Impact of Overt Hypothyroidism on Early Outcomes of Coronary Artery Surgery
Impact of Overt Hypothyroidism
Keywords:coronary artery bypass grafting, overt hypothyroidism, complications, inotropic suppor
Background: The association between preoperative overt hypothyroidism and early outcomes after coronary artery bypass grafting (CABG) is unclear. This study aimed to evaluate the influence of overt hypothyroidism on the outcomes of CABG.
Methods: The series included 189 overt hypothyroid patients, who underwent CABG at Fuwai Hospital. These patients were 1:4 matched with 737 euthyroid patients using propensity score matching. The early postoperative outcomes were compared.
Results: After propensity score matching, the incidences of impaired wound healing, reintubation, and the total complications were higher in hypothyroid patients than euthyroid patients (11.8% vs. 0.9%, P < 0.001; 2.1% vs. 0.4%, P = 0.03; 39.6% vs. 30.3%, P = 0.015, respectively). Multivariate analysis showed overt hypothyroidism was significantly associated with the occurrence of impaired wound healing (odds ratio [OR]=12.29, P < 0.001), reintubation (OR=5.71, P = 0.047), and the total complications (OR=1.31, P = 0.049). The OR of the total complications was 1.43 (P = 0.03) in hypothyroid patients with abnormal thyroid-stimulating hormone compared with euthyroid patients. The proportions of the use of dopamine, adrenaline, milrinone, and dobutamine in hypothyroid patients were higher than euthyroid patients (75.4% vs. 67.6%, P = 0.038; 10.7% vs. 6.1%, P = 0.028; 3.2% vs. 0.3%, P = 0.001; 4.8% vs. 1.2%, P = 0.004, respectively). The total duration of inotropic support and mechanical ventilation time in hypothyroid patients were longer than euthyroid patients (median duration: 4 days vs. 3 days, P = 0.003; 17 hours vs. 15 hours, P < 0.001, respectively).
Conclusions: CABG in overt hypothyroid patients is associated with a higher incidence of postoperative complications, stronger postoperative inotropic support, and longer mechanical ventilation time.
Biondi B. 2012. Mechanisms in endocrinology: Heart failure and thyroid dysfunction. Eur. J. Endocrinol. 167(5):609-618.
Biondi B, Cooper DS. 2008. The clinical significance of subclinical thyroid dysfunction. Endocr. Rev. 29(1):76-131.
Cakmak G, Saler T, Saglam ZA, et al. 2011. Pulmonary functions in patients with subclinical hypothyroidism. J. Pak. Med. Assoc. 61(10):951-953.
Cerillo AG, Storti S, Kallushi E, et al. 2014. The low triiodothyronine syndrome: a strong predictor of low cardiac output and death in patients undergoing coronary artery bypass grafting. Ann. Thorac. Surg. 97(6):2089-2095.
Chou SL, Chern CH, How CK, Wang LM, Huang CI, Lee CH. 2005. A rare case of massive pericardial effusion secondary to hypothyroidism. J. Emerg. Med. 28(3):293-296.
Falcone C, Matrone B, Bozzini S, et al. 2014. Time-domain heart rate variability in coronary artery disease patients affected by thyroid dysfunction. Int. Heart J. 55(1):33-38.
Gencer B, Collet TH, Virgini V, et al. 2012. Subclinical thyroid dysfunction and the risk of heart failure events: an individual participant data analysis from 6 prospective cohorts. Circulation 126(9):1040-1049.
Grais IM, Sowers JR. 2014. Thyroid and the heart. Am. J. Med. 127(8):691-698.
Jaimes MC, Torrado L, Reyes N, Mackenzie JC, Mallarino J. 2017. Hypothyroidism is a Risk Factor for Atrial Fibrillation after Coronary Artery Bypass Graft. Braz J Cardiovasc Surg 32(6):475-480.
Jonklaas J, Bianco AC, Bauer AJ, et al. 2014. Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association task force on thyroid hormone replacement. Thyroid 24(12):1670-1751.
Kinugawa K, Minobe WA, Wood WM, et al. 2001. Signaling pathways responsible for fetal gene induction in the failing human heart: evidence for altered thyroid hormone receptor gene expression. Circulation 103(8):1089-1094.
Klein I, Danzi S. 2007. Thyroid disease and the heart. Circulation 116(15):1725-1735.
Kosmidou I, Chen S, Kappetein AP, et al. 2018. New-Onset Atrial Fibrillation After PCI or CABG for Left Main Disease: The EXCEL Trial. J. Am. Coll. Cardiol. 71(7):739-748.
Ladenson PW, Levin AA, Ridgway EC, Daniels GH. 1984. Complications of surgery in hypothyroid patients. Am. J. Med. 77(2):261-266.
Okosieme O, Gilbert J, Abraham P, et al. 2016. Management of primary hypothyroidism: statement by the British Thyroid Association Executive Committee. Clin Endocrinol (Oxf) 84(6):799-808.
Ovadia S, Lysyy L, Zubkov T. 2007. Pericardial effusion as an expression of thyrotoxicosis. Tex Heart Inst J 34(1):88-90.
Park YJ, Yoon JW, Kim KI, et al. 2009. Subclinical hypothyroidism might increase the risk of transient atrial fibrillation after coronary artery bypass grafting. Ann. Thorac. Surg. 87(6):1846-1852.
Patil VC, Patil HV, Agrawal V, Patil S. 2011. Cardiac tamponade in a patient with primary hypothyroidism. Indian J Endocrinol Metab 15(Suppl 2):S144-S146.
Shan Z, Chen L, Lian X, et al. 2016. Iodine Status and Prevalence of Thyroid Disorders After Introduction of Mandatory Universal Salt Iodization for 16 Years in China: A Cross-Sectional Study in 10 Cities. Thyroid 26(8):1125-1130.
Tang YD, Kuzman JA, Said S, Anderson BE, Wang X, Gerdes AM. 2005. Low thyroid function leads to cardiac atrophy with chamber dilatation, impaired myocardial blood flow, loss of arterioles, and severe systolic dysfunction. Circulation 112(20):3122-3130.
Zaki SM, Youssef MF. 2013. Thyroid hormone dysfunctions affect the structure of rat thoracic aorta: a histological and morphometric study. Folia Morphol (Warsz) 72(4):333-339.
Zheng Z, Jayaram R, Jiang L, et al. 2016. Perioperative Rosuvastatin in Cardiac Surgery. N Engl J Med 374(18):1744-1753.
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).