Low T3 Would Indicate Adverse Outcomes for Inpatients with Decompensated Heart Failure

Lucrecia Secco, Silvana Mettini, Cecilia Cejas, Cecilia Biglia, Dario A. Fernández, Stella M. Pereiro González

Abstract


Background: Low T3 syndrome is associated with elevated circulating levels of cytokines and interleukins, reinforcing thehypothesis of a close relation between the neuroendocrine system and certain inflammatory and immunological mechanismsinvolved in heart failure.Objective: To assess the progress of patients admitted for decompensated heart failure according to T3 levels on admission,and events during hospitalization and follow-up.Materials and methods: It was a prospective, observational, analytical study of 524 patients hospitalized for the first timewith a diagnosis of decompensated heart failure. In-hospital and follow-up mortality and readmissions were evaluated accordingto normal or low T3 levels on admission. Ninety-one patients with known dysthyroidism, hypo or hyperthyroidism,previous thyroid surgery, sepsis or acute coronary syndrome were excluded. A subgroup analysis of patients receiving chronicamiodarone therapy was conducted, and prognostic variables were evaluated.Results: Of the 433 patients analyzed, 40.0% had low T3 (LT3) levels. Age, albumin level, age >75 years, and glomerularfiltration rate (GFR) were independent predictors of LT3. While adaptation of guideline-recommended treatments increasedin both groups, treatment rates in the LT3 group were significantly lower than those in the normal T3 (NT3) group (LT3vs. NT3: Betablockers 81.5% vs. 89.4%, p=0.02; ACEI/ARA II 78.5% vs. 87.9%, p=0.001; anti-aldosterone agents 29.2% vs.40.5%; p=0.019). Hospital mortality was higher in the LT3 group (5.8 vs. 1.5%), with no difference in rehospitalizations ormortality rates at follow-up. Of the subgroup of patients without amiodarone on admission (353), 37.8% had LT3. Patientsin this subgroup were found to have significant differences in follow-up and in-hospital mortality (5.3% in LT3 vs. 0.9% inNT3, p=0.03, and 40.2% vs. 26.6%, p=0.023) respectively.Conclusions: Decompensated heart failure patients with LT3 on admission would represent a subgroup with more severedisease and worse prognosis during hospitalization.

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Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020 www.sac.org.ar revista@sac.org.ar