Thyroid Dysfunction and Heart Failure with Preserved Ejection Fraction: a Systematic Review

Abstract

Background and Aim: Thyroid Hormones (TH) play a major role in cardiovascular homeostasis. Thyroid Dysfunction (TD) has been linked with the development of diastolic dysfunction, which in turn is the main cardiac abnormality in patients with Heart Failure with Preserved Ejection Fraction (HFpEF). However, the link between TD and HFpEF is poorly determined. Our aim is to systematically review the scientific evidence regarding TD and its relation with HFpEF. Methods: A literature search was performed on the PubMed, Web of Science and ClinicalTrials.gov databases. A total of 107 articles was retrieved. Nine studies were included. Data were extracted using a predesigned form. Results: Several studies found evidence of TD being linked with HFpEF. TD was more prevalent in patients with HFpEF than in patients with Heart Failure (HF) without preserved Ejection Fraction. TD was also linked with a worse prognosis in patients with HFpEF. Lower TH levels were correlated with echocardiographic changes, higher B-type Natriuretic Peptide (BNP) and worse clinical outcomes in patients with HFpEF. Subclinical hypothyroidism (SCH), low T3 syndrome and thyrotoxicosis were specifically found to be related with the development and progression of HFpEF. Conclusion: Conclusive evidence shows that TD seems to be an important etiologic and prognostic factor in HFpEF. Nevertheless, more studies are required to firmly establish this relation. It is predictable that new therapeutic and prophylactic strategies can arise from this comprehensive view of HFpEF.