Health
No benefits of LVEF with thyroid Tx in patients with acute MI
Researchers report that levothyroxine did not significantly improve left ventricular ejection fraction (LVEF) in people with asymptomatic hypothyroidism and acute myocardial infarction (MI).
In a randomized trial of 95 adults, mean LVEF was 51.3% to 53.8% at baseline after 52 weeks of treatment, according to Salman Razvi, MD, MD, University of Newcastle at Newcastle upon Tyne, England. Rose to.
This was not significantly different from the placebo result, where the mean LVEF increased from 54.0% at baseline to 56.1%, due to the lack of a primary endpoint (group adjusted difference was 0.76 percentage points, 95% CI- 0.93 to 2.46, P= 0.37), written by Razvi’s group JAMA..
Also, daily levothyroxine treatment did not improve any of the secondary measures compared to placebo including ventricular volume and infarct size after 52 weeks:
- End-diastolic volume/body surface area: 66.7 mL/m2 Levothyroxine vs 70.4 mL / m2 For placebo
- End-systolic volume/body surface area: 31.1 mL/m2 vs 31.4 mL / m2
- Median infarct size: 5.6 g vs 7.0 g
- Average mass of the left ventricle: 99.2 g vs 94 g
- Cardiac output: 4.1 L/min vs 4.6 L/min
- Stroke volume: 75.4 mL vs 78.9 mL
Regarding other secondary outcomes, those for daily levothyroxine also did not show a significant improvement in self-reported measures of quality of life. .. Depression, measured according to the Epidemiologic Research Center Depression Scale, was slightly worse (10 vs 5) in those treated with levothyroxine, although there was no statistical difference.
Looking specifically at cardiovascular (CV) events during the 52-week follow-up period, approximately 33% of patients receiving levothyroxine experienced adverse CV events in 37% of patients receiving placebo. did.
“Based on these findings, we preserve and screen for subsequent treatment of subclinical hypothyroidism in patients with acute myocardial infarction. [left ventricular] The function is not justified.”
In a double-blind study conducted at six hospitals in the United Kingdom, 46 patients randomized to receive levothyroxine treatment were started at a dose of 25 μg and then titrated to a serum thyrotropin level of 0.4- Reached 2.5 mU / L. It was then compared to 49 in the placebo group.
For inclusion, all participants had serum thyrotropin levels above 4.0 mU/L, normal free thyroxine levels on two separate occasions 7 to 10 days apart, and one below 10 mU/L. The thyrotropin readings are shown. All participants were also diagnosed with ST-elevation MI (STEMI) or non-STEMI upon admission to the hospital.
MRI was used to assess heart volume and function.
“The high risk of mortality in asymptomatic hypothyroidism patients after acute myocardial infarction, despite ineffective findings, is an ongoing Highlights the need for research,” the Razvi group argued.
However, one of the key points in these findings was that levothyroxine replacement therapy did not appear to increase the risk of adverse events in this patient population.
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Disclosure
This work was supported in part by the University of Leeds NIHR infrastructure.
Razvi and co-authors did not reveal a link to the industry.
..
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