title: Echocardiographic evaluation of left ventricular diastolic dysfunction in subclinical hypothyroidism: A case-control study.
abstract: OBJECTIVE
  To study the prevalence of left ventricular diastolic dysfunction (LVDD) in patients with subclinical hypothyroidism (SCH) and the response of LVDD to L-thyroxine therapy.
  
  
  METHODS
  This cross-sectional case-control study with one longitudinal arm included 67 patients with SCH attending a tertiary care hospital in Uttarakhand, India, and 67 age- and sex-matched healthy controls. LVDD was assessed by 2D, pulsed-wave Doppler (PWD), continuous wave Doppler (CWD), and tissue Doppler echocardiography (TDE). Patients with LVDD received L-thyroxine therapy with reassessment for LVDD 6 months later.
  
  
  RESULTS
  SCH patients had a higher prevalence of LVDD than controls (13.43% versus 1.49%; p = 0.017). LVDD showed a significant association with gender (p = 0.004) and serum FT4 (p = 0.001). E velocity, E' velocity, A' velocity, iso-volumetric relaxation time (IVRT), E/A, and E'/A' ratios were significantly lower, while A velocity, deceleration time (DT), E/E' ratio, left atrial (LA) volume index, and peak tricuspid regurgitation (TR) velocity were significantly higher in cases than controls (p < 0.05 each). The E/A ratio correlated significantly with age, serum very low-density lipoprotein (VLDL), triglycerides (TG), thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and high-density lipoprotein (HDL) (p < 0.05 each). E' velocity correlated significantly with age, serum total cholesterol, VLDL, and TG (p < 0.05 each), DT with serum total cholesterol (p = 0.047), and LA volume index with age (p = 0.021). Age (p = 0.016) and serum HDL (p = 0.029) were independent predictors of E/A ratio. Gender was an independent predictor for LVDD (p = 0.003). Echocardiographic indices for LVDD showed significant improvement after 6 months of L-thyroxine therapy (p < 0.05 each).
  
  
  CONCLUSIONS
  LVDD occurs commonly in SCH patients. It can be detected timely using echocardiography and may be reversed by L-thyroxine therapy.
authors.affiliation: a Department of Medicine , Himalayan Institute of Medical Sciences, Swami Rama Himalayan University , Dehradun , Uttarakhand , India.
authors.forename: Yuthika
authors.initials: Y
authors.lastname: Malhotra
authors.affiliation: a Department of Medicine , Himalayan Institute of Medical Sciences, Swami Rama Himalayan University , Dehradun , Uttarakhand , India.
authors.forename: Rajeev Mohan
authors.identifier: http://orcid.org/0000-0003-0217-4269
authors.initials: RM
authors.lastname: Kaushik
authors.affiliation: a Department of Medicine , Himalayan Institute of Medical Sciences, Swami Rama Himalayan University , Dehradun , Uttarakhand , India.
authors.forename: Reshma
authors.identifier: http://orcid.org/0000-0001-7826-2092
authors.initials: R
authors.lastname: Kaushik
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000188:drug therapy* / Q000453:epidemiology; D007194:India / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D013974:Thyroxine / Q000008:administration & dosage / Q000494:pharmacology*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000453:epidemiology; D055815:Young Adult
chemical_list: D013974:Thyroxine
keywords: Echocardiographic evaluation; left ventricular diastolic dysfunction; subclinical hypothyroidism