Subclinical hypothyroidism, arterial stiffness, and myocardial reserve.
BACKGROUND
Subclinical hypothyroidism (SCH) is associated with increased risk of cardiac disease; its impact on arterial function is less clear.


OBJECTIVE
The objective of the study was the assessment of arterial and cardiac function.


METHODS
The study was a 6-month controlled observational study using pulse wave analysis and tissue Doppler dobutamine stress echocardiography.


METHODS
The study was conducted at a thyroid clinic.


METHODS
Nineteen female SCH patients with raised TSH, normal free T(4), and no cardiovascular disease [aged 49.2 +/- 3.8 yr; body mass index (BMI) 29.9 +/- 6.7 kg/m(2)] were recruited from the thyroid clinic, and 10 female controls (aged 50.2 +/- 3.4 yr; BMI 29.7 +/- 7.2 kg/m(2)) also participated in the study.


METHODS
Incremental doses of l-thyroxine were used.


METHODS
Indices of vascular stiffness and left ventricular echocardiographic function were measured.


RESULTS
Baseline augmentation gradient was elevated in SCH, compared with controls [10.3 +/- 5.1 (sd) mm Hg vs. 8.0 +/- 4.2, P < 0.05]; when euthyroid (mean T(4) dose 114 mug/d), it fell to 8.8 +/- 5.3 mm Hg (P < 0.05). Heart rate-corrected augmentation index was 26.7 +/- 9.9 vs. 18.8 +/- 9.9% (P < 0.02), falling to 19.7 +/- 9.6% (P < 0.001) after treatment. Time of travel of the reflected wave was 139.3 +/- 11.7 msec, compared with 141.5 +/- 8.8 msec in controls (P < 0.05), increasing to 144.9 +/- 11.9 msec (P < 0.05). There were no differences in resting global, regional left ventricular function, or regional myocardial velocities during maximal dobutamine stress between SCH patients and controls, or in treated patients, compared with baseline.


CONCLUSIONS
Arterial stiffness was increased in SCH and improved with l-thyroxine, which may be beneficial, whereas myocardial functional reserve was similar to controls and remained unaltered after treatment.
Centre for Endocrine and Diabetes Sciences, Cardiff University, University Hospital of Wales, Cardiff CF14 4XN, Wales, United Kingdom.
P J D
PJ
Owen
C
C
Rajiv
D
D
Vinereanu
T
T
Mathew
A G
AG
Fraser
J H
JH
Lazarus
D001158:Arteries / Q000503:physiopathology*; D015150:Echocardiography, Doppler; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000503:physiopathology*; D009131:Muscle, Smooth, Vascular / Q000503:physiopathology; D013599:Systole; D013974:Thyroxine / Q000627:therapeutic use; D017539:Tunica Intima / Q000473:pathology; D016277:Ventricular Function, Left
D013974:Thyroxine