Assessment value of FT4 combined with LVEF in hyperthyroid heart disease

doi:10.3969/j.issn.1004-583X.2025.10.004

Abstract

Abstract:

Objective To evaluate the diagnostic value of free thyroxine (FT₄) combined with left ventricular ejection fraction (LVEF) for hyperthyroid heart disease (HHD) in patients with hyperthyroidism. Methods This retrospective study included 104 consecutive patients diagnosed with hyperthyroidism or HHD who were evaluated in the Cardiology Department (outpatient and inpatient) of Beijing Renhe Hospital from January 2023 to January 2025. Based on the presence of HHD, patients were classified into the hyperthyroidism-only group (n=64) and HHD group (n=40). The demographics (sex, age, smoking history), thyroid function indices (free triiodothyronine [FT₃], FT₄, thyroid-stimulating hormone [TSH]), and echocardiographic indices (left ventricular end-diastolic diameter [LVEDD], left ventricular end-systolic diameter [LVESD], and LVEF) between groups were compared. Multivariable logistic regression was used to analyze the independent factors associated with HHD. Receiver operating characteristic (ROC) curves were drawn to analyze the discriminative performance of individual indices and the FT₄+LVEF combination. Results Patients with HHD were older and more likely to have a history of smoking than those with hyperthyroidism alone (P<0.05). Compared with the hyperthyroidism-only group, the HHD group had significantly higher FT₃, FT₄, LVEDD, and LVESD, and lower TSH and LVEF (all P<0.05). Multivariable logistic regression analysis showed that age, smoking history, FT₃, FT₄, LVESD and LVEDD were risk factors for HHD, while LVEF and TSH were protective factors (all P<0.05). ROC analysis showed that both thyroid and cardiac indices had significant predictive value for HHD (P<0.05). The combination of FT₄ and LVEF provided the highest overall performance (area under the curve [AUC]=0.98), with a specificity of 64.06%, and a sensitivity of 51.82%(P<0.001). Conclusion FT₄ and LVEF each have clinical value in evaluating hyperthyroidism complicated by HHD. Their combination improves discrimination and can serve as an important reference for clinical decision-making.

Key words: hyperthyroidism, hyperthyroid heart disease, risk factors, correlation analysis

CLC Number:

R581.1

Liu Shenghua. Assessment value of FT₄ combined with LVEF in hyperthyroid heart disease[J]. Clinical Focus, 2025, 40(10): 897-903.

Add to citation manager EndNote|Ris|BibTeX

URL: https://www.lchc.cn/EN/10.3969/j.issn.1004-583X.2025.10.004

https://www.lchc.cn/EN/Y2025/V40/I10/897

Figures/Tables 9

References 38

[1]	许波进, 彭文芳, 黄珊. 2022版《中国甲状腺功能亢进症和其他原因所致甲状腺毒症诊治指南》解读[J]. 外科理论与实践, 2023, 28(6): 512-519. doi:10.16139/j.1007-9610.2023.06.05.
[2]	蔡丹阳, 李洁, 李运伦. 以线粒体自噬为靶点的益气活血类中药保护心肌缺血再灌注损伤研究进展[J]. 环球中医药, 2023, 16(9): 1913-1919. doi:CNKI:SUN:HQZY.0.2023-09-041.
[3]	Rhodes MA, Adams CS, Bragg S, et al. Thyroid and parathyroid conditions: Hyperthyroidism[J]. FP Essent, 2022, 514: 11-17. pmid: 35235281
[4]	徐鑫, 赵锴, 杨孜. ¹³¹I联合生脉注射液治疗甲亢性心脏病的临床研究[J]. 中西医结合心脑血管病杂志, 2018, 16(18): 2612-2615.
[5]	Polikar R, Burger AG, Scherrer U, et al. The thyroid and the heart[J]. Circulation, 1993, 87(5): 1435-1441. doi: 10.1161/01.cir.87.5.1435. pmid: 8490997
[6]	Liu J, Wu G, Li S, et al. The genetic association between hyperthyroidism and heart failure: A Mendelian randomization study[J]. Front Endocrinol (Lausanne), 2024, 15: 1344282. doi: 10.3389/fendo.2024.1344282.
[7]	王双. 甲亢性心脏病相关临床检验指标探析[J]. 中西医结合心血管病电子杂志, 2022, 10(22): 139-141+130. doi:10.16282/j.cnki.cn11-9336/r.2022.22.014.
[8]	吴清原, 郭思佳, 孙增涛, 等. 基于线粒体功能探讨培宗气理论治疗慢性阻塞性肺疾病的机制研究[J]. 天津中医药, 2024, 41(1): 117-122. doi:CNKI:SUN:TJZY.0.2024-01-020.
[9]	任艳茹, 马俊, 刘萍, 等. 甲状腺功能亢进性心脏病相关危险因素分析[J]. 宁夏医学杂志, 2020, 42(5): 406-408. doi:10.13621/j.1001-5949.2020.05.0406.
[10]	Haidous M, Al Armashi AR, Balozian P, et al. A case of severe dilated cardiomyopathy and hyperthyroidism[J]. Cureus, 2022, 14(3): e22968. doi:10.7759/cureus.22968.
[11]	中华医学会内分泌学分会《中国甲状腺疾病诊治指南》编写组. 中国甲状腺疾病诊治指南——甲状腺功能亢进症[J]. 中华内科杂志, 2007, 46(10): 876-882. doi:CNKI:SUN:ZHNK.0.2007-10-044.
[12]	Li H, Zeng RL, Liao YF, et al. Association of plasma connective tissue growth factor levels with hyperthyroid heart disease[J]. Curr Med Sci, 2021, 41(2): 348-355. doi: 10.1007/s11596-021-2354-x. Epub 2021 Apr 20. pmid: 33877553
[13]	张成伟, 马慧慧, 魏琴, 等. 老年甲亢性心脏病患者血清TPO-Ab、BNP、Tg-Ab水平与心肌损伤标志物的关系[J]. 中国老年学杂志, 2024, 44(20): 4865-4869. doi:CNKI:SUN:ZLXZ.0.2024-20-001.
[14]	Zubair Khan M, Gupta A, Hodge J, et al. Clinical outcomes of atrial fibrillation with hyperthyroidism[J]. J Arrhythm, 2021, 37(4): 942-948. doi: 10.1002/joa3.12550. pmid: 34386120
[15]	Huang PS, Cheng JF, Chen JJ, et al. Higher risk of incident hyperthyroidism in patients with atrial fibrillation[J]. J Clin Endocrinol Metab, 2023, 109(1): 92-99. doi: 10.1210/clinem/dgad448.
[16]	Petrie MA, Taylor EB, Suneja M, et al. Genomic and epigenomic evaluation of electrically induced exercise in people with spinal cord injury: Application to precision rehabilitation[J]. Phys Ther, 2022, 102(1):pzab243. doi: 10.1093/ptj/pzab243.
[17]	Okafor EN, Ugonabo MC, Chukwukelu EE, et al. Prevalence and pattern of thyroid disorders among patients attending University of Nigeria Teaching Hospital, Enugu, Southeastern Nigeria[J]. Niger Med J, 2019, 60(2): 62-67. doi: 10.4103/nmj.NMJ_34_19.
[18]	Fages-Masmiquel E, Ponjoan A, Blanch J, et al. The effect of age and sex on factors associated with dementia[J]. Rev Neurol, 2021, 73(12): 409-415. Spanish. doi: 10.33588/rn.7312.2021301. pmid: 34877643
[19]	Naz F, Malik S, Asif K, et al. Unravelling atrial fibrillation aetiology and anticoagulation trends in stroke: Where do we stand? A study from Northern Pakistan[J]. J Ayub Med Coll Abbottabad, 2024, 36(3): 470-4747. doi: 10.55519/JAMC-03-13418.
[20]	Kim HJ, Kang T, Kang MJ, et al. Incidence and mortality of myocardial infarction and stroke in patients with hyperthyroidism: A nationwide cohort study in Korea[J]. Thyroid, 2020, 30(7): 955-965. doi: 10.1089/thy.2019.0543. Epub 2020 Mar 26. pmid: 32093587
[21]	Zhang X, Chen L, Sheng J, et al. The association of autoantibodies in hyperthyroid heart disease combined with pulmonary hypertension[J]. Int J Endocrinol, 2019:9325289. doi: 10.1155/2019/9325289.
[22]	Sönmez E, Bulur O, Ertugrul DT, et al. Hyperthyroidism influences renal function[J]. Endocrine, 2019, 65(1): 144-148. doi: 10.1007/s12020-019-01903-2. Epub 2019 Mar 23. pmid: 30904999
[23]	Janus I, Noszczyk-Nowak A, Bubak J, et al. Comparative cardiac macroscopic and microscopic study in cats with hyperthyroidism vs. cats with hypertrophic cardiomyopathy[J]. Vet Q, 2023, 43(1): 1-11. doi: 10.1080/01652176.2023.2234436.
[24]	Nie D, Xia C, Wang Z, et al. CaMKII inhibition protects against hyperthyroid arrhythmias and adverse myocardial remodeling[J]. Biochem Biophys Res Commun, 2022, 615: 136-142. doi: 10.1016/j.bbrc.2022.04.082. Epub 2022 Apr 20.
[25]	Lin C, Kuo FC, Chau T, et al. Artificial intelligence-enabled electrocardiography contributes to hyperthyroidism detection and outcome prediction[J]. Commun Med (Lond), 2024, 4(1): 42. doi:10.1038/s43856-024-00472-4.
[26]	Bektur Aykanat NE, Şahin E, Kaçar S, et al. Investigation of the effect of hyperthyroidism on endoplasmic reticulum stress and tran- sient receptor potential canonical 1 channel in the kidney[J]. Turk J Med Sci, 2021, 51(3): 1554-1563. doi: 10.3906/sag-2007-109.
[27]	Fan SWD, Ong LT. Prevalence and risk factors of heart failure in patients diagnosed with hyperthyroidism: A systematic review and meta-analysis[J]. touchREV Endocrinol, 2024, 20(2): 91-99. doi: 10.17925/EE.2024.20.2.12. Epub 2024 Jul 22.
[28]	Naser JA, Pislaru S, Stan MN, et al. Incidence, risk factors, natural history and outcomes of heart failure in patients with Graves' disease[J]. Heart, 2022, 108(11): 868-874. doi: 10.1136/heartjnl-2021-319752.
[29]	Mastroianno S, Di Stolfo G, Maggio A, et al. Role of Subclinical iatrogenic hyperthyroidism in the setting of heart disease and arrhythmic burden[J]. Endocr Metab Immune Disord Drug Targets, 2020, 20(6):959-962. doi: 10.2174/1871530320666191227103627. pmid: 31880254
[30]	刘盼茹, 郭玺, 唐乙朝, 等. 自身免疫性疾病与肠道菌群互作及中药干预研究进展[J]. 南京中医药大学学报, 2023, 39(7): 693-700. doi:10.14148/j.issn.1672-0482.2023.0693.
[31]	李丹, 黄峰. 血清FT₃、FT₄水平对甲亢患者并发甲亢性心脏病的评估价值[J]. 医学临床研究, 2024, 41(3): 368-370+374. doi:CNKI:SUN:HNYZ.0.2024-03-013.
[32]	王竹英. 分析甲亢性心脏病患者血浆B型脑钠肽水平的变化及意义[J]. 心血管病防治知识, 2020, 10(24): 42-44. doi:CNKI:SUN:XUGB.0.2020-24-014.
[33]	朱莉, 祝国华, 张斌, 等. 血清T3、T4、H-TSH、FT₃、FT₄在甲亢和甲减诊断中的评价探讨[J]. 解放军预防医学杂志, 2019, 37(5): 49-50. doi:10.13704/j.cnki.jyyx.2019.05.024.
[34]	田永波, 孙敏, 金安林, 等. 血清TPO-Ab、NT-proBNP及CRP在甲亢性心脏病早期诊断中的临床价值[J]. 临床医学研究与实践, 2021, 6(26): 109-112. doi:10.19347/j.cnki.2096-1413.202126037.
[35]	黄玉婵, 阎施杜, 张帆, 等. 活血利水方药理论与应用探讨[J]. 中草药, 2024, 55(14): 4978-4990. doi:CNKI:SUN:ZCYO.0.2024-14-030.
[36]	孙可心, 项莹. 甲状腺功能亢进及其药物在心血管疾病中的作用[J]. 心血管康复医学杂志, 2023, 32(1): 73-77. doi:CNKI:SUN:XXGK.0.2023-01-019.
[37]	Merkx R, Leerink JM, Feijen ELAM, et al. Extensive cardiac function analyses using contemporary echocardiography in childhood cancer survivors: A DCCSS LATER study[J]. JACC CardioOncol, 2023, 5(4): 472-485. doi: 10.1016/j.jaccao.2023.06.003.
[38]	Zhang Y, Jiang H, Cui J, et al. Ablation of ventricular preexcitation to cure preexcitation-induced dilated cardiomyopathy in infants: Diagnosis and outcome[J]. Circ Arrhythm Electrophysiol, 2023, 16(4):e011569. doi:10.1161/CIRCEP.122.011569. Epub 2023 Mar 9.

典型症状群	高代谢症候群:体重进行性下降、怕热多汗、食欲亢进
	神经兴奋性增加:手颤、失眠、易激惹等
影像学证据	甲状腺肿大
实验室指标	血清甲状腺激素水平上升、促甲状腺激素(thyroid stimulating hormone,TSH)降低

典型症状群	高代谢症候群:体重进行性下降、怕热多汗、食欲亢进
	神经兴奋性增加:手颤、失眠、易激惹等
影像学证据	甲状腺肿大
实验室指标	血清甲状腺激素水平上升、促甲状腺激素(thyroid stimulating hormone,TSH)降低

必要条件	确诊甲亢
次要条件	①明显的房性心律失常:房性心动过速、心房扑动、心房颤动;②心力衰竭;③心脏扩大
排除条件	其他原因导致的心脏疾病

必要条件	确诊甲亢
次要条件	①明显的房性心律失常:房性心动过速、心房扑动、心房颤动;②心力衰竭;③心脏扩大
排除条件	其他原因导致的心脏疾病

组别	例数	女性 [例(%)]	年龄 (岁)	吸烟史 [例(%)]
甲亢组	64	35(54.69)	34.78±8.37	8(12.50)
HHD组	40	22(55.00)	40.13±10.61	16(40.00)
t/χ²值		0.001	2.853	10.490
P值		0.975	0.005	0.001

Assessment value of FT₄ combined with LVEF in hyperthyroid heart disease

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 9

References 38

Related Articles 15

Recommended Articles

Metrics

Comments

组别	例数	FT₃(ng/L)	FT₄(ng/L)	TSH(mIU/L)	LVEDD(mm)	LVESD(mm)	LVEF(%)
甲亢组	64	10.45±3.56	39.40±6.90	0.08(0.07, 0.09)	50.09±4.26	39.66±3.58	55.43±6.63
HHD组	40	12.69±2.92	55.10±11.80	0.06(0.04, 0.08)	54.85±5.73	43.79±3.66	51.59±6.06
t/Z值		3.340	5.350	-3.971	4.532	5.681	2.968
P值		0.001	<0.001	<0.001	<0.001	<0.001	0.004

变量	赋值
因变量
分组	0=甲亢,1=HHD
自变量
年龄	连续性变量
吸烟史	1=无,2=有
FT₃、FT₄、TSH	连续性变量
LVESD、LVEDD、LVEF	连续性变量

因素	回归系数	标准误	Wald χ²值	P值	95%可信区间
因素	回归系数	标准误	Wald χ²值	P值	下限	上限
FT₃	0.201	0.065	9.488	0.002	0.073	0.329
FT₄	1.115	0.251	19.750	<0.001	0.623	1.606
TSH	-34.220	9.938	11.857	0.001	-53.698	-14.742
LVESD	0.194	0.048	16.311	<0.001	0.100	0.288
LVEDD	0.323	0.072	19.845	<0.001	0.181	0.465
LVEF	-0.094	0.034	7.665	0.006	-0.161	-0.028
年龄	0.061	0.023	7.074	0.008	0.016	0.106
吸烟史	1.540	0.497	9.606	0.002	0.566	2.515

预测项目	AUC	截断值	95%可信区间		特异度(%)	灵敏度(%)	P值
预测项目	AUC	截断值	下限	上限	特异度(%)	灵敏度(%)	P值
FT₄联合LVEF	0.98	-3.14	0.871	0.999	64.06	51.82	<0.001
FT₄	0.82	4.98	0.723	0.920	96.88	67.50	<0.001
LVEDD	0.79	44.23	0.698	0.877	79.10	89.06	<0.001
LVESD	0.75	57.85	0.653	0.855	95.31	27.50	<0.001
TSH	0.73	0.05	0.618	0.842	90.63	47.50	<0.001
FT₃	0.69	16.20	0.590	0.791	96.88	12.50	0.001
LVEF	0.67	62.39	0.559	0.773	12.50	97.50	<0.001

[1]	Wei Tingting, Pan Zhengyan, Feng Xianyan, Long Yaxiu. Analysis of risk factors for colorectal cancer with liver metastasis based on the SEER database: A propensity score matching study [J]. Clinical Focus, 2025, 40(9): 816-820.
[2]	You Jiawei, An Yanxin, Lyu Jianing, Gao Xiaohong, Hu Liyan, Shan Jie, Chen Lin. Correlation between social activities and heart disease in people aged 45 and over in China [J]. Clinical Focus, 2025, 40(8): 689-693.
[3]	Ma Liang, Severine Martin, Sun Guangdong. Analysis of clinical characteristics of malaria-related acute kidney injury based on Gabonese data [J]. Clinical Focus, 2025, 40(8): 717-720.
[4]	Zhao Xueting, Bai Jiawen, Sun Jun. Analysis of risk factors for liver fibrosis in metabolic dysfunction-associated fatty liver disease and construction of a nomogram [J]. Clinical Focus, 2025, 40(5): 417-422.
[5]	Xiao Ke, Wang Qi. Clinical characteristics and risk factor analysis of type 2 diabetes mellitus complicated with cryptococcal meningitis [J]. Clinical Focus, 2025, 40(5): 423-427.
[6]	Xu Huifeng, Jin Yanyong, Gou Ruolan, Hu Mingzhe. Risk factors for hydrocephalus in children with cerebral hemorrhage and its prediction model [J]. Clinical Focus, 2025, 40(4): 325-328.
[7]	Liu Shenghua. Correlation between serum uric acid levels and coronary artery calcification severity in patients with stable angina pectoris [J]. Clinical Focus, 2025, 40(3): 211-216.
[8]	Tong Mingxia, Chen Ke, Xiang Xiaocong, Zhou Lifeng. Analysis of lean metabolic-associated fatty liver disease among young and middle-aged people and its risk factors [J]. Clinical Focus, 2025, 40(2): 128-132.
[9]	Qian Chenying, Yan Wenjun, Huang Yan, Zhao Zhi. Analysis of risk factors for multidrug-resistant bacterial infection in patients with decompensated cirrhosis [J]. Clinical Focus, 2025, 40(2): 143-146.
[10]	Pu Qian, Cheng Gang, Dao Jiecao, Qi Zizhao, Dou Lele, Zhao Junfang, Zhang Wenjun, Guo Caixia, Wang Yingying. Risk factors for constipation in patients with chronic kidney disease in Gansu province: a single-center study [J]. Clinical Focus, 2025, 40(1): 44-53.
[11]	Han Kaiyang, Feng Tongtong, Bao Ying. Analysis of clinical characteristics and risk factors of lupus nephritis combined with neuropsychiatric systemic lupus erythematosus in children [J]. Clinical Focus, 2024, 39(9): 812-815.
[12]	Jiao Fei, Yao Zhiping, Wang Langui. Risk factors of seizures in patients with central nervous system cystic echinococcosis [J]. Clinical Focus, 2024, 39(8): 712-715.
[13]	Li Qian, Zhong Ping. Clinical characteristics and risk factors of Parkinson's disease with white matter lesions [J]. Clinical Focus, 2024, 39(3): 222-226.
[14]	He Tian, Han Linqiu, Shi Zuxin, Shen Mingyan. Incidence and risk factors of postoperative multidrug-resistant bacterial infections in liver transplant patients: A meta-analysis [J]. Clinical Focus, 2024, 39(11): 965-973.
[15]	Yu Zeyu, Lin Xi, Chen Zhanghua, Yang Wei, Chen Zhimin, Zhang Hai. Analysis of risk factors for refractory Mycoplasma pneumoniae pneumonia in children [J]. Clinical Focus, 2024, 39(1): 43-46.