Combined Use of Low T3 Syndrome and NT-proBNP As Predictors for Death in Patients with Acute Decompensated Heart Failure

Overview

Journal BMC Endocr Disord

Publisher Biomed Central

Specialty Endocrinology

Date 2021 Jul 3

PMID 34215247

Citations 5

Authors

Xinke Zhao

Rongcheng Zhang

HuGang Jiang

Kai Liu

Chengxu Ma

Ming Bai

Tao An

Younan Yao

Xinqiang Wang

Ming Wang

Yingdong Li

Yuhui Zhang

Jian Zhang

Affiliations

Soon will be listed here.

Abstract

Background: In patients with established HF, low triiodothyronine syndrome (LT3S) is commonly present, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a useful marker for predicting death. This study was aimed to evaluate the prognostic value of LT3S in combination with NT-proBNP for risk of death in patients with heart failure (HF).

Methods: A total of 594 euthyroid patients hospitalized with acute decompensated HF were enrolled by design. Of these patients, 27 patients died during hospitalization and 100 deaths were identified in patients discharged alive during one year follow-up. Patients were divided into 2 groups on the base of the reference ranges of free T3 (FT3) levels: LT3S group (FT3 < 2.3pg/mL, n = 168) and non-LT3S group (FT3 ≥ 2.3pg/mL, n = 426).

Results: In multivariable Cox regression, LT3S was significantly associated with 1 year all-cause mortality (adjusted hazard ratio, 1.85; 95 % confidence interval [CI], 1.21 to 2.82; P = 0.005), but not significant for in-hospital mortality (adjusted hazard ratio, 1.58; 95 % CI, 1.58 to 2.82; P = 0.290) after adjustment for clinical variables and NT-proBNP. Addition of LT3S and NT-proBNP to the prediction model with clinical variables significantly improved the C statistic for predicting 1 year all-cause mortality.

Conclusions: In patients with acute decompensated HF, the combination of LT3S and NT-proBNP improved prediction for 1 year all-cause mortality beyond established risk factors, but was not strong enough for in-hospital mortality.

Citing Articles

Developing a nomogram for risk prediction of the low T3 syndrome.

Feng X, Chen H, Yin L, Chen J, Chen L Sci Rep. 2025; 15(1):4863.

PMID: 39929921 PMC: 11811073. DOI: 10.1038/s41598-025-89484-1.

Is Low-free Triiodothyronine (fT3) Associated with Increased Morbidity in Patients Admitted to Coronary Care Units?.

Akkus O, Sen F, Yasdibas R, Otegen A, Huzmeli I, Akkus G Endocr Metab Immune Disord Drug Targets. 2024; 25(1):57-65.

PMID: 38706313 DOI: 10.2174/0118715303287732240201122412.

The Interplay of Comorbidities in Chronic Heart Failure: Challenges and Solutions.

Agress S, Sheikh J, Ramos A, Kashyap D, Razmjouei S, Kumar J Curr Cardiol Rev. 2024; 20(3):13-29.

PMID: 38347774 PMC: 11284697. DOI: 10.2174/011573403X289572240206112303.

Non-thyroidal Illness in Children with Congestive Heart Failure.

Sahoo B, Dabas A, Goswami B, Agarwal A, Kurian S J Clin Res Pediatr Endocrinol. 2024; 16(2):192-199.

PMID: 38347684 PMC: 11590725. DOI: 10.4274/jcrpe.galenos.2024.2023-12-7.

[The impact of low T3 syndrome on the prognosis of patients with newly diagnosed multiple myeloma].

Zhang J, Zhang L, Xia Y, Jin Y, Shen X, Chen L Zhonghua Xue Ye Xue Za Zhi. 2023; 44(3):216-221.

PMID: 37356983 PMC: 10119724. DOI: 10.3760/cma.j.issn.0253-2727.2023.03.007.

References

Sabatino L, Chopra I, Tanavoli S, Iacconi P, Iervasi G . A radioimmunoassay for type I iodothyronine 5'-monodeiodinase in human tissues. Thyroid. 2001; 11(8):733-9. DOI: 10.1089/10507250152484565. View

Duntas L, Nguyen T, Keck F, Nelson D, Distefano 3rd J . Changes in metabolism of TRH in euthyroid sick syndrome. Eur J Endocrinol. 1999; 141(4):337-41. DOI: 10.1530/eje.0.1410337. View

Peeters R, Wouters P, Kaptein E, van Toor H, Visser T, Van den Berghe G . Reduced activation and increased inactivation of thyroid hormone in tissues of critically ill patients. J Clin Endocrinol Metab. 2003; 88(7):3202-11. DOI: 10.1210/jc.2002-022013. View

Pingitore A, Iervasi G, Barison A, Prontera C, Pratali L, Emdin M . Early activation of an altered thyroid hormone profile in asymptomatic or mildly symptomatic idiopathic left ventricular dysfunction. J Card Fail. 2006; 12(7):520-6. DOI: 10.1016/j.cardfail.2006.05.009. View

Fonarow G, Adams Jr K, Abraham W, Yancy C, Boscardin W . Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis. JAMA. 2005; 293(5):572-80. DOI: 10.1001/jama.293.5.572. View

Sato Y, Yoshihisa A, Kimishima Y, Kiko T, Kanno Y, Yokokawa T . Low T3 Syndrome Is Associated With High Mortality in Hospitalized Patients With Heart Failure. J Card Fail. 2019; 25(3):195-203. DOI: 10.1016/j.cardfail.2019.01.007. View

Hartupee J, Mann D . Neurohormonal activation in heart failure with reduced ejection fraction. Nat Rev Cardiol. 2016; 14(1):30-38. PMC: 5286912. DOI: 10.1038/nrcardio.2016.163. View

. [Chinese guidelines for the diagnosis and treatment of heart failure 2014]. Zhonghua Xin Xue Guan Bing Za Zhi. 2014; 42(2):98-122. View

Galli E, Pingitore A, Iervasi G . The role of thyroid hormone in the pathophysiology of heart failure: clinical evidence. Heart Fail Rev. 2008; 15(2):155-69. DOI: 10.1007/s10741-008-9126-6. View

10.

Cappola A, Desai A, Medici M, Cooper L, Egan D, Sopko G . Thyroid and Cardiovascular Disease: Research Agenda for Enhancing Knowledge, Prevention, and Treatment. Circulation. 2019; 139(25):2892-2909. PMC: 6851449. DOI: 10.1161/CIRCULATIONAHA.118.036859. View

11.

Pilo A, Iervasi G, VITEK F, Ferdeghini M, Cazzuola F, Bianchi R . Thyroidal and peripheral production of 3,5,3'-triiodothyronine in humans by multicompartmental analysis. Am J Physiol. 1990; 258(4 Pt 1):E715-26. DOI: 10.1152/ajpendo.1990.258.4.E715. View

12.

Peeters R, Kester M, Wouters P, Kaptein E, van Toor H, Visser T . Increased thyroxine sulfate levels in critically ill patients as a result of a decreased hepatic type I deiodinase activity. J Clin Endocrinol Metab. 2005; 90(12):6460-5. DOI: 10.1210/jc.2005-0866. View

13.

Fraczek-Jucha M, Zbierska-Rubinkiewicz K, Kabat M, Plens K, Rychlak R, Nessler J . Low triiodothyronine syndrome and selenium deficiency - undervalued players in advanced heart failure? A single center pilot study. BMC Cardiovasc Disord. 2019; 19(1):105. PMC: 6505272. DOI: 10.1186/s12872-019-1076-5. View

14.

Simonides W, Mulcahey M, Redout E, Muller A, Zuidwijk M, Visser T . Hypoxia-inducible factor induces local thyroid hormone inactivation during hypoxic-ischemic disease in rats. J Clin Invest. 2008; 118(3):975-83. PMC: 2230657. DOI: 10.1172/JCI32824. View

15.

Chuang C, Jong Y, Wu C, Lo H . Impact of triiodothyronine and N-terminal pro-B-type natriuretic peptide on the long-term survival of critically ill patients with acute heart failure. Am J Cardiol. 2014; 113(5):845-50. DOI: 10.1016/j.amjcard.2013.11.039. View

16.

Rothberger G, Gadhvi S, Michelakis N, Kumar A, Calixte R, Shapiro L . Usefulness of Serum Triiodothyronine (T3) to Predict Outcomes in Patients Hospitalized With Acute Heart Failure. Am J Cardiol. 2016; 119(4):599-603. DOI: 10.1016/j.amjcard.2016.10.045. View

17.

Hayashi T, Hasegawa T, Kanzaki H, Funada A, Amaki M, Takahama H . Subclinical hypothyroidism is an independent predictor of adverse cardiovascular outcomes in patients with acute decompensated heart failure. ESC Heart Fail. 2016; 3(3):168-176. PMC: 5071693. DOI: 10.1002/ehf2.12084. View

18.

Asai K, Shirakabe A, Kiuchi K, Kobayashi N, Okazaki H, Matsushita M . Relation of Low Triiodothyronine Syndrome Associated With Aging and Malnutrition to Adverse Outcome in Patients With Acute Heart Failure. Am J Cardiol. 2019; 125(3):427-435. DOI: 10.1016/j.amjcard.2019.10.051. View

19.

Chopra I, Wu S, Teco G, Santini F . A radioimmunoassay for measurement of 3,5,3'-triiodothyronine sulfate: studies in thyroidal and nonthyroidal diseases, pregnancy, and neonatal life. J Clin Endocrinol Metab. 1992; 75(1):189-94. DOI: 10.1210/jcem.75.1.1619009. View

20.

St Germain D, Galton V . The deiodinase family of selenoproteins. Thyroid. 1997; 7(4):655-68. DOI: 10.1089/thy.1997.7.655. View