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`. Prevalence of Low T3 syndrome and its association with severity in patients of Chronic heart failure : A hospital based study Sangeet Saurav , Abhinaba Debnath ,Anupam Singh, Rajendra Jha Department of Medicine , RIMS,Ranchi. Introduction.

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Prevalence of Low T3 syndrome and its association with severity in patients of Chronic heart failure : A hospital based study

SangeetSaurav, AbhinabaDebnath,Anupam Singh, RajendraJha

Department of Medicine ,

RIMS,Ranchi

introduction
Introduction
  • Clinical and experimental evidence has shown that T3 plays a major role in modulating heart rate and cardiac contractility
  • A typical pattern of altered thyroid hormone metabolism characterized by low T3 circulating levels has been described

in patients with acute myocardial infarction and heart

failure

. The principal pathophysiological mechanism underlying low circulating T3 is the reduced enzyme activity of monodeiodinase responsible for converting T4 into T3 inperipheral tissues

low t3 syndrome as bad prognostic marker
Low T3 syndrome as bad prognostic marker

This low-T3 syndrome has commonly been interpreted by

the medical community as an euthyroid sick syndrome, an

adaptive compensatory and thus beneficial response that

decreases energy consumption

However new Western studies suggest that Low-T3 syndrome is a strong predictor of death in cardiac patients and might be directly implicated in the poor prognosis of cardiac patients.

lacunae in knowledge
Lacunae in knowledge
  • Low T3 syndrome ( normal TSH and T4 with low T3) is reported to be prevalent in Chronic heart failure (CHF) in western literature with independent significant association with NYHA class and other cardiological parameters ; but there is a paucity of Indian studies regarding the same
materials and methods
Materials and Methods
  • Aim: To calculate the prevalence of low T3 syndrome in patients of Chronic heart failure and to find correlation between levels of thyroid hormones and severity of chronic heart failure as assesssed by NYHA score and echocardiographic variables.
  • Method: A prospective study of thyroid hormone levels in patients aged 15-60 with CHF seen in medicine Outpatient and inpatient department was carried out.Patients already on thyroxine treatment and amiodarone were excluded.
materials and methods1
Materials and Methods
  • Echocardiography and thyroid profile( fT3,fT4,TSH ) was sent in every patients. Prevalence of low T3 syndrome in population was determined . Spearman’s rank correlation was performed between fT3 anf fT3/fT4 levels and NYHA class,Left ventricular ejection fraction(LVEF), Left atria (LA) size and left ventricular end diastolic diameter(LVEDD
results
Results
  • The cohort consisted of 50 adult patients.19/50 ( 38% , 95% C.I . 25.84-51.91) patients had low T3 syndrome.
  • There was an increasing trend of prevalence of low T3 with increase in CHF stage ( NYHA class I-II : 4/24 (16%), NYHA class III- IV: 15/26 ( 57%), 95% C.I. : 41% (17-65, p=0.006).Mean T3 level was significantly lower in severe NYHA class with significant inter class differences ( ANOVA test, F=18.5,p=0.00001).
results1
Results
  • There was a positive correlation of LVEF with fT3 levels : r=0.67 (0.48-0.8),p<0.001 and fT3/fT4 levels r=0.652 (0.46-0.79). p<0.001.There was higher prevalence of low T3 syndrome ( 7% vs 56% ,chi square p=0.003) and low fT3/fT4 ratios (28 % vs 72% ,chi square p=0.0046) in patients of increased LA size ( LA>3.5 cm). There was also a statistically significant negative correlation between LVEDD anf fT3 levels : r=-0.421(-0.62— -0.16), p=0.003 and fT3/fT4 levels r=-0.492 (-0.68- -0.25 )
conclusion
Conclusion

This is the first hospital based study to determine prevalence of low T3 syndrome in CHF in India,which is quite high.

Higher prevalence of low T3 syndrome is seen in patients of severe NYHA classes. In these patients,f T3 levels also came out to be positively correlated with LVEF and significantly negatively correlated with LA size and LVEDD.

Further studies must be done in future to consider a trial of low dose thyroxine in patients of CHF with low T3 syndrome

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