Key result
Low FT3 linked to ~392% higher risk of mortality or cardiac transplantation.
Why the study?
Thyroid hormone is a fundamental regulator in cardiovascular homeostasis, but its role as an independent predictor of adverse events in HOCM patients was unclear.
Does lower free triiodothyronine (FT3) level predict all-cause mortality or cardiac transplantation in patients with hypertrophic obstructive cardiomyopathy?
Cohort (n=756)
No
Does lower free triiodothyronine (FT3) level predict all-cause mortality or cardiac transplantation in patients with hypertrophic obstructive cardiomyopathy?
Hazard Ratio: 4.918 (95% CI 1.076–22.485)
Absolute Event Rate: 13.4% vs 1.2%
p-value: p=0.040
Lower free triiodothyronine levels are independently associated with an increased risk of all-cause mortality and cardiac transplantation in patients with hypertrophic obstructive cardiomyopathy.
May refine risk stratification in advanced cardiac disease; hypothesis-generating and requires prospective validation before clinical use.
Context: Thyroid hormone acts as a fundamental regulator in cardiovascular homeostasis in pathophysiological conditions. Objective: This study aims to determine whether thyroid hormone could be an independent predictor of adverse events in patients with hypertrophic obstructive cardiomyopathy (HOCM). Design, Patients, and Outcome Measures: The original cohort consisted of 965 consecutive patients with HOCM who were admitted to Fuwai Hospital from October 2009 to December 2014, and 756 patients completed thyroid function evaluations. Patients were divided into three groups according to free triiodothyronine (FT3) levels: tertile 1 (<2.81 pg/mL, n = 247), tertile 2 (2.81 to 3.11 pg/mL, n = 250), tertile 3 (3.12 to 4.09 pg/mL, n = 259). Results: In correlation analysis, FT3 showed significantly positive correlation with left ventricular ejection fraction (r = 0.109, P = 0.003). After a median follow-up of 44 months, a total of 45 (6.0%) endpoints (all-cause mortality or cardiac transplantation) occurred with rates of 13.4%, 3.6%, and 1.2% in tertiles 1, 2, and 3, respectively. Univariate Cox analysis established FT3 as a predictor of endpoint [hazard ratio (HR), 0.111; 95% confidence interval (CI), 0.065, 0.189; P < 0.001]. After adjustment for traditional risk factors, the prognostic value of FT3 level was still significant (HR, 0.216; 95% CI, 0.083, 0.559; P = 0.002). Compared with patients in tertile 3, those in tertile 1 were at a much higher risk of endpoint (HR, 4.918; 95% CI, 1.076, 22.485; P = 0.040). Conclusions: FT3 correlated with cardiac function and could serve as an independent predictor of all-cause mortality and cardiac transplantation in patients with HOCM. These results suggest that monitoring thyroid function in HOCM patients is necessary.
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Zhang et al. (2018) conducted a cohort in Hypertrophic obstructive cardiomyopathy (HOCM) (n=756). Low free triiodothyronine (FT3) level (<2.81 pg/mL) vs. Higher FT3 level (3.12 to 4.09 pg/mL) was evaluated on All-cause mortality or cardiac transplantation (HR 4.918, 95% CI 1.076-22.485, p=0.040). Low free triiodothyronine levels were associated with a higher risk of all-cause mortality or cardiac transplantation compared to higher levels (HR 4.918; 95% CI 1.076-22.485; P=0.040).
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