s):  
Heart Rate ◽  
Thyroid Cancer ◽  
Cardiovascular System ◽  
Young Patients ◽  
Sharp Decrease ◽  
The State ◽  
The Body ◽  
Suppressive Therapy ◽  
Subclinical Hyperthyroidism ◽  
Sympathoadrenal System

Thyroid hormones can affect the cardiovascular system directly by binding to nuclear thyroid receptors, as well as indirectly by changing the neuro – humoral status of the body as a whole. The aim of the work was to assess the effect of levothyroxine suppressive therapy on the regulation of the heart rate and activity of the sympathoadrenal system, as well as the level of cortisol in the blood of young patients with thyroid cancer. It is shown that the effect of suppressive therapy with levothyroxine on the state of the cardiovascular system is manifested in an increase in the risk of tachycardia and changes in heart rate variability associated with the body mass index. Patients with thyroid cancer had a sharp decrease in normetanephrine (norepinephrine metabolite) in the urine. The levels of metanephrine (metabolite of adrenaline) and dopamine in the urine was dependent on the tonus of the autonomic nervous system and blood pressure. The revealed shifts indicate that against the background of subclinical hyperthyroidism, the mechanisms aimed at stabilizing the heart rate and preventing the effects of hyperstimulation of thyroid and beta-adrenoreceptors of the myocardium are included.

scholarly journals Cardiac Effects of Thyrotropin Oversuppression with Levothyroxine in Young Women with Differentiated Thyroid Cancer

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Kyung-Soon Hong ◽  
Jung-Woo Son ◽  
Ohk Hyun Ryu ◽  
Moon-Gi Choi ◽  
Ji Yeon Hong ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Thyroid Stimulating Hormone ◽  
Suppressive Therapy ◽  
Fixed Dose ◽  
Free T4 ◽  
Serum Free ◽  
Cardiac Effects ◽  
Free T3 ◽  
Cardiac Functions

Background. We investigated the cardiac effects of TSH (thyroid-stimulating hormone) oversuppression in women with thyroidectomized differentiated thyroid cancer (DTC) during levothyroxine suppression therapy.Methods. Fourteen young female patients with DTC were enrolled. The duration of TSH-suppressive therapy was 5 to 9 years. They satisfied the following criteria: (1) a serum level of TSH < 0.1 mU/L in the intermediate-risk or TSH < 0.3 mU/L in the low-recurrence-risk group and (2) having been receiving a fixed dose of LT4 before the study. Controls matched for age, sex, and body mass index (BMI) were compared in terms of the levels of serum free T4, free T3, TSH, plasma N-terminal pro-brain natriuretic peptide (NT-pro-BNP), and cardiac functions and structures.Results. DTC patients and control subjects were well matched in heart rate and blood pressure. There were marked differences in serum TSH (P=0.001) and free T4 (P=0.002). However, there were no differences between the groups in serum free T3 and plasma NT-pro-BNP. Furthermore, there were nonsignificant differences in cardiac functions and structures between the groups.Conclusions. This study shows that TSH suppression therapy in women with DTC may be safe with respect to cardiac functions and structures despite intermittent oversuppression of TSH during long-term suppressive therapy.Trial Registration. This trial is registered with clinicaltrials.gov identifierNCT02645786.

scholarly journals Bradyarrhythmia as a presenting feature of subclinical hyperthyroidism

2016 ◽  
Vol 17 (1) ◽  
pp. 39-40
Author(s):  
NS Neki
Keyword(s):  
Quality Of Life ◽  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Signs And Symptoms ◽  
Suppressive Therapy ◽  
Subclinical Hyperthyroidism ◽  
Hormone Action ◽  
Endogenous Factors ◽  
Thyroid Hormone Action

Subclinical hyperthyroidism appears to be a common disorder. It may be caused by exogenous or endogenous factors: excessive TSH suppressive therapy with L-thyroxine (L-T4) for benign thyroidnodular disease, differentiated thyroid cancer, or hormone over-replacement in patients withhypothyroidism are the most frequent causes. Consistent evidence indicates that subclinicalhyperthyroidism reduces the quality of life, affecting both the psycho and somatic components ofwell-being, and produces relevant signs and symptoms of excessive thyroid hormone action, oftenmimicking adrenergic overactivityJ MEDICINE January 2016; 17 (1) : 39-40

Discharge heart rate and clinical outcomes in hospitalized heart failure patients with coexisted atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Xing ◽  
X Bai ◽  
J Li
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Rate ◽  
Clinical Outcome ◽  
Confidence Interval ◽  
Clinical Outcomes ◽  
Beta Blockers ◽  
Funding Source ◽  
Proportional Hazard ◽  
Cox Proportional Hazard

Abstract Background Whether discharge heart rate for hospitalized heart failure (HF) patients with coexisted atrial fibrillation (AF) is associated with long-term clinical outcomes and whether this association differs between patients with and without beta-blockers have not been well studied. Purpose We investigated the associations between discharge heart rate and clinical outcomes in hospitalized HF patients with coexisted AF, while stratified to beta-blockers at discharge. Methods The study cohort included 1631 HF patients hospitalized primarily with AF, which was from the China PEACE Prospective Heart Failure Study. Clinical outcome was 1-year combined all-cause mortality and HF hospitalization after discharge. We analyzed association between outcome and heart rate at discharge with restricted cubic spline and Cox proportional hazard ratios (HR). Results The median age was 68 (IQR: 60- 77) years, 41.9% were women, discharge heart rate was (median (IQR)) 75 (69- 84) beats per minute (bpm), and 60.2% received beta-blockers at discharge. According to the result of restricted cubic spline plot, the relationship between discharge heart rate and clinical outcome may be nonlinear (P&lt;0.01). Based on above result, these patients were divided into 3 groups: lowest &lt;65 bpm, middle 65–86 bpm and highest ≥87 bpm, clinical outcomes occurred in 128 (64.32%), 624 (53.42%) and 156 (59.32%) patients in the lowest, middle, and highest groups respectively. In the Cox proportional hazard analysis, the lowest and highest groups were associated with increased risks of clinical outcome compared with the middle group (HR: 1.289, 95% confidence interval (CI): 1.056 - 1.573, p=0.013; HR: 1.276, 95% CI: 1.06 - 1.537, p=0.01, respectively). And a significant interaction between discharge heart rate and beta-blocker use was observed (P&lt;0.001 for interaction). Stratified analysis showed the lowest group was associated with increased risks of clinical outcomes in patients with beta-blockers (HR: 1.584, 95% confidence interval (CI): 1.215–2.066, p=0.001). Conclusion There may be a U-curve relationship between discharge heart rate and clinical outcomes in hospitalized HF patients with coexisted AF. They may have the best clinical outcomes with heart rates of 65 - 86 bpm. And strict heart rate control (&lt;65 bpm) may be avoided for patients who discharge with beta-blockers. Figure 1 Funding Acknowledgement Type of funding source: Other. Main funding source(s): This work was supported by the National Key Research and Development Program (2017YFC1310803) from the Ministry of Science and Technology of China; the CAMS Innovation Fund for Medical Science (2017-I2M-B&R-02); the 111 Project from the Ministry of Education of China (B16005).

scholarly journals PROGNOSTIC ROLE OF ATRIAL FIBRILLATION AND HEART RATE CONTROL IN CHRONIC HEART FAILURE PATIENTS

2013 ◽  
Vol 61 (10) ◽  
pp. E735
Author(s):  
Savina Nodari ◽  
Marco Triggiani ◽  
Laura Lupi ◽  
Alessandra Manerba ◽  
Giuseppe Milesi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Rate ◽  
Chronic Heart Failure ◽  
Rate Control ◽  
Heart Rate Control ◽  
Prognostic Role ◽  
Heart Failure Patients

Cardiovascular effects of non-cardiovascular drugs

ESC CardioMed ◽  
2018 ◽  
pp. 222-226
Author(s):  
Pauline Bosco-Levy ◽  
Julien Bezin ◽  
Francesco Salvo ◽  
Nicholas Moore
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Heart Rate ◽  
Cardiovascular Diseases ◽  
Adverse Effects ◽  
Cardiovascular Effects ◽  
Mechanisms Of Action ◽  
Cardiovascular Drugs ◽  
Vascular Bed ◽  
The Moment

Many drugs that were not designed to treat cardiovascular diseases may affect the cardiovascular system, causing adverse reactions. The objective of this chapter is to review in a systematic manner these adverse effects of non-cardiovascular drugs. The heart consists of four main entities that may be affected by non-cardiovascular drugs and lead to very different types of events: (1) the conduction tissue, that governs heart rate and rhythm, associated with arrhythmia and sudden death; (2) the endocardium and valves, associated with valvular disease and endocardial fibrosis; (3) the myocardium, which can directly or indirectly lead to heart failure; and (4) the coronary arteries, and in general the vascular bed, with myocardial ischaemia and infarction as main adverse events. These different elements may be affected by different drugs with different mechanisms of action, though some drugs may affect several components (e.g. myocardial infarction may result in heart failure). The objective of this chapter is not to provide exhaustive listings of all drugs ever associated with any of these events, which can be found online and will be obsolete the moment they are published, but an understanding of the typology of these events and their mechanism.

P6361Prognostic value of discharge heart rate in acute heart failure patients: more relevant in atrial fibrillation?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Vidal-Perez ◽  
R Agra-Bermejo ◽  
D Pascual-Figal ◽  
F Gude Sampedro ◽  
C Abou Jokh ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Rate ◽  
Sinus Rhythm ◽  
Acute Heart Failure ◽  
Left Ventricular Ejection ◽  
Long Term Outcomes ◽  
All Cause Mortality ◽  
One Year

Abstract Background The prognostic impact of heart rate (HR) in acute heart failure (AHF) patients is not well known especially in atrial fibrillation (AF) patients. Purpose The aim of the study was to evaluate the impact of admission HR, discharge HR, HR difference (HRD) (admission- discharge) in AHF patients with sinus rhythm (SR) or AF on long- term outcomes. Methods We included 1398 patients consecutively admitted with AHF between October 2013 and December 2014 from a national multicentric, prospective registry. Logistic regression models were used to estimate the association between admission HR, discharge HR and HR difference and one- year all-cause mortality and HF readmission. Results The mean age of the study population was 72±12 years. Of these, 594 (42.4%) were female, 655 (77.8%) were hypertensive and 655 (46.8%) had diabetes. Among all included patients, 745 (53.2%) had sinus rhythm and 653 (46.7%) had atrial fibrillation. Only discharge HR was associated with one-year all-cause mortality (Relative risk (RR)= 1.182, confidence interval (CI) 95% 1.024–1.366, p=0.022) in SR. In AF patients discharge HR was associated with one-year all-cause mortality (RR= 1.276, CI 95% 1.115–1.459, p≤0.001). We did not observe a prognostic effect of admission HR or HRD on long-term outcomes in both groups. This relationship is not dependent on left ventricular ejection fraction (Figure 1) Effect of post-discharge heart rate Conclusions In AHF patients lower discharge HR, neither the admission nor the difference, is associated with better long-term outcomes especially in AF patients Acknowledgement/Funding Heart Failure Program of the Red de Investigaciόn Cardiovascular del Instituto de Salud Carlos III, Madrid, Spain (RD12/0042) and the Fondo Europeo de

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