301 research outputs found
B-type natriuretic peptide in children undergoing pediatric cardiac surgery: Just a marker of disease severity strongly related to age or much more?
Age- and disease-related variations in B-type natriuretic peptide response after pediatric cardiac surgery
Acute Effects Of Triiodothyronine T. (T3) Replacement Therapy in Patients with Chronic Heart Failure and Low-T3 Syndrome: A Randomized, Placebo-Controlled Study
Context: Low-T3 syndrome is a predictor of poor outcome in patients with cardiac dysfunction. The
study aimed to assess the short-term effects of synthetic L-T3 replacement therapy in patients with
low-T3 syndrome and ischemic or nonischemic dilated cardiomyopathy (DC).
Design:Atotal of 20 clinically stable patients with ischemic (n12) or nonischemic (n8) DC were
enrolled. There were 10 patients (average age 72 yr, range 66–77; median, 25–75th percentile)
who underwent 3-d synthetic L-T3 infusion (study group); the other 10 patients (average age 68 yr,
range 64–71) underwent placebo infusion (control group). Clinical examination, electrocardiography,
cardiac magnetic resonance, and bio-humoral profile (free thyroid hormones, TSH, plasma
renin activity, aldosterone, noradrenaline, N-terminal-pro-B-Type natriuretic peptide, and IL-6)
were assessed at baseline and after 3-d synthetic L-T3 (initial dose: 20 g/m2 body surfaced) or
placebo infusion.
Results: After T3 administration, free T3 concentrations increased until reaching a plateau at 24–48
h (3.43, 3.20–3.84 vs. 1.74, 1.62–1.93 pg/ml; P 0.03) without side effects. Heart rate decreased
significantly after T3 infusion (63, 60–66 vs. 69, 60–76 beats per minute; P 0.008). Plasma noradrenaline
(347; 270–740 vs. 717, 413–808 pg/ml; P 0.009), N-terminal pro-B-Type natriuretic
peptide (3000, 438-4005 vs. 3940, 528-5628 pg/ml; P0.02), and aldosterone (175, 152–229 vs. 231,
154–324 pg/ml; P 0.047) significantly decreased after T3 administration. Neurohormonal profile
did not change after placebo infusion in the control group. After synthetic L-T3 administration,
left-ventricular end-diastolic volume (142, 132–161 vs. 133, 114–158 ml/m2 body surface; P 0.02)
and stroke volume (40, 34–44 vs. 35, 28–39 ml/m2 body surface; P 0.01) increased, whereas
external and intracardiac workload did not change.
Conclusions: In DC patients, short-term synthetic L-T3 replacement therapy significantly improved
neuroendocrine profile and ventricular performance. These data encourage further controlled
trials with more patients and longer periods of synthetic L-T3 administration
Interassay variability of immunometric methods for thyrotropin in an external quality assessment survey: evidence that functional sensitivity is not always adequate for clinical decisions
Stress/rest myocardial perfusion abnormalities by gated SPECT: still the best predistor of cardiac events in stable ischemic heart disease
Altered tissue degradation and distribution of Atrial Natriuretic Peptide in patients with idiopathic dilated cardiomyopathy and its relationship with clinical severity of the disease and sodium handling
Association Between Increased Mortality and Mild Thyroid Dysfunction in Cardiac Patients
BACKGROUND: The effects of subclinical thyroid dysfunction on cardiac outcome are not well defined. METHODS: To assess the relationship between mild thyroid dysfunction and the incidence of death in cardiac patients, we evaluated 3121 cardiac patients. Cardiac and overall deaths were considered. Four groups were defined: euthyroidism, subclinical hypothyroidism (SCH), subclinical hyperthyroidism (SCT), and low triiodothyronine syndrome (low T3). RESULTS: After mean follow-up of 32 months, there were 65 and 140 cardiac and overall deaths (3.4% and 7.3%), respectively, in euthyroidism, 15 and 27 (7.2% and 13.0%) in SCH, 8 and 9 (8.2% and 9.2%) in SCT, and 59 and 119 (6.5% and 13.1%) in low T3. Survival rates for cardiac death were lower in SCH, SCT, and low T3 than in euthyroidism (log-rank test; chi2 = 19.46; P < .001). Survival rates for overall death were lower in SCH and low T3 than in euthyroidism (log-rank test; chi2 = 26.67; P < .001). After adjustment for several risk factors, hazard ratios (HRs) for cardiac death were higher in SCH (HR, 2.40; 95% confidence interval [CI], 1.36-4.21; P = .02), SCT (HR, 2.32; 95% CI, 1.11-4.85; P = .02), and low T(3) (HR, 1.63; 95% CI, 1.14-2.33; P = .007) than in euthyroidism; HRs for overall death were higher in SCH (HR, 2.01; 95% CI, 1.33-3.04; P < .001) and low T3 (HR, 1.57; 95% CI, 1.22-2.01; P < .001) but not in SCT. CONCLUSION: A mildly altered thyroid status is associated with an increased risk of mortality in patients with cardiac disease
Acute effects of amiodarone administration on thyroid function in patients with cardiac arrhythmia
Is the low tri-iodothyronine state a crucial factor in determining the outcome of coronary artery bypass patients? Evidence from a clinical pilot study
The cardiovascular system is an important target for thyroid hormones. The present study evaluates the changes affecting thyroid hormone metabolism during and 6 days after coronary artery bypass and their relationship with the post-operative outcome of the patients. Thirty-three patients were enrolled in the study; their thyroid hormone profiles were determined at 13 sampling points during surgery and for 6 days afterwards. Serum total tri-iodothyronine (T3) and free T3 (FT3) concentrations decreased significantly after surgery (P<0.001) and they remained significantly low until the end of the study. Free thyroxine (FT4) and T4 declined significantly immediately after surgery (P<0.05 for FT4, P<0.001 for T4) but they returned to baseline values (24 h and 96 h post-surgery respectively). Serum reverse T3 increased remarkably 36 h after surgery (P<0.001) and remained significantly higher than the baseline value throughout the study. A relevant finding was that the days of post-operative hospitalization (10+/-3 days, means+/-S.D.) was inversely correlated with the slope of the recovery of T3 concentration (P<0.001) or with the area under the plasma curves of T3 (P=0.024, time range 72-144 h) and the FT3/FT4 ratio (P=0.037, time range 72-144 h) during the post-operative period. Our data suggest a prolonged reduction of T4 to T3 conversion in patients undergoing cardiac surgery and indicate that the recovery period is the most critical in the evaluation of a possibly successful approach for T3 substitutive therapy
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