title: How Does Subclinical Hyperthyroidism Affect Right Heart Function and Mechanics?
abstract: OBJECTIVE
  Right heart function and mechanics have not been investigated in patients with subclinical hyperthyroidism. Our aim was to investigate right ventricular (RV) and right atrial (RA) function and deformation as evaluated by 3-dimensional echocardiography (3DE) and speckle-tracking 2-dimensional echocardiography (2DE) in these individuals.
  
  
  METHODS
  We included 39 untreated women with endogenous subclinical hyperthyroidism and 39 healthy women matched by age. All participants underwent laboratory analyses that included thyroid hormone levels and comprehensive 2DE and 3DE examinations.
  
  
  RESULTS
  Three-dimensional echocardiographic RV volumes were significantly elevated in the patients with subclinical hyperthyroidism (P < .05), whereas the 3DE RV ejection fraction was reduced in this group, but with borderline significance. Two-dimensional echocardiographic longitudinal RV and RA strain were significantly reduced in the patients with subclinical hyperthyroidism. Two-dimensional echocardiographic RV systolic and early diastolic strain rates were reduced, whereas late diastolic strain rates were increased in the patients with subclinical hyperthyroidism. The same changes were detected in RA mechanics among the patients with subclinical hyperthyroidism. The thyrotropin (TSH) level correlated with the left ventricular mass index, transmitral early diastolic peak flow velocity (E)/late diastolic flow velocity (A) ratio, tricuspid E/A ratio, 2DE RV global strain, 2DE RA, strain, and 3DE RV end-diastolic volume. A multivariate regression analysis showed that the mitral E/A ratio, 2DE RV global strain, and 3DE RV end-diastolic volume were independently associated with the TSH level.
  
  
  CONCLUSIONS
  Right ventricular and RA function as evaluated by 3DE and speckle-tracking 2DE is significantly impaired in patients with subclinical hyperthyroidism. The TSH level correlated with parameters for RV function and mechanics in the whole study population.
authors.affiliation: Departments of Cardiology (M.T., V.C., V.Z., T.M.) and Endocrinology (S.I.), University Clinical Hospital Center Dr Dragisa Misovic-Dedinje, Belgrade, Serbia; School of Medicine, University of Belgrade, Serbia (M.T., V.C., V.Z.); and Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy (C.C.). marijana_tadic@hotmail.com.
authors.forename: Marijana
authors.initials: M
authors.lastname: Tadic
authors.affiliation: Departments of Cardiology (M.T., V.C., V.Z., T.M.) and Endocrinology (S.I.), University Clinical Hospital Center Dr Dragisa Misovic-Dedinje, Belgrade, Serbia; School of Medicine, University of Belgrade, Serbia (M.T., V.C., V.Z.); and Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy (C.C.).
authors.forename: Vera
authors.initials: V
authors.lastname: Celic
authors.affiliation: Departments of Cardiology (M.T., V.C., V.Z., T.M.) and Endocrinology (S.I.), University Clinical Hospital Center Dr Dragisa Misovic-Dedinje, Belgrade, Serbia; School of Medicine, University of Belgrade, Serbia (M.T., V.C., V.Z.); and Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy (C.C.).
authors.forename: Cesare
authors.initials: C
authors.lastname: Cuspidi
authors.affiliation: Departments of Cardiology (M.T., V.C., V.Z., T.M.) and Endocrinology (S.I.), University Clinical Hospital Center Dr Dragisa Misovic-Dedinje, Belgrade, Serbia; School of Medicine, University of Belgrade, Serbia (M.T., V.C., V.Z.); and Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy (C.C.).
authors.forename: Sanja
authors.initials: S
authors.lastname: Ilic
authors.affiliation: Departments of Cardiology (M.T., V.C., V.Z., T.M.) and Endocrinology (S.I.), University Clinical Hospital Center Dr Dragisa Misovic-Dedinje, Belgrade, Serbia; School of Medicine, University of Belgrade, Serbia (M.T., V.C., V.Z.); and Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy (C.C.).
authors.forename: Vladimir
authors.initials: V
authors.lastname: Zivanovic
authors.affiliation: Departments of Cardiology (M.T., V.C., V.Z., T.M.) and Endocrinology (S.I.), University Clinical Hospital Center Dr Dragisa Misovic-Dedinje, Belgrade, Serbia; School of Medicine, University of Belgrade, Serbia (M.T., V.C., V.Z.); and Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy (C.C.).
authors.forename: Tamara
authors.initials: T
authors.lastname: Marjanovic
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D003430:Cross-Sectional Studies; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D006980:Hyperthyroidism / Q000503:physiopathology*; D021621:Imaging, Three-Dimensional; D016278:Ventricular Function, Right
keywords: 2-dimensional speckle tracking; 3-dimensional echocardiography; echocardiography; right ventricle; subclinical hyperthyroidism