Subclinical Hypothyroidism Might Increase the Risk of Postoperative Atrial Fibrillation after Aortic Valve Replacement

 

 Artikel einzeln kaufen Lizenzen und Reprints Alle Artikel dieser Rubrik

Abstract

Background To evaluate the influence of subclinical hypothyroidism (SCH) on the development of postoperative atrial fibrillation (AF) in patients undergoing aortic valve replacement surgery with extracorporeal circulation.

Methods A prospective study in a tertiary hospital between July 2005 and December 2013 in which all patients undergoing aortic valve replacement with no other valve surgery were consecutively included. Patients who were in preoperative sinus rhythm were selected and they underwent thyroxine (T4) and thyroid-stimulating hormone determination in the month before surgery. Postoperative AF was defined as the development of AF during hospital admittance. Descriptive analysis and binary logistic regression were performed for the target variable.

Results A total of 467 patients were studied, with 35 cases of SCH. The incidence of postoperative AF was 57% in the group with SCH versus 30.3% (p = 0.001) in the group without hypothyroidism, without significant differences in other postoperative complications. In the logistic regression analysis, the independent predictors of postoperative AF were SCH, age, and aortic clamping time. SCH multiplies the odds ratio of postoperative AF by 3.14 (95% confidence interval: 1.24–7.96).

Conclusion SCH behaves like a risk factor for the development of postoperative AF in patients undergoing aortic valve replacement with extracorporeal circulation. Other studies are needed to determine whether preoperative T4 replacement therapy and/or more aggressive AF prophylaxis can prevent this complication in patients undergoing aortic valve replacement.

• References

• 1 Fatourechi V. Subclinical hypothyroidism: an update for primary care physicians. Mayo Clin Proc 2009; 84 (1) 65-71
  CrossrefPubMedGoogle Scholar
• 2 Gaitonde DY, Rowley KD, Sweeney LB. Hypothyroidism: an update. Am Fam Physician 2012; 86 (3) 244-251
  PubMedGoogle Scholar
• 3 Mansourian AR. A review on cardiovascular diseases originated from subclinical hypothyroidism. Pak J Biol Sci 2012; 15 (2) 58-67
  CrossrefPubMedGoogle Scholar
• 4 Danzi S, Klein I. Thyroid hormone and the cardiovascular system. Med Clin North Am 2012; 96 (2) 257-268
  CrossrefPubMedGoogle Scholar
• 5 Kim EJ, Lyass A, Wang N , et al. Relation of hypothyroidism and incident atrial fibrillation (from the Framingham Heart Study). Am Heart J 2014; 167 (1) 123-126
  CrossrefPubMedGoogle Scholar
• 6 Duntas LH, Biondi B. New insights into subclinical hypothyroidism and cardiovascular risk. Semin Thromb Hemost 2011; 37 (1) 27-34
  Artikel in Thieme ConnectPubMedGoogle Scholar
• 7 Gao N, Zhang W, Zhang YZ, Yang Q, Chen SH. Carotid intima-media thickness in patients with subclinical hypothyroidism: a meta-analysis. Atherosclerosis 2013; 227 (1) 18-25
  CrossrefPubMedGoogle Scholar
• 8 Weiss IA, Bloomgarden N, Frishman WH. Subclinical hypothyroidism and cardiovascular risk: recommendations for treatment. Cardiol Rev 2011; 19 (6) 291-299
  CrossrefPubMedGoogle Scholar
• 9 Danzi S, Klein I. Subclinical hypothyroidism and the heart: the beat goes on. Thyroid 2012; 22 (3) 235-236
  CrossrefPubMedGoogle Scholar
• 10 Pasqualetti G, Tognini S, Polini A, Caraccio N, Monzani F. Subclinical hypothyroidism and heart failure risk in older people. Endocr Metab Immune Disord Drug Targets 2013; 13 (1) 13-21
  CrossrefPubMedGoogle Scholar
• 11 Park YJ, Yoon JW, Kim KI , et al. Subclinical hypothyroidism might increase the risk of transient atrial fibrillation after coronary artery bypass grafting. Ann Thorac Surg 2009; 87 (6) 1846-1852
  CrossrefPubMedGoogle Scholar
• 12 Siregar S, Groenwold RH, de Heer F, Bots ML, van der Graaf Y, van Herwerden LA. Performance of the original EuroSCORE. Eur J Cardiothorac Surg 2012; 41 (4) 746-754
  CrossrefPubMedGoogle Scholar
• 13 Anderson JL, Halperin JL, Albert NM , et al. Management of patients with atrial fibrillation (compilation of 2006 ACCF/AHA/ESC and 2011 ACCF/AHA/HRS recommendations): a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013; 61 (18) 1935-1944
  CrossrefPubMedGoogle Scholar
• 14 Tokmaji G, McClure RS, Kaneko T, Aranki SF. Management strategies in cardiac surgery for postoperative atrial fibrillation: contemporary prophylaxis and futuristic anticoagulant possibilities. Cardiol Res Pract 2013; 2013: 637482
  PubMedGoogle Scholar
• 15 Martínez-Comendador J, Castaño M, Mosquera I , et al. Cryoablation of atrial fibrillation in cardiac surgery: outcomes and myocardial injury biomarkers. J Cardiothorac Vasc Anesth 2011; 25 (6) 1030-1035
  CrossrefPubMedGoogle Scholar
• 16 Peretto G, Durante A, Limite LR, Cianflone D. Postoperative arrhythmias after cardiac surgery: incidence, risk factors, and therapeutic management. Cardiol Res Pract 2014; 2014: 615987
  PubMedGoogle Scholar
• 17 Kokkonen L, Majahalme S, Kööbi T , et al. Atrial fibrillation in elderly patients after cardiac surgery: postoperative hemodynamics and low postoperative serum triiodothyronine. J Cardiothorac Vasc Anesth 2005; 19 (2) 182-187
  CrossrefPubMedGoogle Scholar
• 18 Cerillo AG, Bevilacqua S, Storti S , et al. Free triiodothyronine: a novel predictor of postoperative atrial fibrillation. Eur J Cardiothorac Surg 2003; 24 (4) 487-492
  CrossrefPubMedGoogle Scholar
• 19 Boylston BF. Triiodothyronine and cardiac surgery. JAMA 1996; 276 (2) 100-101
  PubMedGoogle Scholar
• 20 Klemperer JD, Klein I, Gomez M , et al. Thyroid hormone treatment after coronary-artery bypass surgery. N Engl J Med 1995; 333 (23) 1522-1527
  CrossrefPubMedGoogle Scholar
• 21 Teiger E, Menasché P, Mansier P , et al. Triiodothyronine therapy in open-heart surgery: from hope to disappointment. Eur Heart J 1993; 14 (5) 629-633
  CrossrefPubMedGoogle Scholar
• 22 Bosch RF, Wang Z, Li GR, Nattel S. Electrophysiological mechanisms by which hypothyroidism delays repolarization in guinea pig hearts. Am J Physiol 1999; 277 (1, Pt 2) H211-H220
  PubMedGoogle Scholar
• 23 Klemperer JD, Klein IL, Ojamaa K , et al. Triiodothyronine therapy lowers the incidence of atrial fibrillation after cardiac operations. Ann Thorac Surg 1996; 61 (5) 1323-1327 , discussion 1328–1329
  CrossrefPubMedGoogle Scholar
• 24 Ranasinghe AM, Quinn DW, Pagano D , et al. Glucose-insulin-potassium and tri-iodothyronine individually improve hemodynamic performance and are associated with reduced troponin I release after on-pump coronary artery bypass grafting. Circulation 2006; 114 (1, Suppl): I245-I250
  PubMedGoogle Scholar
• 25 Sirlak M, Yazicioglu L, Inan MB , et al. Oral thyroid hormone pretreatment in left ventricular dysfunction. Eur J Cardiothorac Surg 2004; 26 (4) 720-725
  CrossrefPubMedGoogle Scholar