Why the study?
Hypothyroidism is associated with adverse outcomes in heart failure, but its association with cardiac resynchronization therapy outcomes in severe heart failure was not clear.
Does hypothyroidism affect clinical outcomes and appropriate ICD therapies in patients with severe heart failure receiving cardiac resynchronization therapy?
Does hypothyroidism affect clinical outcomes and appropriate ICD therapies in patients with severe heart failure receiving cardiac resynchronization therapy?
In patients with heart failure receiving CRT, elevated baseline TSH is associated with an increased risk of ventricular arrhythmic events requiring appropriate ICD therapy, suggesting TSH may be a useful biomarker for sudden death risk stratification.
Hypothyroidism should not preclude CRT in severe HF; leaves open whether TSH modulates arrhythmic risk.
Background Hypothyroidism is known to be associated with adverse clinical outcomes in heart failure. The association between hypothyroidism and cardiac resynchronization therapy outcomes in patients with severe heart failure is not clear. Methods The study included 1,316 patients who received cardiac resynchronization therapy between 2002 and 2015. Baseline demographics and cardiac resynchronization therapy outcomes, including left ventricular ejection fraction, New York Heart Association class, appropriate implantable cardioverter-defibrillator therapy, and all-cause mortality, were collected from the electronic health record. Results Of the study cohort, 350 patients (26.6%) were classified as the hypothyroidism group. The median duration of follow-up was 3.6 years (interquartile range, 1.7-6.2). Hypothyroidism was not associated with a higher risk of all-cause mortality in patients receiving CRT for heart failure. The risk of appropriate implantable cardioverter-defibrillator therapy significantly increased in association with increased baseline thyroid-stimulating hormone level in the entire cohort (hazard ratio, 1.23 per 5mIU/L increase; 95% CI, 1.01-1.5; P=0.04) as well as in the hypothyroid group (hazard ratio, 1.44 per 5mIU/L increase; 95% CI, 1.13-1.84; P=0.004). Conclusions CRT improves cardiac function in hypothyroid patients. The ventricular arrhythmic events requiring ICD therapies are associated with baseline TSH level, which might be considered as an important biomarker to stratify the risk of sudden death for patients with heart failure and hypothyroidism.
No takes yet. Share an insight, caveat, or question.
Yang et al. (2020) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: