Prognostic Relevance of Thyroid Disorders in Adults With Congenital Heart Disease
Section snippets
Methods
Data on consecutive patients with ACHD, >18 years, attending our tertiary center between 2014 and 2019 were retrospectively collected. The study population was divided in 2 groups according to the history of TD at baseline, defined as clinical manifest or subclinical (abnormal serum thyroid stimulating hormone [TSH] level) thyroid dysfunction including iatrogenic disease after thyroidectomy, goiter, and thyroid malformation. Electronic records were reviewed for clinical data between patients’
Results
A total of 495 patients (32.2 [24.5 to 45.6] years, 54% women) were included. Baseline clinical details are summarized in Table 1. The majority (414 = 84%) had moderate/complex disease. A total of 151 patients (30.5%) had a diagnosis of TD (Table 2). Of them, 115 were on replacement therapy (76%) and 7 were on suppressive treatment (5%) at last clinical assessment. Laboratory data of thyroid function obtained on an outpatient basis at last assessment were available for 73 patients. A total of
Discussion
TD were highly prevalent in our ACHD population and were related to increased risk of adverse outcome even after stratification for genetic disorders and statistical adjustment for baseline differences between groups. Thyroid hormones influence the cardiovascular system with effects on cardiac contractility, heart rate, peripheral vascular smooth muscle, and blood volume.1 A growing number of studies shed light on the association of even subclinical TD with the risk of death, HF, and AA in the
Conclusion
TD are highly prevalent in patients with complex ACHD and are associated with a fourfold increased risk of adverse outcome after propensity score matching accounting for baseline clinical differences and established risk factors for cardiac events. Our results support routine screening for TD during follow-up of patients with ACHD, which may allow to identify patients at higher risk of events.
Disclosures
The authors have no conflicts of interest to declare.
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Flavia Fusco and Giancarlo Scognamiglio contributed equally to the manuscript.