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Objective:To explore the application value of real-time three-dimensional echocardiography (RT-3DE) in evaluating the characteristics and regularities of left atrial volume and function changes in patients with hyperthyroidism and hyperthyroid heart disease.Methods:Fifty-six patients who were diagnosed with hyperthyroidism and hyperthyroid heart disease without treatments in Henan Provincial People′s Hospital from March 2020 to September 2020 were selected. They were divided into hyperthyroidism group(30 patients) and hyperthyroid heart disease group (26 patients). Another 30 healthy volunteers were selected as the control group. The following parameters were obtained by RT-3DE left atrial automatic quantification technology, left atrial minimum, maximum, presystolic volume index(LAVImin, LAVImax, LAVIpreA), left atrial passive, active emptying volume index and stroke volume index (LAVIp, LAVIa, LAVIEV), left atrial passive, active, total ejection fraction(LApEF, LAaEF, LAEF), during left ventricular systole, early diastole, late diastole left atrial longitudinal strain (LASr, LAScd, LASct) and circumferential strain (LASr-c, LAScd-c, LASct-c). The differences of the above parameters between the two groups were compared.Results:Compared with the control group, LAVImax, LAVIpreA, LAaEF, LAVIEV, LAVIa, LASr, LASct-c increased and LApEF decreased in the hyperthyroidism group (all P<0.05). While, LAVImin, LAVImax, LAVIpreA and LAVIEV increased, and LAaEF, LApEF, LAEF, LASct, LAScd-c and LASr-c decreased in hyperthyroid heart disease group(all P<0.05). Compared with the hyperthyroidism group, LAVImin, LAVImax and LAVIpreA in hyperthyroid heart disease group were further increased, while LAEF, LAaEF, LASr, LASr-c, LASct, LASct-c and LAScd-c were decreased (all P<0.05). LAEF were positively correlated with LASr and LASr-c ( r=0.617, 0.837; all P<0.01), LApEF were positively correlated with LAScd and LAScd-c ( r=0.620, 0.800, all P<0.01), LAaEF were positively correlated with LASct and LASct-c ( r=0.680, 0.727; all P<0.01). Conclusions:In the patients with hyperthyroidism, the left atrial reserve and systolic function are increased, which are still in the compensation stage, and the pipeline function is decreased. The left atrial reserve, pipeline and systolic function in the hyperthyroid heart disease patients are all decreased, and the pipeline function may be impaired earlier than the systolic and reserve function.
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Objective High levels of triiodothyronine (T3) can lead to hyperthyroid heart disease, but its mechanism is unclear. This study aims to investigate the effects of T3 on the expression of B-cell activating factor (BAFF) in cardiomyocytes and to explore its possible role in the pathogenesis of hyperthyroid heart disease. Methods Sixty healthy C57BL/6J mice were selected and randomly divided into two groups: the experimental group and the control group. The experimental group received intraperitoneal injection of T3 at 5 μg/ml, one time/d, for 42 consecutive days. The concentrations of serum T3 and tetraiodothyronine (T4) were detected by radioimmunoassay; ELISA was used to determine BAFF expression in peripheral blood, and the cardiac index and the transverse diameter of myocardial cells in each group were determined. Immunohistochemistry and Western blot were used to detect the expression of BAFF protein in myocardium and of myocardial tumor necrosis factor-α (TNF-α) protein; the expression of BAFF mRNA in myocardium was detected by Real-Time PCR; flow cytometry (FCM) was used to detect changes in the proportion of B-cells in the heart. Results Compared with the control group, the serum T3 concentration, cardiac index, BAFF and myocardial cell transverse diameter of the experimental group significantly increased (P<0.05), and the T4 concentration decreased (P<0.05). Under the light microscope, the cardiomyocytes of the control group were normal, while those of the experimental group were hypertrophied and disordered in structure. Compared with the control group (0.765±0.164), BAFF protein expression significantly increased in the experimental group (1.865±0.290) (P<0.05). Compared with the control group (0.537±0.089), the expression of TNF-α protein significantly increased in the experimental group (0.737±0.065) (P<0.05). Correlation analysis of T3 with BAFF gene expression in cardiomyocytes and BAFF level in peripheral blood showed that T3 was positively correlated with both the former with a correlation coefficient of 0.637 (P<0.01) and the latter with 0.778 (P<0.01). For FCM, compared with the control group [(12.40±1.09)%], the proportion of myocardial B-cells increased in the experimental group [(16.12±0.631)%] (P<0.05). Conclusion High concentration of T3 can promote the expression of BAFF in myocardial cells and lead to the activation of B-cells, thus increasing the inflammatory response and leading to myocardial hypertrophy.
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AIM:To observe the effect of thyroxine on the expression of T-type calcium channels Cav3. 1, Cav3. 2 and Cav3. 3 in rat myocardium, and to explore the possible biological mechanism between the changes of the ex-pression of T-type calcium channels and the arrhythmia in hyperthyroid heart disease. METHODS:Healthy SD rats (n=20) were randomly divided into normal control group (n=10) and hyperthyroid heart disease group (n=10). The animal model was established by intraperitoneal injection of levothyroxine for 35 d. The contents of T3 and T4 in serum, the heart-to-body weight ratio, the diameter of cardiac myocytes and electrocardiograph were measured to evaluate hyperthyroid heart disease. Moreover, the mRNA and protein expression levels of T-type calcium channels in the myocardium were measured by RT-PCR, immunohistochemistry and Western blot. RESULTS:After intraperitoneal injection of levothyroxine for 35 d, compared with the normal control group, the serum contents of T3 and T4, the heart-to-body weight ratio and the diameter of cardiac myocytes were significantly increased in hyperthyroid heart disease group (P<0.05), and arrhythmia occurred in hyperthyroid heart disease group. By immunohistochemistry and Western blot, the protein expression of Cav3. 1 in-creased significantly (P<0.05), while the protein expression of Cav3.2 decreased significantly (P<0.01). However, no change of the Cav3. 3 protein was observed. The results of RT-PCR were the same as immunohistochemistry and Western blot. CONCLUSION:Thyroxine promotes the expression of Cav3. 1 in the myocardium but inhibits the expression of Cav3. 2 at mRNA and protein levels, which might be involved in arrhythmia in hyperthyroid heart disease.
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Objective To discuss the clinical characteristics of hyperthyroid heart disease(HHD)and ex-plore the strategy to guarantee radioiodine-131 therapy(RAI)safety. Methods Clinical data and treatment regi-mens of 40 HHD patients admitted into our department from 2012-2016 were analyzed. Common complications as atrial fibrillation,heart failure,liver damage incidences and their characteristics were concluded. Curative effects of radioiodine-131 was evaluated. Results The incidence of atrial fibrillation(AF)was 45.0%. Heart failure (HF)of left ventricular ejection fraction(LVEF)was 80.0%.Severity of HF was accompanied with serum brain na-triuretic peptide(BNP)increase and LVEF decrease.Liver function was moderate-medium impaired(61.5%).De-gree of HF was positively correlated with direct bilirubinhe(R = 0.390,P = 0.012). The RAI one-dose cure rate for hyperthyroidism was 77.5%.ATD use before RAI has no effect on the cure rate. Four patients who can′t be treated with ATD deteriorated after RAI,two of them died because of seriously infection and HF,the other two re-covered with saturated solution of potassium iodide or lithium. Conclusion HHD treatment should be made fa-miliar. ATD before RAI treatment can avoid thyroid function impairment. If anti-thyroid medication can not be used on patients,glucocorticoids,saturated solution of potassium iodide or lithium can be applied according to the patients′conditions.
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Objective To discuss the aged people N-terminal pro-B-type natriuretic peptide (NT-proBNP)changes in thyroid function disorder and its correlation.Methods With electrochemical luminescence analyzer,detected serum NT-proBNP lev-el 38 patients with hyperthyroid heart disease,68 patients with hyperthyroidism,31 patients with hypothyroidism,and 43 ca-ses of healthy controls.Compared each groupserum NT-proBNP level of older population with middle-aged people,and anal-ysied the correlation.Results The serum NT-proBNP level of Hyperthyroidism heart group,hyperthyroidism,hypothyroid-ism group and normal control group were 827.61±626.13,107.18±54.46,162.94±134.14,68.76±39.21 pg/ml,respec-tively.The serum level of HT-pro BNP.Hyperthyroidism group,hyperthyroidism,hypothyroidism group compared with nor-mal control group,there were statistically significan(t = 7.458,4.312,3.794,P = 0.000,0.000,0.001).Hyperthyroidism heart,hypothyroidism with hyperthyroidism group serum level of NT-proBNP comparison there was statistical significance(t=7.078,2.232;P = 0.000,0.032).Hyperthyroidism heartgroup,hypothyroidism group and normal control group older population was higher than the level of serum NT-proBNP middle-aged,difference was statistically significant (t=-3.216,-2.510,-2.653;P =0.007,0.016,0.014).Hyperthyroidism group of elderly serum NT-proBNP level higher than that of middle-aged people,but there was no statistically significant difference (t=-0.140,P =0.890).Multiple regression analy-sis in hyperthyroidism group serum levels of NT-proBNP and FT4 had positive correlation (r=0.224,P =0.033)and hypo-thyroidismgroup serum levels of NT-proBNP and T3 had negative correlation (r=-0.363,P =0.022).Conclusion Thy-roid dysfunction in elderly people for the level of serum NT-proBNP had significant influence.Auxiliary disgnosis and cura-tive effect observation of the serum level of NT-proBNP in people with different thyroid functional status has certain clinical value.
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Objective To analyze the age of onset,duration and chnical characteristics of hyperthyroid heart disease and to investigate its pathogenesis,diagnosis and treatment.Methods Forty patients were selected as our subjects.The information of clinical symptoms,assistant examinations,diagnosis and treatment were collected.Results After comprehensive treatment,39 patients recovered and one patient died of complication pulmonary infection.Conclusion The key to hyperthyroid heart disease is early diagnosis and positive treatment and then reduce the morbidity and mortality of cardiovascular complications.
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Objective To analyze the effect of iodine-131I in the treatment of patients with hyperthyroid heart disease(HHD).Methods The clinical materials and therapeutic effect by 131 I were reviewed in 100 patients with HDD.Results The heal rate of hyperthyroidism and HHD were 82.3％,86.5％ in treatment group,and were higher than that of the control group (69.0％ and 76.2％ ) ( x2 =3.80,3.83,P ＜ 0.05 ) ; HHD with atrial fibrillation was 65.0％,average cardioversion after 131I treatment was 74.4％ after the treatment by 131I;The LVEDD、LVESD、LVEDV and HR after 131 I treatment were lower compared with before treatment ( all P ＜ 0.05 ),SV and EF were increased ( all P ＜ 0.01 ).Conclusion 131I treatment in patients with HHD,can significantly improve the efficacy of a heart disease