scholarly journals DOSE-DEPENDENT EFFECTS OF LEVOTHYROXINE IN HEART FAILURE IN PATIENTS WITH CONCOMITANT THYROID PATHOLOGY

2021 ◽  
pp. 100-109
Author(s):  
Sergii Pyvovar ◽  
Yurii Rudyk ◽  
Tetiana Lozik
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Ejection Fraction ◽  
Autoimmune Thyroiditis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Thyroid Pathology ◽  
Patients With Heart Failure ◽  
Dose Dependent

Abstract. Currently, the use of thyroid hormones in the setting of heart failure (HF) is still an "open book". There are several unanswered questions: the regimen, doses and schedule of drug use, as well as the consequences of such therapy. Large clinical studies can provide information on the effect of these hormones on the long-term prognosis in patients with heart failure. At the same time, the presence of comorbid thyroid pathology, which requires the prescription of levothyroxine (LT), makes it possible to partially answer these questions. The aim is to study of the dose-dependent effect of LT on the course of HF in patients with autoimmune thyroiditis (AIT). Material and methods. The study included 218 patients with HF on the background of post-infarction cardiosclerosis. 109 (50.0 %) patients with AIT received LT due to hypothyreosis in the past. These patients intake LT during 2 years before included in the study and have euthyreosis. Whether the levels of thyroid stimulating hormone (TSH), free triiodthyronine (FT3) and free thyroxine (FT4) were determined. Results. Patients who used LT, comparing with patients without this drug, had smaller end-diastolic diametr (EDD) and end-systolic diametr (ESD) and end-diastolic volum (EDV) and end-systolic volum (ESV) of left ventricle (LV) and 22.9 % greater LV ejection fraction (EF) (+ 22.9 %, p = 0.0001), as well as higher low serum N-terminal prohormone of brain natriuretic peptide (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, ejection fraction of left ventricle (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 (+ 37.9 %, p = 0.0001) and patients who took LT at a dose 0.1 - 0.33 μg/kg (+ 36.9 %, p = 0.0001). LVEF was the highest in patients taking LT at a dose of > 1.20 μg/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 (- 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). Conclusions. 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 μg/kg. The use of an LT dose of > 0.53 μg/kg leads to a significant decrease in the frequency of re-hospitalization due to decompensation of heart failure during 2 years. Keywords: heart failure, autoimmune thyroiditis, levothyroxine, left ventricular, ejection fraction.

Abstract 17311: Ventricular Arrhythmias and Fibrosis in Patients With Heart Failure and Preserved Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Natasha Cuk ◽  
Jae H Cho ◽  
Donghee Han ◽  
Joseph E Ebinger ◽  
Eugenio Cingolani
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Mri ◽  
Ventricular Arrhythmias ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Preserved Ejection Fraction ◽  
Ventricular Ejection Fraction ◽  
Patients With Heart Failure ◽  
Ventricular Fibrosis

Introduction: Sudden death due to ventricular arrhythmias (VA) is one of the main causes of mortality in patients with heart failure and preserved ejection fraction (HFpEF). Ventricular fibrosis in HFpEF has been suspected as a substrate of VA, but the degree of fibrosis has not been well characterized. Hypothesis: HFpEF patients with increased degree of fibrosis will manifest more VA. Methods: Cedars-Sinai medical records were probed using Deep 6 artificial intelligence data extraction software to identify patients with HFpEF who underwent cardiac magnetic resonance imaging (MRI). MRI of identified patients were reviewed to measure extra-cellular volume (ECV) and degree of fibrosis. Ambulatory ECG monitoring (Ziopatch) of those patients were also reviewed to study the prevalence of arrhythmias. Results: A total of 12 HFpEF patients who underwent cardiac MRI were identified. Patients were elderly (mean age 70.3 ± 7.1), predominantly female (83%), and overweight (mean BMI 32 ± 9). Comorbidities included hypertension (83%), dyslipidemia (75%), and coronary artery disease (67%). Mean left ventricular ejection fraction by echocardiogram was 63 ± 8.7%. QTc as measured on ECG was not significantly prolonged (432 ± 15 ms). ECV was normal in those patients for whom it was available (24.2 ± 3.1, n = 9) with 3/12 patients (25%) demonstrating ventricular fibrosis by MRI (average burden of 9.6 ± 5.9%). Ziopatch was obtained in 8/12 patients (including all 3 patients with fibrosis) and non-sustained ventricular tachycardia (NSVT) was identified in 5/8 (62.5%). One patient with NSVT and without fibrosis on MRI also had a sustained VA recorded. In those patients who had Ziopatch monitoring, there was no association between presence of fibrosis and NSVT (X2 = 0.035, p = 0.85). Conclusions: Ventricular fibrosis was present in 25% of HFpEF patients in this study and NSVT was observed in 62.5% of those patients with HFpEF who had Ziopatch monitoring. The presence of fibrosis by Cardiac MRI was not associated with NSVT in this study; however, the size of the cohort precludes broadly generalizable conclusions about this association. Further investigation is required to better understand the relationship between ventricular fibrosis by MRI and VA in patients with HFpEF.

scholarly journals Early Rhythm Control Therapy in Patients with Atrial Fibrillation and Heart Failure

Circulation ◽  
2021 ◽  
Author(s):  
Andreas Rillig ◽  
Christina Magnussen ◽  
Ann-Kathrin Ozga ◽  
Anna Suling ◽  
Axel Brandes ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Rhythm Control ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Heart Failure Patients ◽  
Patients With Heart Failure ◽  
Control Therapy

Background: Even on optimal therapy, many patients with heart failure and atrial fibrillation experience cardiovascular complications. Additional treatments are needed to reduce these events, especially in patients with heart failure and preserved left ventricular ejection fraction (HFpEF). Methods: This prespecified subanalysis of the randomized EAST - AFNET 4 trial assessed the effect of systematic, early rhythm control therapy (ERC; using antiarrhythmic drugs or catheter ablation) compared to usual care (UC, allowing rhythm control therapy to improve symptoms) on the two primary outcomes of the trial and on selected secondary outcomes in patients with heart failure, defined as heart failure symptoms NYHA II-III or left ventricular ejection fraction [LVEF] <50%. Results: This analysis included 798 patients (300 (37.6%) female, median age 71.0 [64.0, 76.0] years, 785 with known LVEF). The majority of patients (n=442) had HFpEF (LVEF≥50%; mean LVEF 61% ± 6.3%), the others had heart failure with mid-range ejection fraction (n=211; LVEF40-49%; mean LVEF 44% ± 2.9%) or heart failure with reduced ejection fraction (n=132; LVEF<40%; mean LVEF 31% ± 5.5%). Over the 5.1-year median follow-up, the composite primary outcome of cardiovascular death, stroke or hospitalization for worsening of heart failure or for acute coronary syndrome occurred less often in patients randomized to ERC (94/396; 5.7 per 100 patient-years) compared with patients randomized to UC (130/402; 7.9 per 100 patient-years; hazard ratio 0.74 [0.56-0.97], p=0.03), not altered by heart failure status (interaction p-value=0.63). The primary safety outcome (death, stroke, or serious adverse events related to rhythm control therapy) occurred in 71/396 (17.9%) heart failure patients randomized to ERC and in 87/402 (21.6%) heart failure patients randomized to UC (hazard ratio 0.85 [0.62-1.17], p=0.33). LV ejection fraction improved in both groups (LVEF change at two years: ERC 5.3%±11.6%, UC 4.9%±11.6%, p=0.43). ERC also improved the composite outcome of death or hospitalization for worsening of heart failure. Conclusions: Rhythm control therapy conveys clinical benefit when initiated within one year of diagnosing atrial fibrillation in patients with signs or symptoms of heart failure. Clinical Trial Registration: Unique Identifiers: ISRCTN04708680, NCT01288352, EudraCT2010-021258-20, Study web site www.easttrial.org; URLs: www.controlled-trials.com; https://clinicaltrials.gov; https://www.clinicaltrialsregister.eu

Sign in / Sign up

Export Citation Format

Share Document