Features of early remodeling of the left heart in patients with acute myocardial infarction and concomitant hypothyroidism

Objective: to evaluate the features of structural and functional remodeling of the left heart during hospitalization in patients with ST-segment elevation myocardial infarction (STEMI) and concomitant newly diagnosed hypothyroidism. Materials and methods: the study included 133 patients with STEMI aged 40 to 88 years admitted to the Rostov Regional Clinical Hospital. All patients were divided into 3 groups depending on the newly diagnosed hypothyroidism: Group 1 (control) included patients with STEMI without hypothyroidism syndrome (n=57), Group 2A — patients with STEMI and subclinical hypothyroidism (n=42) and Group 2B — patients with STEMI and manifest hypothyroidism (n=34). Patient data, clinical symptoms, information on complications in the acute period of myocardial infarction, echocardiographic examination results were entered into a specially developed questionnaire. Results: patients with STEMI of all groups were found to have increased values of indexed LV ESV and LVM, decreased values ​​of indicators characterizing myocardial contractility, as well as the presence of stage I LVDD. Patients with subclinical hypothyroidism were found to have statistically significantly higher values ​​of the indexed LA volume than patients without hypothyroidism. The peculiarities of structural and functional remodeling of the heart in the presence of overt hypothyroidism include significantly higher linear and volumetric parameters of the LA (ILP and IOLP), a greater decrease in the contractility of the LV myocardium (lower values of SV, SI and IOC), a more pronounced impairment of diastolic properties of the myocardium (lower DT value) compared to the control group. Conclusion: in patients with STEMI and concomitant overt hypothyroidism, more pronounced remodeling of the left heart in conditions of acute myocardial injury (larger size and volume of the LA, more pronounced impairment of systolic and diastolic function of the LV).

1. Izkhakov E, Zahler D, Rozenfeld KL, Ravid D, Banai S, Topilsky Y, et al. Unknown Subclinical Hypothyroidism and In-Hospital Outcomes and Short- and Long-Term All-Cause Mortality among ST Segment Elevation Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention. J Clin Med. 2020;9(12):3829. DOI: 10.3390/jcm9123829

2. Nowbar AN, Gitto M, Howard JP, Francis DP, Al-Lamee R. Mortality From Ischemic Heart Disease. Circ Cardiovasc Qual Outcomes. 2019;12(6):e005375. DOI: 10.1161/CIRCOUTCOMES.118.005375

3. Korzukhin A.Yu., Yuldoshev J.R., Troshina A.A., Khuramshina L.R., Guzarik V.N., Dyrnaeva A.D., et al. Type 2 myocardial infarction: diagnostic and therapeutic difficulties in modern cardiology. Complex Issues of Cardiovascular Diseases. 2023;12(3):84-97. (In Russ.) DOI: 10.17802/2306-1278-2023-12-3-84-97

4. Huang R, Yan L, Lei Y, Li Y. Hypothyroidism and Complicated Sick Sinus Syndrome and Acute Severe Psychiatric Disorder: A Case Report. Int Med Case Rep J. 2021;14:171-176. DOI: 10.2147/IMCRJ.S296071

5. Fernandez-Ruocco J, Gallego M, Rodriguez-de-Yurre A, Zayas-Arrabal J, Echeazarra L, Alquiza A, et al. High Thyrotropin Is Critical for Cardiac Electrical Remodeling and Arrhythmia Vulnerability in Hypothyroidism. Thyroid. 2019;29(7):934-945. DOI: 10.1089/thy.2018.0709

6. Vaysman D.Sh., Aleksandrova G.A., Leonov S.A., Savina A.A. The accuracy of indicators and the structure of causes of death from diseases of the circulatory system in the Russian Federation in international comparisons. Current problems of health care and medical statistics. 2019;(3):69-84. (In Russ.) eLIBRARY ID: 41592168 EDN: SGUQYR

7. Diab N, Daya NR, Juraschek SP, Martin SS, McEvoy JW, Schultheiß UT, et al. Prevalence and Risk Factors of Thyroid Dysfunction in Older Adults in the Community. Sci Rep. 2019;9(1):13156. DOI: 10.1038/s41598-019-49540-z

8. Oleinikov V.E., Golubeva A.V., Galimskaya V.A., Babina A.V., Donetskaya N.A. Early markers of pathological left ventricular remodeling in patients after ST-elevation myocardial infarction according to speckle-tracking echocardiography. Russian Journal of Cardiology. 2022;27(6):4837. (In Russ.) DOI: 10.15829/1560-4071-2022-4837

9. Frantz S, Hundertmark MJ, Schulz-Menger J, Bengel FM, Bauersachs J. Left ventricular remodelling post-myocardial infarction: pathophysiology, imaging, and novel therapies. Eur Heart J. 2022;43(27):2549-2561. DOI: 10.1093/eurheartj/ehac223

10. Nikolaeva A.V., Pimenov L.T., Sufiyanov V.G., Dudarev M.V. Risk Factors Promoting Early Cardiovascular Structure Disorders in Patients with Primary Hypothyroidism. The Russian Archives of Internal Medicine. 2022;12(1):53-61. DOI: 10.20514/2226-6704-2022-12-1-53-61

11. Jabbar A, Ingoe L, Junejo S, Carey P, Addison C, Thomas H, et al. Effect of Levothyroxine on Left Ventricular Ejection Fraction in Patients With Subclinical Hypothyroidism and Acute Myocardial Infarction: A Randomized Clinical Trial. JAMA. 2020;324(3):249-258. DOI: 10.1001/jama.2020.9389

12. Russian Society of Cardiology (RSC) 2020 Clinical practice guidelines for Chronic heart failure. Russian Journal of Cardiology. 2020;25(11):4083. (In Russ.) DOI: 10.15829/1560-4071-2020-4083

13. Gegenava B.B., Morgunova T.B., Fadeev V.V. Effect of hypothyroidism on the cardiovascular system. Endocrinology. News. Opinions. Training. 2016;2(15):21-30. (In Russ.)

14. Ushakova L.Yu., Vertinsky E.A., Chizh S.A. Evaluation of left ventricular diastolic function. Meditsinskie novosti. 2018;(12):34–38. eLIBRARY ID: 36826413 EDN: YUSDNZ

15. Baymukanov A.M., Gendlin G.E., Nikitin I.G., Khamnagadaev I.A., Termosesov S.A., Iljich I.L. Left ventricular diastolic dysfunction in endovascular treatment of atrial fibrillation in patients with preserved ejection fraction. Kardiologiia. 2017;57(2S):331-336. (In Russ.) DOI: 10.18087/cardio.2383

16. La Vignera S, Condorelli R, Vicari E, Calogero AE. Endothelial dysfunction and subclinical hypothyroidism: a brief review. J Endocrinol Invest. 2012;35(1):96-103. DOI: 10.3275/8190

17. Mingalimova A.R., Drapkina O.M., Bikbova N.M., Sagirov M.A., Mazanov M.Kh., Timerbaev A.V., et al. Inhospital changes of left ventricular diastolic function in patients undergoing coronary bypass surgery. Russian Journal of Cardiology. 2022;27(8):4948. (In Russ.) DOI: 10.15829/1560-4071-2022-4948

18. GridnevaYu.Yu., Chesnikova A.I., Safronenko V.A., Edlenko E.V., Zatloukal M.Yu. Incidence and clinical significance of newly diagnosed hypothyroidism in patients with ST-segment elevation myocardial infarction. Therapy. 2024;10(4):82–90. (In Russ.) DOI: 10.18565/therapy.2024.4.82-90