Thyroid hormone and heart failure.
Thyroid hormone metabolic disarray has been identified as a risk factor for the progression of heart disease and the development of heart failure (HF). Both hyper- and hypothyroidism have been associated with a failing myocardium. Poor cardiac contractility and low cardiac output due to hyperthyroidism is a rare occurrence and is mostly seen in patients with preexisting heart disease. Referred to as a "rate related" phenomenon, hyperthyroid-induced sustained sinus tachycardia or atrial fibrillation may further reduce ventricular contractility. Increasingly, the hypothyroid state, and in particular a low triiodothyronine level, has been associated with a reduced cardiac performance and poor prognosis in HF, even in the presence of normal thyroid-stimulating hormone levels. Low thyroid hormone levels alter cardiac gene expression and increase systemic vascular resistance, both resulting in a reduction of cardiac contractility and cardiac output. This review summarizes current data on thyroid dysfunction and HF as well as the emerging implications of the "low triiodothyronine state."
Schmidt-Ott
Ursula Maria
UM
Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA.
Ascheim
Deborah Davis
DD
D000638:Amiodarone / Q000009:adverse effects; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects; D006333:Heart Failure / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D013959:Thyroid Diseases / Q000503:physiopathology*; D013974:Thyroxine / Q000502:physiology*; D014284:Triiodothyronine / Q000172:deficiency / Q000502:physiology*
D000889:Anti-Arrhythmia Agents; D014284:Triiodothyronine; D000638:Amiodarone; D013974:Thyroxine