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The relationship of thyroid hormone status with myocardial function in stress cardiomyopathy

Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Hallym University, ChunCheon 200-702, Republic of Korea¹ Division of Cardiology, Department of Internal Medicine, College of Medicine, Hallym University, ChunCheon 200-702, Republic of Korea

(Correspondence should be addressed to S J Lee who is now at Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University, Pyungchon-Dong 896, Dongan-Gu, Anyang-Si, Gyeonggi-Do 431-796, Republic of Korea; Email: leesj{at}hallym.ac.kr)

Objective: This study aimed to investigate thyroid hormone (TH) status and its relationship with myocardial function as well as clinical and biochemical parameters in stress cardiomyopathy (CMP).

Methods: Forty-five patients with stress CMP (the patient group), 31 patients without stress CMP (the control II group), and 58 healthy subjects (the control I group) were included. Sick euthyroid syndrome (SES) was defined as low total triiodothyronine (T₃) with normal TSH levels.

Results: In the patient group at admission, prevalence of SES was 62.2%. Compared with the control I group, the patient group had a decrease in left ventricular ejection fraction (LVEF) and systolic blood pressure (BP) and an increase in troponin-I, CK-MB, and B-type natriuretic peptide (BNP) levels. Total T₃ levels were reduced, and anti-thyroid peroxidase antibody (anti-TPO Ab) positivity, C-reactive protein (CRP) and cortisol levels were elevated. Total T₃ levels were associated with acute physiology and chronic health evaluation II (APACHE II) score, LVEF, systolic BP, and cortisol levels in multivariate analysis. In the control II group, total T₃ levels were not associated with any variables. In the SES (n=28) and myocardial dysfunction (MDys, n=27) subgroups, increased APACHE II score and BNP levels as well as decreased LVEF and systolic BP were significant. Total T₃ levels were reduced, and CRP, cortisol and catecholamines levels were elevated. In the MDys subgroup, anti-TPO Ab positivity and titer were increased.

Conclusion: These results suggest that total T₃ levels may be associated with myocardial contractility, clinical severity, and cortisol levels. Thyroid autoimmunity may influence myocardial contractility in stress CMP.