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Thyroid disorders and prognosis in chronic heart failure: a long-term follow-up study.

BACKGROUND
Thyroid disorders may have a negative impact on the prognosis of patients affected by chronic heart failure (CHF).


OBJECTIVE
The aim of the current study was to evaluate the prognostic role of all thyroid disorders over a long term follow-up in a single centre large sample of CHF outpatients.


METHODS
In all patients thyroid function was evaluated at the enrolment and during follow-up. On the basis of free thriiodothyronine (T3), free thyroxine (fT4) and thyroid stimulating hormone (TSH) serum levels patients were classified into one of the following four categories: as euthyroid subjects, as or patients affected by hypothyroidism, low T3 (LT3) syndrome or hyperthyroidism. During follow-up, death for all causes was assessed as primary end-point, whereas time to the first hospitalization for heart failure worsening was the secondary end-point analyzed.


RESULTS
Among 762 patients, 190 patients were affected by hypothyroidism (Hypo). LT3 syndrome was diagnosed in 15 patients and 59 patients were affected by hyperthyroidism (Hyper). During a long term follow-up (5.1±3.7 years), 303 patients died. Patients with Hypo showed an increased risk of death as well as of hospitalization due to heart failure worsening at univariate regression analysis. At multivariate regression analysis Hypo remained associated with hospitalization after correction for age >75 years, ischemic aetiology, diabetes, therapy with ACE-inhibitors or ARBs, therapy with betablockers and with aldosterone antagonists, NYHA class 3, systolic arterial pressure <95 mmHg, left ventricular ejection fraction <30%, estimated glomerular filtration rate <60 ml/min, hyponatremia and NT-proBNP>1000 pg/ml. At, multivariate analysis, the independent association with death was significant only for the subgroup of patients with TSH >10 mIU/L. LT3 was independently associated with both heart failure hospitalization and death, whereas Hyper was not associated with any of the two considered end-points.


CONCLUSION
Hypo is associated with a worse prognosis over a long-term follow-up. The association with heart failure hospitalization is not dependent on the baseline TSH levels, whereas the association with death is significant only when TSH >10 mIU/L. Finally, Hyper does not have anly association with a worse prognosis.