[Prognostic factors of unfavorable outcome of thyrotoxic cardiomyopathy].
Because of absence of investigations directed at study of quantitative evaluation of prognostic factors of unfavorable outcome of thyreotoxic cardiomyopathy (TCMP) it remains actual to investigate the course and variants of outcomes of TCMP in various groups of patients differing by age, sex, duration, and etiology of thyreotoxicosis (TT), as well as spectrum of concomitant cardiovascular pathology. Aim of the study was to elucidate prognostic factors of unfavorable outcome of TCMP. Material and methods. We examined 113 patients in the age of 62 [54; 70] years hospitalized from 1975 to 2003 with various forms of toxic goiter in combination with cardiac rhythm disturbances and/or signs of heart failure (HF). In 9.7% of patients (11/113) clinical and instrumental signs of TCMP were absent (group 1); asymptomatic myocardial dysfunction diagnosed by echoCG data was observed in 24.8% of patients (28/113) (group 2); 65.5% of patients (74/113) had persistent clinical and instrumental signs of TCMP (group 3). With the aim of detection of prognostic factors determining outcomes of TCMP we carried out mathematical modeling with construction of a regression multifactorial ordinal model. Results. The following factors were most closely linked (p < 0.05) with unfavorable outcome of TCMP: age at the moment of visit (OR 1.2 95%CI 1.03 - 1.30), recurrences of TT (OR 8.1 95%CI 4.12-10.75), history of angina pectoris (OR 34.8 95%CI 1.76 - 43.13), atrial fibrillation (AF) at the moment of hospitalization (OR 2.0 95%CI 1.03 - 3.89), T wave inversion on ECG at rest at the moment of hospitalization (OR 2.9 95%CI 1.63 - 5.20). Conclusions. Prognostic factors of unfavorable outcome of TCMP are age at the moment of outcome, AF at hospitalization, and recurrences of TT. Cardiac rhythm disturbances serve as main reason of appealability of patients with TT. T wave inversion, associated with TCMP in majority of patients, was considered as ECG criterion of effort angina, what led to late diagnosis of TT and determined unfavorable outcome of TCMP.
Shul'gina
V Iu
VIu
I M Sechenov Moscow Medical Academy, ul M Trubeckaya, 8, stroenie 2, Moscow, Russia.
Mel'nichenko
G A
GA
Syrkin
A L
AL
Shornikov
S B
SB
D000367:Age Factors; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D009202:Cardiomyopathies / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology*; D004452:Echocardiography; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013958:Thyroid Crisis / Q000150:complications*