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Prognostic Role of Hypothyroidism in Heart Failure: A Meta-Analysis.

Ning N, Gao D, Triggiani V, Iacoviello M, Mitchell JE, Ma R, Zhang Y, Kou H - Medicine (Baltimore) (2015)

Bottom Line: Random-effects models were used to estimate summary relative risk (RR) statistics.However, the association disappeared on adjustment for B-type natriuretic protein level (RR 1.17, 95% CI: 0.90-1.52) and in studies of patients with mean age <65 years (RR 1.23, 95% CI: 0.88-1.76).We found hypothyroidism associated with increased all-cause mortality as well as cardiac death and/or hospitalization in patients with HF.Further diagnostic and therapeutic procedures for hypothyroidism may be needed for patients with HF.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Nuclear Medicine (NN), The Second Affiliated Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi, P.R. China; Department of Cardiology (DG, RM, YZ, HK), The Second Affiliated Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi, P.R. China; Endocrinology and Metabolic Diseases (VT), Interdisciplinary Department of Medicine, University of Bari, Bari, Italy; Cardiology Unit (MI), Department of Emergency and Organs Transplantation, University of Bari, Bari, Italy; and State University of New York Downstate Medical Center (JE), Brooklyn, NY.

ABSTRACT
Hypothyroidism is a risk factor of heart failure (HF) in the general population. However, the relationship between hypothyroidism and clinical outcomes in patients with established HF is still inconclusive.We conducted a systematic review and meta-analysis to clarify the association of hypothyroidism and all-cause mortality as well as cardiac death and/or hospitalization in patients with HF. We searched MEDLINE via PubMed, EMBASE, and Scopus databases for studies of hypothyroidism and clinical outcomes in patients with HF published up to the end of January 2015. Random-effects models were used to estimate summary relative risk (RR) statistics. We included 13 articles that reported RR estimates and 95% confidence intervals (95% CIs) for hypothyroidism with outcomes in patients with HF. For the association of hypothyroidism with all-cause mortality and with cardiac death and/or hospitalization, the pooled RR was 1.44 (95% CI: 1.29-1.61) and 1.37 (95% CI: 1.22-1.55), respectively. However, the association disappeared on adjustment for B-type natriuretic protein level (RR 1.17, 95% CI: 0.90-1.52) and in studies of patients with mean age <65 years (RR 1.23, 95% CI: 0.88-1.76).We found hypothyroidism associated with increased all-cause mortality as well as cardiac death and/or hospitalization in patients with HF. Further diagnostic and therapeutic procedures for hypothyroidism may be needed for patients with HF.

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Forest plot of RR for hypothyroidism and cardiac death and/or hospitalization in patients with heart failure. Weights are from random-effects analysis.
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Figure 3: Forest plot of RR for hypothyroidism and cardiac death and/or hospitalization in patients with heart failure. Weights are from random-effects analysis.

Mentions: In all, 10 studies16–18,24–30 including 19,354 subjects with HF (2173 with hypothyroidism) were analyzed. As compared with patients with euthyroidism, for patients with hypothyroidism, the overall multivariable-adjusted RR for all-cause mortality was 1.44 (95% CI: 1.29–1.61; P for heterogeneity = 0.554, I2 = 0) (Figure 2). On sensitivity analysis, the combined RRs all showed statistical significance, with a narrow range from 1.39 (95% CI: 1.22–1.1.58) to 1.49 (95% CI: 1.31–1.68). We also conducted a subgroup analysis to evaluate the effect of methodological and study characteristics on RR of all-cause mortality (Table 2). For studies defining hypothyroidism solely on TSH level,16–18,25–27 hypothyroidism was still associated with all-cause mortality (RR 1.47, 95% CI: 1.29–1.66; P for heterogeneity = 0.49, I2 = 0). Hypothyroidism overall was positively associated with all-cause mortality (RR 1.47, 95% CI: 1.31–1.65; P for heterogeneity = 0.51, I2 = 0). In studies reporting the full spectrum of thyroid hormone levels,23,24,26,27,29–31 subclinical hypothyroidism24,26,27,29 was associated with all-cause mortality for patients with HF (RR 1.41, 95% CI: 1.15–1.74, P = 0.44). After excluding patients with baseline thyroid replacement therapy16–18,24,26,27,29 or amiodarone intake,16,18,24,25,27,29 the association remained (RR 1.38, 95% CI: 1.19–1.59; P for heterogeneity = 0.72; RR 1.37, 95% CI: 1.21–1.63; P for heterogeneity = 0.43, respectively). However, for studies adjusting for BNP level,18,29,30 the positive association disappeared (RR 1.17, 95% CI: 0.90–1.52; P for heterogeneity = 0.24). According to the meta-regression analyses, the association was not predicted by cutoff level of TSH (P = 0.21), mean TSH level (P = 0.54), mean age (P = 0.80), follow-up time (P = 0.49), baseline LVEF (P = 0.15), number of cases (P = 0.72), or sex (P = 0.34). We found no evidence of publication bias by Egger test (P = 0.27), Begg test (P = 0.76), or funnel plot (Figure 3).


Prognostic Role of Hypothyroidism in Heart Failure: A Meta-Analysis.

Ning N, Gao D, Triggiani V, Iacoviello M, Mitchell JE, Ma R, Zhang Y, Kou H - Medicine (Baltimore) (2015)

Forest plot of RR for hypothyroidism and cardiac death and/or hospitalization in patients with heart failure. Weights are from random-effects analysis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554113&req=5

Figure 3: Forest plot of RR for hypothyroidism and cardiac death and/or hospitalization in patients with heart failure. Weights are from random-effects analysis.
Mentions: In all, 10 studies16–18,24–30 including 19,354 subjects with HF (2173 with hypothyroidism) were analyzed. As compared with patients with euthyroidism, for patients with hypothyroidism, the overall multivariable-adjusted RR for all-cause mortality was 1.44 (95% CI: 1.29–1.61; P for heterogeneity = 0.554, I2 = 0) (Figure 2). On sensitivity analysis, the combined RRs all showed statistical significance, with a narrow range from 1.39 (95% CI: 1.22–1.1.58) to 1.49 (95% CI: 1.31–1.68). We also conducted a subgroup analysis to evaluate the effect of methodological and study characteristics on RR of all-cause mortality (Table 2). For studies defining hypothyroidism solely on TSH level,16–18,25–27 hypothyroidism was still associated with all-cause mortality (RR 1.47, 95% CI: 1.29–1.66; P for heterogeneity = 0.49, I2 = 0). Hypothyroidism overall was positively associated with all-cause mortality (RR 1.47, 95% CI: 1.31–1.65; P for heterogeneity = 0.51, I2 = 0). In studies reporting the full spectrum of thyroid hormone levels,23,24,26,27,29–31 subclinical hypothyroidism24,26,27,29 was associated with all-cause mortality for patients with HF (RR 1.41, 95% CI: 1.15–1.74, P = 0.44). After excluding patients with baseline thyroid replacement therapy16–18,24,26,27,29 or amiodarone intake,16,18,24,25,27,29 the association remained (RR 1.38, 95% CI: 1.19–1.59; P for heterogeneity = 0.72; RR 1.37, 95% CI: 1.21–1.63; P for heterogeneity = 0.43, respectively). However, for studies adjusting for BNP level,18,29,30 the positive association disappeared (RR 1.17, 95% CI: 0.90–1.52; P for heterogeneity = 0.24). According to the meta-regression analyses, the association was not predicted by cutoff level of TSH (P = 0.21), mean TSH level (P = 0.54), mean age (P = 0.80), follow-up time (P = 0.49), baseline LVEF (P = 0.15), number of cases (P = 0.72), or sex (P = 0.34). We found no evidence of publication bias by Egger test (P = 0.27), Begg test (P = 0.76), or funnel plot (Figure 3).

Bottom Line: Random-effects models were used to estimate summary relative risk (RR) statistics.However, the association disappeared on adjustment for B-type natriuretic protein level (RR 1.17, 95% CI: 0.90-1.52) and in studies of patients with mean age <65 years (RR 1.23, 95% CI: 0.88-1.76).We found hypothyroidism associated with increased all-cause mortality as well as cardiac death and/or hospitalization in patients with HF.Further diagnostic and therapeutic procedures for hypothyroidism may be needed for patients with HF.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Nuclear Medicine (NN), The Second Affiliated Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi, P.R. China; Department of Cardiology (DG, RM, YZ, HK), The Second Affiliated Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi, P.R. China; Endocrinology and Metabolic Diseases (VT), Interdisciplinary Department of Medicine, University of Bari, Bari, Italy; Cardiology Unit (MI), Department of Emergency and Organs Transplantation, University of Bari, Bari, Italy; and State University of New York Downstate Medical Center (JE), Brooklyn, NY.

ABSTRACT
Hypothyroidism is a risk factor of heart failure (HF) in the general population. However, the relationship between hypothyroidism and clinical outcomes in patients with established HF is still inconclusive.We conducted a systematic review and meta-analysis to clarify the association of hypothyroidism and all-cause mortality as well as cardiac death and/or hospitalization in patients with HF. We searched MEDLINE via PubMed, EMBASE, and Scopus databases for studies of hypothyroidism and clinical outcomes in patients with HF published up to the end of January 2015. Random-effects models were used to estimate summary relative risk (RR) statistics. We included 13 articles that reported RR estimates and 95% confidence intervals (95% CIs) for hypothyroidism with outcomes in patients with HF. For the association of hypothyroidism with all-cause mortality and with cardiac death and/or hospitalization, the pooled RR was 1.44 (95% CI: 1.29-1.61) and 1.37 (95% CI: 1.22-1.55), respectively. However, the association disappeared on adjustment for B-type natriuretic protein level (RR 1.17, 95% CI: 0.90-1.52) and in studies of patients with mean age <65 years (RR 1.23, 95% CI: 0.88-1.76).We found hypothyroidism associated with increased all-cause mortality as well as cardiac death and/or hospitalization in patients with HF. Further diagnostic and therapeutic procedures for hypothyroidism may be needed for patients with HF.

Show MeSH
Related in: MedlinePlus