Acute Effects of Triiodothyronine (T3) Replacement Therapy in Patients with Chronic Heart Failure and Low-T3Syndrome: A Randomized, Placebo-Controlled Study
| Autor: | M. Scarlattini, Antonio L'Abbate, Andrea Barison, Alessandro Pingitore, Annalisa Iervasi, Elena Galli, Daniele Nucci, Giorgio Iervasi, Rita Mariotti |
|---|---|
| Rok vydání: | 2008 |
| Předmět: |
Cardiomyopathy
Dilated Male medicine.medical_specialty Hormone Replacement Therapy medicine.drug_class Endocrinology Diabetes and Metabolism Clinical Biochemistry Thyroid Gland Placebo-controlled study Context (language use) Placebo Biochemistry Plasma renin activity Endocrinology Internal medicine medicine Natriuretic peptide Humans Aged Heart Failure business.industry Biochemistry (medical) Heart Low T3 Syndrome Middle Aged medicine.disease Euthyroid Sick Syndromes Heart failure Chronic Disease Triiodothyronine Female business Euthyroid sick syndrome |
| Zdroj: | The Journal of Clinical Endocrinology & Metabolism. 93:1351-1358 |
| ISSN: | 1945-7197 0021-972X |
| DOI: | 10.1210/jc.2007-2210 |
| Popis: | Low-T(3) syndrome is a predictor of poor outcome in patients with cardiac dysfunction. The study aimed to assess the short-term effects of synthetic L-T(3) replacement therapy in patients with low-T(3) syndrome and ischemic or nonischemic dilated cardiomyopathy (DC).A total of 20 clinically stable patients with ischemic (n = 12) or nonischemic (n = 8) DC were enrolled. There were 10 patients (average age 72 yr, range 66-77; median, 25-75th percentile) who underwent 3-d synthetic L-T(3) infusion (study group); the other 10 patients (average age 68 yr, range 64-71) underwent placebo infusion (control group). Clinical examination, electrocardiography, cardiac magnetic resonance, and bio-humoral profile (free thyroid hormones, TSH, plasma renin activity, aldosterone, noradrenaline, N-terminal-pro-B-Type natriuretic peptide, and IL-6) were assessed at baseline and after 3-d synthetic L-T(3) (initial dose: 20 microg/m(2) body surface.d) or placebo infusion.After T(3) administration, free T(3) concentrations increased until reaching a plateau at 24-48 h (3.43, 3.20-3.84 vs. 1.74, 1.62-1.93 pg/ml; P = 0.03) without side effects. Heart rate decreased significantly after T(3) infusion (63, 60-66 vs. 69, 60-76 beats per minute; P = 0.008). Plasma noradrenaline (347; 270-740 vs. 717, 413-808 pg/ml; P = 0.009), N-terminal pro-B-Type natriuretic peptide (3000, 438-4005 vs. 3940, 528-5628 pg/ml; P = 0.02), and aldosterone (175, 152-229 vs. 231, 154-324 pg/ml; P = 0.047) significantly decreased after T(3) administration. Neurohormonal profile did not change after placebo infusion in the control group. After synthetic L-T(3) administration, left-ventricular end-diastolic volume (142, 132-161 vs. 133, 114-158 ml/m(2) body surface; P = 0.02) and stroke volume (40, 34-44 vs. 35, 28-39 ml/m(2) body surface; P = 0.01) increased, whereas external and intracardiac workload did not change.In DC patients, short-term synthetic L-T(3) replacement therapy significantly improved neuroendocrine profile and ventricular performance. These data encourage further controlled trials with more patients and longer periods of synthetic L-T(3) administration. |
| Databáze: | OpenAIRE |
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