Clinical, pathogenetic, and diagnostic features of heart failure in patients with coronary heart disease and thyrotoxicosis

Aim. To assess the diagnostic significance of chronic heart failure (CHF) criteria and to study the features  of structural  and  functional remodeling  of the left heart  in patients with coronary artery disease (CAD) and thyrotoxicosis.

Material and methods. We examined  131 patients  aged  45-65  years  with CAD, CHF and/or  thyrotoxicosis. The clinical state  of patients,  exercise  tolerance,  NT-proBNP level were evaluated. Holter ECG monitoring and Doppler echocardiography (echo) were performed.

Results. Heart  rhythm disturbances (atrial fibrillation, sinus  tachycardia, supraventricular  extrasystole),  more severe vegetative imbalance with sympathetic predominance in patients with CAD, CHF and thyrotoxicosis were determined moreoften than in patients  with CAD and CHF without thyrotoxicosis. Elevated levels of NT-proBNP (more  than  125  pg/ml)  were  found  in both  patients  with CHF and patients with thyrotoxicosis, regardless of the presence of cardiovascular  disease. NT-proBNP levels  in  patients   with CAD and  thyrotoxicosis  without  CHF has exceeded the  threshold  value of 2,8  times  (p=0,001).  The highest  level of NT-proBNP was found in patients with CAD, CHF and thyrotoxicosis. A higher threshold value of NT-proBNP (556,4 pg/ml according  to the results of this study) in HFpEF and HFmrEF patients with CAD and thyrotoxicosis was determined. Analysis of echo parameters in patients with CAD, CHF and thyrotoxicosis revealed significantly lower values  of linear  and  volumetric LV  parameters, type  I  LV  diastolic  dysfunction(100%), HFmrEF (48%), more frequent  occurrence of LV concentric  hypertrophy (84%).

Conclusion.  For  HF diagnosis   in patients   with CAD and  thyrotoxicosis,  it is necessary  to  take  into  account   the  clinical features, heart  rate  variability, LV remodeling, as well as to use a higher threshold level of NT-proBNP.

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