Sevil ÖZKAN, Dursun DUMAN, Mehmet Ali TARIM, Refik DEMİRTUNÇ

Subklinik hipotiroidide aort elastisitesinin değerlendirilmesi

Amaç: Bu çalışmada. subklinik hipotiroidili hastalarda aortun elastikiyet özellikleri ve bunların sol ventrikül diyastolik fonksiyonu ile ilişkileri transtorasik ekokardiyografik metod ile araştırıldı. Hastalar ve Yöntemler: Transtorasik ekokardiyografi yapılarak aortun elastikiyet parametreleri olarak aortik strain. beta indeksi ve distensibilite indeksine bakıldı. Bulgular: Kontrol grubu ve subklinik hipotiroidili hasta grubu arasında aortik strain (sırasıyla %9.45’e karşı %5.79. p < 0.001) ve distensibilite (4.64’e karşı 3.02 10-3.cm2.dyn-1. p < 0.005) yönünden anlamlı farklar vardı. Subklinik hipotiroidi grubunda mitral erken diyastolik akım hızı (E) ortalaması (p < 0.05). mitral diyastolik akım hızı/ mitral geç diyastolik akım hızı (E/A) (p < 0.01) kontrol grubu ortalamasına göre anlamlı olarak düşük. mitral geç diyastolik akım hızı ortalaması (A) ve izovolümetrik relaksasyon zamanı ( IVRZ) (p < 0.05) kontrol grubu ortalamasına göre yüksek bulundu. Sonuç: Subklinik hipotiroidili hastalarda aortik stiffness’de artış gözlenmektedir. Subklinik hipotiroidili hastalarda gözlenen diyastolik fonksiyon bozukluğundan esas olarak aortik stiffness artışı sorumlu olabilir.

Anahtar Kelimeler:

Aortik stiffness. Subklinik hipotiroidizm. Sol ventrikül diyastolik disfonksiyonu

The evaluation of aortic elasticity in subclinical hypothyroidism

Objective: In this study we evaluated the elastic properties ofthe aorta in patients with subclinical hypothyroidism and theirrelation with left ventricular diastolic function by transthoracicechocardiography.Patients and Methods: Aortic transthoracic echocardiographywas performed and the aortic elasticity was evaluated using thefollowing parameters; strain, the beta index and distensibility.Results: There was significant difference in terms of aorticstrain (5.79% vs. 9.45% p <0.001) and distensibility (4.64 versus3.02 10-3.cm2. dyn-1. p <0.005) between the control group andpatients with subclinical hypothyroidism group. In the subclinicalhypothyroidism group the average mitral early diastolic velocity(E). (p <0.05) were significantly lower than the mean mitraldiastolic flow velocity / mitral late diastolic flow velocity (E / A)(p <0.01) observed in the control group. and higher than the meanmitral late diastolic flow velocity (A) and isovolumetric relaxationtime (IVRT) (P <0.05) in the control group.Conclusions: In patients with subclinical hypothyroidisman increase in the aortic stiffness was observed. The diastolicdysfunction observed in subclinical hypothyroidism is mainlyresponsible for the increase in the aortic stiffness.Keywords: Aortic stiffness. Subclinical hypothyroidism. Leftventricular diastolic dysfunction

Keywords:

Aortic stiffness, Subclinical hypothyroidism Left ventricular diastolic dysfunction,

___

1. Surks MI. Ortiz E. Daniels GH. et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA. 2004; 291:228-38. doi: 10.1001/ jama.291.2.228.
2. Canaris GJ. Monowitz NR. Mayor G. et al. The Colorado thyroid disease prevalence study. Arch Intern Med 2000; 160:526-34.doi: 10.1001/archinte.160.4.526.
3. Hollowell JG. Staehling NW. Flanders WD. et al. Serum TSH. T4 and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey ( NHANES III). J Clin Endocrinol Metab 2002; 87: 489-99.
4. Biondi B. Cooper DS. The clinical significance of subclinical thyroid dysfunction. Endocr Rev 2008; 29:76-131. doi: http:// dx.doi.org/10.1210/er.2006-0043.
5. Hak AE. Pols HA. Visser TJ. et al. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam Study. Ann Intern Med 2000; 132:270-8. doi:10.7326/0003- 4819-132-4-20002150-00030
6. Cappola AR. Razvi S. Walsh JP. et al. Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA 2010 ; 304: 1365-74. doi: 10.1001/ jama.2010.1361.
7. Walsh JP. Bremner AP. Bulsara MK. et al. Subclinical thyroid dysfunction as a risk factor for cardiovascular disease. Arch Intern Med 2005; 165 : 2467-72. doi:10.1001/ archinte.165.21.2467.
8. Vaderpump MP. Tunbridge WM. French JM. et al. The development of schemic heart disease in relation to autoimmune thyroid disease in a 20- year follow-up study of an English community. Thyroid 1996; 6: 155-60.
9. Schultz M. Kistorp C. Raymond I. et al. Cardiovascular events in thyroid disease: A population based. prospective study. Horm Metab Res 2011; 43: 653-9. doi: 10.1055/s-0031- 1283162.
10. Stefanadis C. Wooley CF. Bush CA. Kolibash AL. Boudoulas J. Aortic distensibility anormalities in coronary artery disease. Am J Cardiol 1987; 59:1300-4.
11. Eren M. Gorgulu Ş. Uslu N. Celik S. Dağdeviren B. Tezel T. Relation between aortic stiffness and left ventricular diastolic function in patients with hypertension . diabetes. or both. Heart 2001;90:37-43. doi: 10.1136/heart.90.1.37
12. Ikonomidis I. Lekakis J. Stamatelopoulos K. et al. Aortic elastic properties and left ventricular diastolic function in patients with Adamantiades-Behcet’s Disease. J Am Coll Cardiol 2004; 43: 1075-81.doi:10.1016/j.jacc.2003.10.042
13. Lacombe F. Dart A. Dewar E. et al. Arterial elastic properties in man: a comparison of echo-Doppler indices of aortic stiffness. Eur Heart J 1992. 13: 1040-5. doi:http://dx.doi. org/1040-1045.
14. Nicole M. Van Popole MD. Diederick E. Association between arterial stiffness and atherosclerosis. The Rotterdam Study. Stroke 2001;32:454-60. doi:10.1161/01.STR.32.2.454
15. Cheitlin MD. Alpert JS. Armstrong WF. et al. ACC/AHA guidelines for the clinical application of echocardiography. A report of the American College of Cardiology /American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography. Circulation 1997; 95: 1686-744. 253 . doi: 10.1161/01.CIR.95.6.1686.
16. Stratos C. Stefanadis C. Kallikazaros I.et al. Ascending Aorta distensibility abnormalities in hypertensive patients and response to nifedipine administration.Am J Med 1992; 93:505-12. doi:http://dx.doi.org/10.1016/0002-9343(92) 90577-X
17. Laurent S. Boutouyrie P. Asmar R. et al. Aortic stiffness is an indepent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension. 2001; 37: 1236-41. doi:10.1161/01.HYTP.37.5.1236
18. Ochs N. Auer R. Bauer DC. et al. Meta-analysis: subclinical thyroid dysfunction and the risk for coronary heart disease and mortality. Ann Intern Med. 2008;148:832-45. doi:10.7326/0003-4819-148-11-200806030-00225
19. Imaizumi M. Akahoshi M. Ichimaru S. et al. Risk for ischemic heart disease and all-cause mortality in subclinical hypothyroidism. J Clin Endocrinol Metab. 2004;89:3365-70. doi:10.1210/jc.2003-031089
20. Devdhar M. Ousman YH. Burman KD. Hypothyroidism. Endocrin Metab Clin.North Am. 2007; 36: 595-615. doi:10.1016/j.ecl.2007.04.008
21. Biondi B. Fazio S. Palmieri EA. et al. Left ventricular diastolic dysfunction in patients with subclinical hypothyroidism. J Clin. Endocrinol Metab 1999; 84:2064-7.
22. Niafar M. Tofan M. Ghafoori S. et al. Subclinical hypothyroidism effects on cardiac function. Pak J Biol Sci. 2009; 12:1056-62.
23. Franklin SS. Khan SA. Wong ND.et al. Is pulse pressure useful in predicting risk for coronary heart disease? The Framingham Heart Study. Circulation 1999; 100:354-60. doi:10.1161/01.CIR.100.4.354
24. Stefanadis C. Dernellis J. Vlachopoulos C. et al. Aortic function in arterial hypertension determined by pressurediameter relation: effects of diltiazem. Circulation 1997; 96:1853-8.doi: 10.1161/01.CIR.96.6.1853
25. Lacombe F. Dart A. Dewar E. et al.Arterial elastic properties in man: a comparison of echo-Doppler indices of aortic stiffness. Eur Heart J1992; 13: 1040- 5. doi: http://dx.doi. org/1040-1045.
26. Stehourwer CD. Henry RM. Ferreira I. Arterial stiffness in diabetes and the metabolic syndrome: a pathway to cardiiovascular disease. Diabetologia 2008; 51: 527-39. doi:10.1007/s00125-007-0918-3.
27. Lideman RD. Romero LJ. Schade DS.et al. Impact of subclinical hypothyroidism on serum total homocysteine concentrations. the prevalence of coronary heart disease (CHD). and CHD risk factors in the New Mexico Elder Health Survey. Thyroid 2003;13:595-600. doi:10.1089/105072503322238863.
28. Plana N. Ferre R. Merinos J. et al. Heterozygous familial hypercholesterolaemic patients have increased stiffness. as determined using the augmentation Index. J Atheroscler Thromb 2011; 18: 1110-6. doi: http://doi.org/10.5551/ jat.9795.
29. Ravzi S. Weaver JU. Vanderpump MP. et al. The incidence of ischemic heart disease and mortality in people with subclinical hypothyroidism : Reanalysis of the Whickham Surver cohort. J Clin Endocrinol Metab 2010; 95: 1734-40. doi:10.1210/ jc.2009-1749.
30. Rodondi N. Bauer DC. Cappola AR. et al. Subclinical thyroid dysfunction. cardiac function. and the risk of heart failure. The Cardiovascular Health study. J Am Coll Cardiol 2008; 52: 1152-9. doi:10.1016/j.jacc.2008.07.009.
31. Rodondi N. den Elzen WP. Baıer DC. et al. Thyroid Studies Collaboration . Subclinical hypothroidism and the risk of coronary heart disaese and mortality. JAMA 2010; 304: 1365- 74.
32. Biondi B. Klein I. Hypothyroidism as a risk factor for cardiovascular disease. Endocrin2004; 24: 1-13.
33. Duntas LH. Mantzou E. Koutras DA. Cırculating levels of oxidized low-density lipoprotein in overt and mild hypothyroidism. Thyroid 2002;12:1003-7. doi:10.1089/105072502320908349.
34. Gen R. Akbay E. Sezer K.et al. Insulın resistance and cardiovascular risk factors in patients with mild severe subclinical hypothyroidism. Endocrinologist 2010; 20: 128- 30. doi:http://dx.doi.org/10.1097/TEN.Ob013e3181dfe618.
35. Dardano A. Ghiadoni L. Plantinga Y. et al. Recombinant human thyrotropin reduced endothelium-dependent vasodilation in patients monitored for differentiated thyroid carcinoma. J Clin Endocrinol Metab 2006;91:4175-8. doi:http://dx.doi. org/10.1210/jc.2006-0440.
36. Nagasaki T. Inaba M. Kumeda Y. et al. Increased pulse wave velocity in subclinical hypothyroidism. J Clin Endocrinol Metab 2006; 91: 154-158. doi:http://dx.doi.org/10.1210/ jc.2005-1342.
37. Mishra TK. Routray SN. Das S.et al. Left ventricular dysfunction in patients with subclinical hypothyroidism and its reversibility after hormone therapy. J Assoc Physicians India 2005; 53:943-6.
38. Shatynska-Mytsyk I. Rodrigo L. Cioccocioppo R.et al. The impact of thyroid hormone replacement therapy on left ventricular diastolic function in patients with subclinical hypothyroidism. J Endocrinol Invest 2015 mar 5. doi: 10.1007//s40618-015-0262-2.
39. Owen PJ. Rajiv C. Vinereanu D. et al.Subclinial hypothyroidism. arterial stiffness and myocardial reserve. J Clin Endocrinol Metab. 2006; 91:2126-32.doi:http://dx.doi. org/10.1210/jc.2005-2108
40. Malayeri AA. Natori S. Bahrami H. et al. Relation of aortic wall thickness and distensibility to cardiovascular risk factors. Am J Cardiol 2008; 102:491-6.doi:10.1016/j. amjcard.2008.04.010.
41. Masaki M. Komamura K. Goda A. et al. Elevated arterial stiffness and diastolic dysfunction in subclinical hypothyroidism. Circulation Journal 2014; 78: 1494-1500. doi:http://doi.org/10.1253/circj.CJ-13-1556.
42. Yurtdaş M. Gen R. Özcan T.et al. Assessment of the elasticity properties of the ascending aorta in patients with subclinical hypothyroidism by tissue Doppler imaging. Arq Bras Endocrinol Metab 2013; 57 : 132-8.doi:http://dx.doi. org/10.1590/S0004-27302013000200006.