Echocardiographic Evaluation of Left and Right Ventricular Function in Subclinical Hypothyroidism

Abstract

Objective: The aim of the present study was to evaluate rest systolic and diastolic cardiac function by echocardiography in subclinical hypothyroidism (SH).

Methods: A cross sectional study was performed and the results obtained in the evaluation of two groups (SH and euthyroidism) were compared. Subjects with systemic arterial hypertension, diabetes or cardiovascular diseases, or that in use of drugs that influence thyroid function were excluded.

Results: The two groups (SH=37; euthyroidism=35) had similar demographic characteristics as age, Blood Pressure, Body Mass Index and frequencies of sedentarism, tabagism, menopause. There was a tendency to diastolic dysfunction, with higher median values of Deceleration Time of mitral E wave in the SH group (230 vs. 216 ms; p=0.053), which was also slightly positively associated with serum TSH levels (r_s=0.154; p=0.095). As expected, Deceleration Time was negatively correlated with E wave velocity (r_s=−0.353; p=0.001) and E/A index (r_s=−0.238; p=0.022) and was powerless positively associated with Isovolumic Relaxation Time (r_s=0.178; p=0.067) and A wave velocity (r_s=0.177; p=0.069). It was not detected left systolic dysfunction, since there were not differences in the means of cardiac output, ejection fraction, ejection time, fractional shortening, isovolumic contraction time and Myocardium performance index of LV.

Conclusion: We did not detect left systolic dysfunction at rest in SH but the findings corroborate with the possibility of diastolic dysfunction in SH group.

Key words

hypothyroidism - subclinical hypothyroidism - heart - myocardial performance index - cardiac function

References

• 1 Arem R, Rokey R, Kiefe C. et al . Cardiac systolic and diastolic function at rest and exercise in subclinical hypothyroidism: effect of thyroid hormone therapy.  Thyroid. 1996;  6 397-402
• 2 Arinc H, Gunduz H, Tamer AS. et al . Tissue Doppler echocardiography in the evaluation of cardiac effects of subclinical hypothyroidism.  Int J Cardiovasc Imaging. 2006;  22 ((2)) 177-186
• 3 Bell GM, Todd WTA, Forfar JC. et al . End organ responses to thyroxine therapy in subclinical hypothyroidism.  Clin Endocrinol. 1985;  22 83-89
• 4 Biondi B, Fazio S, Palmieri EA. et al . Left ventricular diastolic dysfunction in patients with subclinical hypothyroidism.  J Clin Endocrinol Metab. 1999;  84 2064-2067
• 5 Biondi B. Cardiovascular effects of Mild Hypothyroidism.  Thyroid. 2007;  17 ((7)) 625-630
• 6 Maria AN De, Neumann A, Schubart PJ. et al . Systematic correlation of cardiac chamber size and ventricular performance determined with echocardiography and alterations in hearty rate in normal persons.  Am J Cardiol. 1979;  43 1-9
• 7 Bello V Di, Monzani F, Giorgio D. et al . Ultrasonic myocardial textural analysis in subclinical hypothyroidism.  J Am Soc Echocardiogr. 2000;  13 832-840
• 8 Dillmann WH. Biochemical basis of thyroid action hormone action in the heart.  Am J Med. 1990;  88 626-632
• 9 Dujardin KS, Tei C, Yeo TC. et al . Prognostic value of a Doppler MPI combining systolic and diastolic performance in idiopathic dilated cardiomyopathy.  AM J Cardiol. 1998;  82 1071-1076
• 10 Erbel R, Schweizer P, Krebs W. et al . Effects of heart rate on left ventricular volume and ejection fraction: a two dimensional echocardiography study.  Am J Cardiol. 1984;  53 590-597
• 11 Foldes J, Istvanfy M, Halmagyi M. et al . Hypothyroidism and the heart. Examination of left ventricular function in subclinical hypothyroidism.  Acta Med Hung. 1987;  44 337-347
• 12 Forfar JC, Wathen CG, Todd WTA. et al . Left ventricular performance in subclinical hypothyroidism.  Q J Med. 1985;  57 857-865
• 13 Gardin JM, Rohan MK, Davidson DM. et al . Doppler transmitral flow velocity parameters: relationship between age, body surface area, blood pressure, gender in normal subjects.  Am J Non Invas Cardiol. 1987;  1 3-10
• 14 Grodecki PV, Klein AL. Pitfalls in the echo-Doppler assessment of diastolic function.  Echocardiography. 1993;  10 213-234
• 15 Kahaly GL, Mohr-Kahaly S, Beyer J. et al . Left ventricular function analysed by Doppler and echocardiographic methods in short-term hypothyroidism.  Am J Cardiol. 1995;  75 645-648
• 16 Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system.  N Eng J Med. 2001;  344 ((7)) 501-509
• 17 Monzani F, Bello V Di, Caraccio N. et al . Effect of levothyroxine on cardiac function and structure in subclinical hypothyroidism: a double blind placebo- controlled study.  J Clin Endocrinol Metab. 2001;  86 ((3)) 1110-1115
• 18 Ojamaa K, Klein I. In vivo regulation of recombinant cardiac myosin heavy chain gene expression by thyroid hormone.  Endocrinology. 1993;  132 1002-1–10
• 19 Owen PJ, Lazarus JH. Subclinical hypothyroidism: the case for treatment.  Trends Endocrinol Metab. 2003;  14 257-261
• 20 Stoddard MF, Pearson AC, Kern MJ. et al . Influence of alteration of preload on the pattern of left ventricular diastolic filling as assessed by Doppler echocardiography in humans.  Circulation. 1989;  79 1226-1236
• 21 Surks MI, Ortiz E, Daniels GH. et al . Subclinical Thyroid Disease. Scientific Review and Guidelines for Diagnosis and Management.  JAMA. 2004;  291 ((2)) 228-238
• 22 Tei C, Dujardin KS, Hodge DO. et al . Doppler MPI combining systolic and diastolic myocardial performance: clinical value in cardiac amyloidosis.  J Am Coll Cardiol. 1996;  27 658-664
• 23 Tei C, Ling LH, Hodge DO. et al . New MPI of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function: a study in normals and dilated cadiomyopathy.  J Cardiol. 1995;  26 357-366
• 24 Tei C. New non-invasive MPI for combined systolic and diastolic ventricular function.  J Cardiol. 1995;  26 135-136
• 25 Tielens ET, Pillay M, Storm C. et al . Cardiac function at rest in hypothyroidism evaluated by equilibrium radionuclide angiography.  Clin Endocrinol. 1999;  50 497-502
• 26 Tseng KH, Walfish PG, Persaud JO. et al . Concurrent aortic and mitral valve echocardiography permits measurement of systolic time intervals as an index of peripheral tissue thyroid functional status.  J Clin Endocrinol Metab. 1989;  69 633-638
• 27 Varma R, Jain AK, Ghose T. Heart in hypothyroidism. An echocardiographic study.  J Assoc Physicians India. 1996;  44 ((6)) 390-392
• 28 Vitale G, Galderisi M, Lupoli GA. et al . Left ventricular myocardial impairment in subclinical hypothyroidism assessed by a new ultrasound tool: pulsed tissue Doppler.  J Clin Endocrinol Metab. 2002;  87 ((9)) 4350-4355
• 29 Yazic M, Gorgulu S, Sertbas Y. et al . Effects of thyroxine therapy on cardiac function in patients with subclinical hypothyroidism: index of myocardial performance in the evaluation of left ventricular function.  Int J Cardiol. 2004;  95 ((2–3)) 135-143
• 30 Yeo TC, Dujardin KS, Tei C. et al . Value of a doppler derived MPI combining systolic and diastolic time intervals in predicting outcome in primary pulmonary hypertension.  Am J Cardiol. 1998;  81 1157-1161

Correspondence