Effect of subclinical hypothyroidism on prognosis of patients with chronic systolic heart failure: A meta-analysis

doi:10.3969/j.issn.1004-583X.2022.10.004

Abstract

Abstract:

Objective To systematically evaluate the effect of subclinical hypothyroidism (SCH) on prognosis of patients with chronic systolic heart failure (CSHF). Methods A computer search was conducted in Web of Science, Cochrane Library, Chinese Biomedical Database (CBM), China National Knowledge Internet (CNKI), Wanfang, VIP database up to May 2022. The literatures regarding SCH-related prognosis of CSHF patients were extracted based on predefined inclusion/exclusion criteria. The Newcastle-Ottawa scale (NOS) was performed to evaluate the relevant data extracted, a Meta-analysis was conducted using STATA 12.0 statistical software, and the hazard ratio (HR) and its 95% confidence interval (95%CI) were used as the effect quantities. Results Eligible 9 literatures representing 21 723 CSHF patients (hypothyroidism in 1 225; euthyroidism in 19 120) were included in the meta-analysis. Meta-analysis results showed that all-cause mortality (HR=1.58, 95%CI: 1.30-1.92), cardiovascular adverse event and (or) re-hospitalization (HR=1.42, 95%CI: 1.16-1.73) were risk factors for hypothyroidism as compared to euthyroidism. SCH was associated with poor prognosis of CSHF patients in subgroup analysis. The less than 24 months follow-ups were most strongly associated with all-cause mortality (HR=2.50), Asian CSHF patients were most strongly associated with cardiovascular adverse event and (or) re-hospitalization(HR=1.59). Conclusion SCH might be associated with the risk factors for all-cause mortality, cardiovascular events, and/or hospitalization of CHF patients.

Key words: hypothyroidism, systolic heart failure, prognosis, meta-analysis

CLC Number:

Zuo Xiuxiu, Hou Tianhua, Wang Hongxiang. Effect of subclinical hypothyroidism on prognosis of patients with chronic systolic heart failure: A meta-analysis[J]. Clinical Focus, 2022, 37(10): 905-911.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2022.10.004

https://huicui.hebmu.edu.cn/EN/Y2022/V37/I10/905

Figures/Tables 6

References 31

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作者	年份	国家	总人数/甲状腺正常人数/亚临床甲减人数	TSH界值(mIU/L)		随访时间(月)	平均年龄(岁)	男性占比(%)	结局	调整因素
作者	年份	国家	总人数/甲状腺正常人数/亚临床甲减人数	对照组	试验组	随访时间(月)	平均年龄(岁)	男性占比(%)	结局	调整因素
Iacoviello等^[7]	2008	意大利	338/304/34	>0.35	>5.5	16	64	77	心脏事件全因死亡住院率	年龄,糖尿病,NYHA分级,平均动脉压,心率,心房颤动,左室射血分数,左室舒张末期内径、心肌梗死、肾小球滤过率,血红蛋白,钠离子,NT-proBNP、ACEI或ARB药物的缺乏治疗
Sato等^[8]	2018	日本	1100/911/132	>0.4	>4	36	67	73	心脏事件全因死亡	年龄,性别,体重指数,收缩压,心率,NYHA分级,是否有缺血性因素,高血压、糖尿病、慢性肾脏病,贫血,心房颤动,吸烟史,钠离子,C反应蛋白,BNP,左室射血分数
Kannan等^[9]	2018	美国	1365/1006/74	>0.45	>4.51	50	56.6	65	心脏事件全因死亡	年龄,性别,种族,体重指数,缺血性病因,胺碘酮的使用,甲状腺药物使用
Frey等^[10]	2013	德国	758/628/34	>0.3	>4.0	37	68	71	全因死亡	年龄
Wang等^[11]	2015	中国	458/353/41	>0.55	>4.78	17	51	71	住院率心脏事件全因死亡	年龄,性别,贫血,肾脏功能障碍,高脂血症,吸烟,糖尿病
Li等^[12]	2014	中国	963/816/79	>0.35	>5.5	42	52.1	73.7	全因死亡	年龄,性别,高血压史,心房颤动,室性心动过速,饮酒吸烟,左室直径,左房直径,左室射血分数,FT3,T3,T4,亚临床甲亢,亚临床甲减
刘凯等^[13]	2019	中国	1100/911/132	>0.4	>4	36.6	71.3	55.8	心脏事件全因死亡	年龄、性别、体重指数、收缩压,心率,NYHA分级,缺血性心脏病,高血压,糖尿病,血脂水平,慢性肾病,贫血,心房颤动,吸烟史,血钠,C-反应蛋白、BNP和左室射血分数
Rhee等^[14]	2013	美国	15570/14130/691	>0.39	>4.6	429	46.7	46.5	全因死亡	年龄,性别,种族,糖尿病,吸烟,高血压,高胆固醇血症,BMI,既往脑卒中,心肌梗死
Shuichi等^[15]	2015	日本	71/61/8	>0.35	>5.5	无	无	无	住院率	无

作者	年份	国家	总人数/甲状腺正常人数/亚临床甲减人数	TSH界值(mIU/L)		随访时间(月)	平均年龄(岁)	男性占比(%)	结局	调整因素
作者	年份	国家	总人数/甲状腺正常人数/亚临床甲减人数	对照组	试验组	随访时间(月)	平均年龄(岁)	男性占比(%)	结局	调整因素
Iacoviello等^[7]	2008	意大利	338/304/34	>0.35	>5.5	16	64	77	心脏事件全因死亡住院率	年龄,糖尿病,NYHA分级,平均动脉压,心率,心房颤动,左室射血分数,左室舒张末期内径、心肌梗死、肾小球滤过率,血红蛋白,钠离子,NT-proBNP、ACEI或ARB药物的缺乏治疗
Sato等^[8]	2018	日本	1100/911/132	>0.4	>4	36	67	73	心脏事件全因死亡	年龄,性别,体重指数,收缩压,心率,NYHA分级,是否有缺血性因素,高血压、糖尿病、慢性肾脏病,贫血,心房颤动,吸烟史,钠离子,C反应蛋白,BNP,左室射血分数
Kannan等^[9]	2018	美国	1365/1006/74	>0.45	>4.51	50	56.6	65	心脏事件全因死亡	年龄,性别,种族,体重指数,缺血性病因,胺碘酮的使用,甲状腺药物使用
Frey等^[10]	2013	德国	758/628/34	>0.3	>4.0	37	68	71	全因死亡	年龄
Wang等^[11]	2015	中国	458/353/41	>0.55	>4.78	17	51	71	住院率心脏事件全因死亡	年龄,性别,贫血,肾脏功能障碍,高脂血症,吸烟,糖尿病
Li等^[12]	2014	中国	963/816/79	>0.35	>5.5	42	52.1	73.7	全因死亡	年龄,性别,高血压史,心房颤动,室性心动过速,饮酒吸烟,左室直径,左房直径,左室射血分数,FT3,T3,T4,亚临床甲亢,亚临床甲减
刘凯等^[13]	2019	中国	1100/911/132	>0.4	>4	36.6	71.3	55.8	心脏事件全因死亡	年龄、性别、体重指数、收缩压,心率,NYHA分级,缺血性心脏病,高血压,糖尿病,血脂水平,慢性肾病,贫血,心房颤动,吸烟史,血钠,C-反应蛋白、BNP和左室射血分数
Rhee等^[14]	2013	美国	15570/14130/691	>0.39	>4.6	429	46.7	46.5	全因死亡	年龄,性别,种族,糖尿病,吸烟,高血压,高胆固醇血症,BMI,既往脑卒中,心肌梗死
Shuichi等^[15]	2015	日本	71/61/8	>0.35	>5.5	无	无	无	住院率	无

作者	暴露组代表性	非暴露组代表性	暴露因素确定	研究时没有要观察的结局指标	是否控制混杂因素	盲法独立	随访时间是否足够长	随访完整性	总分(分)
Iacoviello等^[7]	1	1	1	1	1	1	0	1	7
Sato等^[8]	1	1	1	1	1	1	1	1	8
Kannan等^[9]	1	1	1	1	1	1	1	1	8
Frey等^[10]	1	1	1	1	1	1	1	1	8
Wang等^[11]	1	1	1	1	1	1	0	1	7
Li等^[12]	1	1	1	1	2	1	1	1	9
刘凯等^[13]	1	1	1	0	1	1	1	1	7
Rhee等^[14]	1	1	1	1	1	1	1	1	8
Shuichi等^[15]	1	1	1	0	1	0	0	1	5

作者	暴露组代表性	非暴露组代表性	暴露因素确定	研究时没有要观察的结局指标	是否控制混杂因素	盲法独立	随访时间是否足够长	随访完整性	总分(分)
Iacoviello等^[7]	1	1	1	1	1	1	0	1	7
Sato等^[8]	1	1	1	1	1	1	1	1	8
Kannan等^[9]	1	1	1	1	1	1	1	1	8
Frey等^[10]	1	1	1	1	1	1	1	1	8
Wang等^[11]	1	1	1	1	1	1	0	1	7
Li等^[12]	1	1	1	1	2	1	1	1	9
刘凯等^[13]	1	1	1	0	1	1	1	1	7
Rhee等^[14]	1	1	1	1	1	1	1	1	8
Shuichi等^[15]	1	1	1	0	1	0	0	1	5

亚组	全因死亡					心脏事件和(或)再住院
	文章数量	异质性检验		Meta分析		文章数量	异质性检验		Meta分析
	文章数量	I²(%)	P	HR	95%CI	文章数量	I²(%)	P	HR	95%CI
种族
欧美洲	4	2.7	0.379	1.59	1.29-1.97	2	86.5	0.006	1.11	1.06-1.15
亚洲	4	66.6	0.029	1.56	1.28-1.90	3	60.3	0.081	1.59	1.29-1.96
年龄
≤65岁	5	54.4	0.076	1.74	1.44-2.10	3	89.6	0.000	1.11	1.07-1.16
>65岁	3	0	0.703	1.37	1.09-1.71	2	0	0.976	1.42	1.13-1.79
随访时间
≤24月	2	0	0.347	2.50	1.76-3.56	2	91.7	0.001	1.11	1.06-1.15
>24月	6	0	0.637	1.44	1.23-1.69	3	0	0.532	1.53	1.26-1.86
样本量
≤1 000例	4	70.4	0.017	1.73	1.33-2.24	2	91.7	0.001	1.11	1.06-1.15
>1 000例	4	0	0.729	1.52	1.28-1.80	3	0	0.532	1.53	1.26-1.86