title: Thyroid Status, Cardiac Function, and Mortality in Patients With Idiopathic Dilated Cardiomyopathy.
abstract: BACKGROUND
  Previous studies claiming a relationship between thyroid dysfunction and poor prognosis of heart failure (HF) had a major limitation in that they included patients with different etiologies.
  
  
  OBJECTIVE
  With complete information of thyroid function profile from 458 consecutive patients with idiopathic dilated cardiomyopathy, we tested the hypothesis that thyroid status can independently influence mortality in patients with HF. Design, Patients, and Outcome Measure: The original cohort consisted of 572 consecutive patients with idiopathic dilated cardiomyopathy, and 458 patients remained at the end of follow-up. All patients took thyroid function tests and other regular examinations in hospital. The risk of mortality was evaluated based on free T3, TSH, and the whole thyroid function profile, respectively.
  
  
  RESULTS
  The most frequent thyroid dysfunction was subclinical hypothyroidism (n = 41), followed by subclinical hyperthyroidism (n = 35), low-T3 syndrome (n = 17), and hypothyroidism (n = 12). Logistic analysis showed log-TSH and free T3 as independent predictors of exacerbated cardiac function (New York Heart Association stages III-IV vs New York Heart Association stages I-II). During the follow-up (17 ± 8 mo), 111 cumulative deaths occurred. Hypothyroidism was the strongest predictor of mortality [hazard ratio (HR) 4.189; 95% confidence interval (CI) 2.118-8.283)], followed by low-T3 syndrome (HR 3.147; 95% CI 1.558-6.355) and subclinical hypothyroidism (HR 2.869; 95% CI 1.817-4.532). Subclinical hyperthyroidism showed no significant impact.
  
  
  CONCLUSIONS
  We found a clear association between thyroid dysfunction and increased risk of mortality in idiopathic dilated cardiomyopathy with HF. These results suggest that monitoring thyroid function in HF patients is necessary, and further studies on the treatment of HF with thyroid dysfunction are needed.
authors.affiliation: State Key Laboratory of Cardiovascular Disease (W.W., Y.Y., Y.-D.T.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100031, China; Department of Endocrinology and Metabolism (H.G.), The First Affiliated Hospital of China Medical University, Shenyang 110001, China; Department of Biomedical Sciences (A.M.G.), New York Institute of Technology-College of Osteopathic Medicine, Old Westbury, New York 11568; Clinical Physiology Institute (G.I.), Consiglio Nazionale delle Ricerche/Fondazione G Monasterio Consiglio Nazionale delle Ricerche-Regione Toscna, 54100 Pisa e Massa, Italy.
authors.forename: Wenyao
authors.initials: W
authors.lastname: Wang
authors.affiliation: State Key Laboratory of Cardiovascular Disease (W.W., Y.Y., Y.-D.T.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100031, China; Department of Endocrinology and Metabolism (H.G.), The First Affiliated Hospital of China Medical University, Shenyang 110001, China; Department of Biomedical Sciences (A.M.G.), New York Institute of Technology-College of Osteopathic Medicine, Old Westbury, New York 11568; Clinical Physiology Institute (G.I.), Consiglio Nazionale delle Ricerche/Fondazione G Monasterio Consiglio Nazionale delle Ricerche-Regione Toscna, 54100 Pisa e Massa, Italy.
authors.forename: Haixia
authors.initials: H
authors.lastname: Guan
authors.affiliation: State Key Laboratory of Cardiovascular Disease (W.W., Y.Y., Y.-D.T.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100031, China; Department of Endocrinology and Metabolism (H.G.), The First Affiliated Hospital of China Medical University, Shenyang 110001, China; Department of Biomedical Sciences (A.M.G.), New York Institute of Technology-College of Osteopathic Medicine, Old Westbury, New York 11568; Clinical Physiology Institute (G.I.), Consiglio Nazionale delle Ricerche/Fondazione G Monasterio Consiglio Nazionale delle Ricerche-Regione Toscna, 54100 Pisa e Massa, Italy.
authors.forename: A Martin
authors.initials: AM
authors.lastname: Gerdes
authors.affiliation: State Key Laboratory of Cardiovascular Disease (W.W., Y.Y., Y.-D.T.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100031, China; Department of Endocrinology and Metabolism (H.G.), The First Affiliated Hospital of China Medical University, Shenyang 110001, China; Department of Biomedical Sciences (A.M.G.), New York Institute of Technology-College of Osteopathic Medicine, Old Westbury, New York 11568; Clinical Physiology Institute (G.I.), Consiglio Nazionale delle Ricerche/Fondazione G Monasterio Consiglio Nazionale delle Ricerche-Regione Toscna, 54100 Pisa e Massa, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Iervasi
authors.affiliation: State Key Laboratory of Cardiovascular Disease (W.W., Y.Y., Y.-D.T.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100031, China; Department of Endocrinology and Metabolism (H.G.), The First Affiliated Hospital of China Medical University, Shenyang 110001, China; Department of Biomedical Sciences (A.M.G.), New York Institute of Technology-College of Osteopathic Medicine, Old Westbury, New York 11568; Clinical Physiology Institute (G.I.), Consiglio Nazionale delle Ricerche/Fondazione G Monasterio Consiglio Nazionale delle Ricerche-Regione Toscna, 54100 Pisa e Massa, Italy.
authors.forename: Yuejin
authors.initials: Y
authors.lastname: Yang
authors.affiliation: State Key Laboratory of Cardiovascular Disease (W.W., Y.Y., Y.-D.T.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100031, China; Department of Endocrinology and Metabolism (H.G.), The First Affiliated Hospital of China Medical University, Shenyang 110001, China; Department of Biomedical Sciences (A.M.G.), New York Institute of Technology-College of Osteopathic Medicine, Old Westbury, New York 11568; Clinical Physiology Institute (G.I.), Consiglio Nazionale delle Ricerche/Fondazione G Monasterio Consiglio Nazionale delle Ricerche-Regione Toscna, 54100 Pisa e Massa, Italy.
authors.forename: Yi-Da
authors.initials: YD
authors.lastname: Tang
mesh_terms: D000328:Adult; D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology*; D015331:Cohort Studies; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013959:Thyroid Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D013960:Thyroid Function Tests; D013961:Thyroid Gland / Q000503:physiopathology*; D016277:Ventricular Function, Left / Q000502:physiology