Left Ventricular Diastolic Dysfunction in Patients with Subclinical Hypothyroidism
Bernadette Biondi,
Serafino Fazio,
Emiliano Antonio Palmieri,
Carlo Carella,
Nicola Panza,
Antonio Cittadini,
Filomena Bonè,
Gaetano Lombardi and
Luigi Saccà
Departments of Internal Medicine (S.F., E.A.P., A.C., F.B., L.S.)
and Endocrinology (B.B., N.P., G.L.) of the University Federico II, and
Department of Endocrinology (C.C.) of the Second University,
Naples, Italy
Address all correspondence and requests for reprints to: Luigi Saccà, M.D., Department of Internal Medicine, via Pansini, 5, 80131 Naples, Italy.
Although subclinical hypothyroidism is frequently diagnosed,the
decision to institute a substitutive therapy with
L-T4 remainscontroversial. Because the
cardiovascular system is considereda main target for the action of
thyroid hormone, we investigatedwhether subclinical hypothyroidism
induces cardiovascular abnormalities.
Twenty-six patients (mean age, 36 ± 12 yr) were evaluatedby
Doppler-echocardiography, whereas a subgroup of 10 patients,randomly
selected, were reevaluated after 6 months of
L-T4 substitutivetherapy (mean dose, 68 µg
daily). Thirty subjects (matchedfor age, sex, and body surface area)
served as controls.
Mean plasma TSH was significantly higher in patients
(P <0.001), whereas mean serum free
T4 and free T3 concentrations,although in the
normal range, were significantly lower (P <0.001
and P < 0.005, respectively). Blood pressure and
heartrate did not differ from control values. Echocardiogram
examinationshowed no abnormalities of the left ventricular morphology
anda slight, but not significant, reduction in the systolic function
inthe patient group. In contrast, Doppler-derived indices of diastolic
functionshowed significant prolongation of the isovolumic relaxation
time(94 ± 13 vs. 84 ± 8 msec;
P < 0.001), increasedA wave (55 ± 13
vs. 48 ± 9 cm/sec; P < 0.05),
andreduced early diastolic mitral flow velocity/late diastolicmitral
flow velocity ratio (1.4 ± 0.3 vs. 1.7
±0.3; P < 0.001). In the subgroup of 10
patients, thyroidhormone profile was normalized by 6 months of
L-T4 substitutivetherapy, whereas no changes
were observed in the left ventricularmorphology. Systolic function was
significantly enhanced, ascompared with pretreatment values
(P < 0.01) but did notdiffer from control values.
Also, systemic vascular resistancewas significantly decreased by
L-T4 replacement therapy. Assessmentof
diastolic function showed significant shortening of isovolumic
relaxationtime (77 ± 15 vs. 91 ± 8;
P < 0.05), reductionof A wave (51 ± 13
vs. 60 ± 12; P < 0.01),and
increase of early diastolic mitral flow velocity/late diastolicmitral
flow velocity ratio (1.7 ± 0.4 vs. 1.3 ±
0.3;P < 0.001). These indices, however, were
comparable withthose of control subjects.
These findings indicate that subclinical hypothyroidism affects
diastolicfunction and that this abnormality may be reversed by
L-T4 substitutivetherapy.
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