Hernán Cohen-Arazi, Sociedad Argentina de Cardiología, Área de Investigación, Consejo de Insuficiencia Cardíaca, Buenos Aires, Argentina
Alfredo Hirschson-Prado, Sociedad Argentina de Cardiología, Área de Investigación, Consejo de Insuficiencia Cardíaca, Buenos Aires, Argentina
Alberto Fernández, Sociedad Argentina de Cardiología, Área de Investigación, Consejo de Insuficiencia Cardíaca, Buenos Aires, Argentina
Julieta Soricetti, Sociedad Argentina de Cardiología, Área de Investigación, Consejo de Insuficiencia Cardíaca, Buenos Aires, Argentina
Paula Pérez-Terns, Sociedad Argentina de Cardiología, Área de Investigación, Consejo de Insuficiencia Cardíaca, Buenos Aires, Argentina
Guillermina Sorasio, Sociedad Argentina de Cardiología, Área de Investigación, Consejo de Insuficiencia Cardíaca, Buenos Aires, Argentina
Guillermina A. Guazzone, Sociedad Argentina de Cardiología, Área de Investigación, Consejo de Insuficiencia Cardíaca, Buenos Aires, Argentina
Adrián J. Lescano, Sociedad Argentina de Cardiología, Área de Investigación, Consejo de Insuficiencia Cardíaca, Buenos Aires, Argentina
Introduction: Thyroid-stimulating hormone (TSH) levels should be measured in patients with acute heart failure (AHF) due to their relationship with prognosis. The objective was to assess the rate of TSH measurement in patients with AHF and determine the association between TSH levels and 30-day mortality. Method: A sub-analysis of the ARGEN-IC registry was conducted. This was a prospective multicenter study in Argentina, that gathered data from 50 healthcare institutions (period: August 2018 to March 2019) of patients that had a primary diagnosis of AHF. Descriptive statistics were used to characterize the population, and multiple regression analysis was performed to investigate the relationship between TSH levels and 30-day mortality. Results: Nine-hundred-nine patients were included, with a mean age of 72 ± 14 years, of whom 60% were men. Of the patients, 36.4% had a history of heart failure. The mean left ventricular ejection fraction (LVEF) was 41 ± 15%. TSH levels were measured in 44% of patients with a history of hypothyroidism (aHT) and in 32.8% of patients without aHT. Patients were grouped according to TSH levels into: 1) normal (0.37-4.5 mIU/l), with 237 patients (75%); 2) mild subclinical hypothyroidism (4.5-6.9 mIU/l), with 55 patients (18%); 3) severe subclinical hypothyroidism (7-10 mIU/l), with 6 patients (2%), and 4) overt hypothyroidism (> 10 mIU/l), with 15 patients (5%). The 30-day mortality rates were 2.5, 6.6, 11.1, and 13.3%, respectively (p < 0.001). TSH was associated with mortality with an odds ratio of 1.1 (1.01-1.2; p = 0.02), independently of age and LVEF. Conclusions: A low rate of TSH measurement was noted in patients with AHF, even in those with a history of hypothyroidism. Higher TSH levels were found to be associated with increased 30-day mortality.
Keywords: TSH. Heart failure. Hypothyroidism. Thyroid-stimulating hormone.