Limits...
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.

Show MeSH

Related in: MedlinePlus

Funnel plot assessing publication bias: (A) all-cause mortality; (B) cardiac death and/or hospitalization.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4554113&req=5

Figure 4: Funnel plot assessing publication bias: (A) all-cause mortality; (B) cardiac death and/or hospitalization.

Mentions: We analyzed 10 studies16–18,23,24,26,28,30–32 including 21,858 subjects with HF (2199 cases with hypothyroidism) for and association of hypothyroidism and cardiac mortality and/or hospitalization. The overall multivariable-adjusted RR was 1.37 (95% CI: 1.22–1.55; P for heterogeneity = 0.33, I2 = 12.2%) (Figure 4). The pooled RR estimate with the fixed-effects model was 1.33 (95% CI: 1.20–1.49). In total, 4 studies17,18,26,30 reported the relationship between hypothyroidism and cardiac death. As compared with patients with euthyroidism, for patients with hypothyroidism, the RR was 1.36 (95% CI: 1.12–1.66; P for heterogeneity = 0.65, I2 = 0%). A total of 4 studies18,24,30,32 reported the relationship between hypothyroidism and hospitalization for HR. As compared with patients with euthyroidism, for patients with hypothyroidism, the RR was 1.48 (1.21–1.71; P for heterogeneity = 0.32, I2 = 11%). On sensitivity analysis, the combined RRs all showed statistical significance, with a narrow range of RR from 1.29 (95% CI: 1.16–1.44) to 1.46 (95% CI: 1.26–1.70). We also conducted a subgroup analysis to evaluate the effect of methodological and study characteristics on the RR of cardiac mortality and/or hospitalization (Table 2). For studies reporting a full spectrum of thyroid hormone levels,15,23,26,30,31 hypothyroidism was associated with cardiac mortality and/or hospitalization in patients with HF (RR 1.61, 95% CI: 1.34–1.93, P = 0.60). For studies defining hypothyroidism solely on TSH level,16–18 hypothyroidism was positively associated with cardiac mortality and/or hospitalization: RR 1.20 (95% CI: 1.05–1.38, P < 0.001; P for heterogeneity = 0.96). Three studies16,17,24 reported an association between new-onset hypothyroidism and outcomes in patients with HF. The overall multivariable-adjusted RR for composite outcomes (all-cause or cardiac mortality and/or hospitalization for HF) was 1.53 (95% CI: 1.19–1.96, P = 0.001; P for heterogeneity = 0.16, I2 = 41.8%). According to the meta-regression analyses, study quality (P = 0.04), definition of hypothyroidism (P = 0.04), and number of cases (P = 0.04) were predictors of the interaction, but not cutoff TSH level (P = 0.80), mean TSH level (P = 0.43), mean age (P = 0.12), follow-up time (P = 0.34), baseline LVEF (P = 0.21), number of cases (P = 0.41), or sex (P = 0.54). We found no evidence of publication bias by Egger test (P = 0.46), Begg test (P = 0.45), 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)

Funnel plot assessing publication bias: (A) all-cause mortality; (B) cardiac death and/or hospitalization.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Funnel plot assessing publication bias: (A) all-cause mortality; (B) cardiac death and/or hospitalization.
Mentions: We analyzed 10 studies16–18,23,24,26,28,30–32 including 21,858 subjects with HF (2199 cases with hypothyroidism) for and association of hypothyroidism and cardiac mortality and/or hospitalization. The overall multivariable-adjusted RR was 1.37 (95% CI: 1.22–1.55; P for heterogeneity = 0.33, I2 = 12.2%) (Figure 4). The pooled RR estimate with the fixed-effects model was 1.33 (95% CI: 1.20–1.49). In total, 4 studies17,18,26,30 reported the relationship between hypothyroidism and cardiac death. As compared with patients with euthyroidism, for patients with hypothyroidism, the RR was 1.36 (95% CI: 1.12–1.66; P for heterogeneity = 0.65, I2 = 0%). A total of 4 studies18,24,30,32 reported the relationship between hypothyroidism and hospitalization for HR. As compared with patients with euthyroidism, for patients with hypothyroidism, the RR was 1.48 (1.21–1.71; P for heterogeneity = 0.32, I2 = 11%). On sensitivity analysis, the combined RRs all showed statistical significance, with a narrow range of RR from 1.29 (95% CI: 1.16–1.44) to 1.46 (95% CI: 1.26–1.70). We also conducted a subgroup analysis to evaluate the effect of methodological and study characteristics on the RR of cardiac mortality and/or hospitalization (Table 2). For studies reporting a full spectrum of thyroid hormone levels,15,23,26,30,31 hypothyroidism was associated with cardiac mortality and/or hospitalization in patients with HF (RR 1.61, 95% CI: 1.34–1.93, P = 0.60). For studies defining hypothyroidism solely on TSH level,16–18 hypothyroidism was positively associated with cardiac mortality and/or hospitalization: RR 1.20 (95% CI: 1.05–1.38, P < 0.001; P for heterogeneity = 0.96). Three studies16,17,24 reported an association between new-onset hypothyroidism and outcomes in patients with HF. The overall multivariable-adjusted RR for composite outcomes (all-cause or cardiac mortality and/or hospitalization for HF) was 1.53 (95% CI: 1.19–1.96, P = 0.001; P for heterogeneity = 0.16, I2 = 41.8%). According to the meta-regression analyses, study quality (P = 0.04), definition of hypothyroidism (P = 0.04), and number of cases (P = 0.04) were predictors of the interaction, but not cutoff TSH level (P = 0.80), mean TSH level (P = 0.43), mean age (P = 0.12), follow-up time (P = 0.34), baseline LVEF (P = 0.21), number of cases (P = 0.41), or sex (P = 0.54). We found no evidence of publication bias by Egger test (P = 0.46), Begg test (P = 0.45), 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