Pathophysiological aspects of development myocardial infarction type 2 in subclinical hypothyroidism
https://doi.org/10.33667/2078-5631-2021-42-34-41
Abstract
The main purpose of the following article is to highlight one of the most pressing and poorly studied issues both for cardiology and endocrinology – treatment and prognosis for patients with severe coronary pathology and subclinical hypothyroidism (SH). Pathophysiological mechanisms of type 2 myocardial infarction (MI) development with SH as a background and hormone replacement therapy issues are considered. SH is a modifiable risk factor (RF) for cardiovascular diseases (CVD) and mortality that does not depend on traditional cardiovascular RF. SH is associated with high risk of developing coronary artery disease, MI, heart failure, and CVD mortality. SH incidence of morbidity increases with age, usually the course is oligo- or asymptomatic. SH leads to a number of pathological conditions that cause an imbalance between the myocardial oxygen demand and delivery with a possible development of type 2 MI. Clinical case of type 2 MI development in a patient with severe coronary atherosclerosis and SH is presented. The key point of type 2 MI development mechanism is insufficient oxygen (O2) supply to cardiomyocytes due to multivessel coronary artery atherosclerotic stenosis and sharp increase in O2 demand as a result of cardiomyocyte hypertrophy. Older patients with severe cardiac pathology and SH should refrain from treatment with levothyroxine or start treatment after myocardial revascularization, selecting the dose of the drug individually.
About the Authors
A. A. Ivannikov
Research Institute of Emergency Care n. a. N. V. Sklifosovsky
Russian Federation
Russian Federation
Ivannikov Aleksandr A., clinical resident specializing in cardiology
eLibrary SPIN: 3934–5062
Moscow
A. A. Kanibolotsky
Research Institute of Emergency Care n. a. N. V. Sklifosovsky
Russian Federation
Russian Federation
Kanibolotskiy Aleksandr A., PhD Med, head of Pathological Dept.
eLibrary SPIN: 3976–1662
Moscow
Kh. G. Alidzhanova
Research Institute of Emergency Care n. a. N. V. Sklifosovsky
Russian Federation
Russian Federation
Alidzhanova Khafiza G., DM Sci (habil.), senior researcher
eLibrary SPIN: 5179–1260
Moscow
I. V. Bratischev
Research Institute of Emergency Care n. a. N. V. Sklifosovsky
Russian Federation
Russian Federation
Bratishchev Igor V., anesthesiologist-resuscitator, teacher of Training Centre
Moscow
References
1. Udovcic M., Pena R.H., Patham B., Tabatabai L., & Kansara A. Hypothyroidism and the Heart. Methodist DeBakey Cardiovasc. J, 2017; 13 (2), 55–59. DOI: 10.14797/mdcj-13–2–55.
2. Grais IM, Sowers JR. Thyroid and the heart Amer. J Med. 2014 Volume 127, Issue 8, August 2014, Pages 691–698. https://doi.org/10.1016/j.amjmed.2014.03.009
3. Biondi B., Cappola A.R., Cooper D.S. Subclinical Hypothyroidism. JAMA, 2019; 322 (2), 153. DOI: 10.1001/jama.2019.9052.
4. Razvi S., Jabbar A., Pingitore A., Danzi S., Biondi B., Klein I., et al. Thyroid Hormones and Cardiovascular Function and Diseases. J Amer. Coll. Card. 2018; 71 (16), 1781–1796. DOI: 10.1016/j.jacc.2018.02.045.
5. Davis J.D., Kovar A.J. The Cardiovascular Effects of Subclinical Thyroid Dysfunction J. Cardiothoracic Vasc Anesthesia. 2019. DOI: 10.1053/j.jvca.2019.08.020.
6. Biondi B., Bartalena L., Cooper D.S., Hegedüs L., Laurberg P., & Kahaly G.J. The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism. European Thyroid Journal, 2015; 4 (3), 149–163. DOI: 10.1159/000438750.
7. Surks M. I., Ortiz E., Daniels G. H., Sawin C. T., Col N. F., Cobin R. H., Weissman N.J. Subclinical Thyroid Disease. JAMA, 2004; 291 (2), 228. DOI: 10.1001/jama.291.2.228.
8. Pearce S.H.S., Razvi S., Yadegarfar M.E., Martin-Ruiz C., Kingston A., Collerton J., et al. Serum Thyroid Function, Mortality and Disability in Advanced Old Age: The Newcastle 85+ Study. The Journal of Clinical Endocrinology & Metabolism, 2016; 101 (11), 4385–4394. DOI: 10.1210/jc.2016–1935.
9. Duntas L.H., Yen P.M. (2019). Diagnosis and treatment of hypothyroidism in the elderly. Endocrine. DOI: 10.1007/s12020–019–02067–9
10. Razvi S., Shakoor A., Vanderpump M., Weaver J.U., Pearce the Influence of Age on the Relationship between Subclinical Hypothyroidism and Ischemic Heart Disease: A Meta-analysis. J. Clin. Endocrinology & Metabolism, 2015; 93 (8), 2998–3007. DOI: 10.1210/jc.2008–0167.
11. Rugge J. B., Bougatsos C., Chou R. Screening and Treatment of Thyroid Dysfunction: An Evidence Review for the U.S. Preventive Services Task Force. Ann. Internal Med. 2015; 162 (1), 35. DOI: 10.7326/m14–1456.
12. El Kawkgi O. M., & Brito J. P. Screening for thyroid dysfunction: prevention of overdiagnosis and overtreatment. Canad. Med. Ass. J. 2019; 191 (46), E1260–E1261. DOI: 10.1503/cmaj.191437.
13. Cappola A. R., Desai A. S., Medici M., Cooper L. S., Egan D., Sopko G., et al. Thyroid and Cardiovascular Disease: Research Agenda for Enhancing Knowledge, Prevention, and Treatment. Thyroid. 2019. DOI: 10.1089/thy.2018.0416.
14. Inoue K, Ritz B, Brent GA, Ebrahimi R, Rhee CM, Leung AM. Association of Subclinical Hypothyroidism and Cardiovascular Disease with Mortality. JAMA Netw Open. 2020; 3 (2): e1920745. DOI: 10.1001/jamanetworkopen.2019.20745.
15. Rodondi N., den Elzen W. P.J., Bauer D.C., Cappola A.R., Razvi S., Walsh J. P., et al. Thyroid Studies Collaboration, for the. Subclinical Hypothyroidism and the Risk of Coronary Heart Disease and Mortality. JAMA, 2010; 304 (12), 1365. DOI: 10.1001/jama.2010.1361.
16. Rhee C. M., Curhan G. C., Alexander E. K., Bhan I., & Brunelli S. M. Subclinical Hypothyroidism and Survival: The Effects of Heart Failure and Race. J. Clin. Endocrinology & Metabolism, 2013; 98 (6), 2326–2336. DOI:10.1210/jc.2013–1039.
17. Singh S., Duggal J., Molnar J., Maldonado F., Barsano C.P., & Arora R. Impact of subclinical thyroid disorders on coronary heart disease, cardiovascular and all-cause mortality: A meta-analysis. International Journal of Cardiology, 2008; 125 (1), 41–48. DOI: 10.1016/j.ijcard.2007.02.027
18. Delitala A. P., Fanciulli G., Maioli M., & Delitala G. Subclinical hypothyroidism, lipid metabolism and cardiovascular disease. Eur. J. Intern. Med. 2017; 38, 17–24. DOI: 10.1016/j.ejim.2016.12.015.
19. Pirich C., Müllner M., & Sinzinger H. Prevalence and relevance of thyroid dysfunction in 1922 cholesterol screening participants. J. Clin. Epidem. 2000; 53 (6), 623–629. DOI: 10.1016/s0895–4356(99)00187–0
20. Budnevsky A.V., Kravchenko A. Ya., Drobysheva E.S., Feskova A.A. Subclinical hypothyroidism as one of the causes of dyslipidemia. Clin. Med. 2015; 93 (1): 13–17.
21. Budnevsky A. V., Kravchenko A. Ya., Feskova A. A., Drobysheva E. S. Dyslipidemia in subclinical hypofunction of the thyroid gland and the effectiveness of its correction with L-thyroxine replacement therapy. Young Scientist. 2014. No. 17. S. 138–141.
22. Jabbar A., Ingoe L., Junejo S., Carey P., Addison C., Thomas H., Razvi S. (2020). Effect of Levothyroxine on Left Ventricular Ejection Fraction in Patients with Subclinical Hypothyroidism and Acute Myocardial Infarction. JAMA, 324 (3), 249. DOI: 10.1001/jama.2020.9389.
23. Suh S., & Kim D. K. Subclinical Hypothyroidism and Cardiovascular Disease. Endocrin. and Metabolism, 2015; 30 (3), 246. DOI: 10.3803/enm.2015.30.3.246.
24. Peeters R. P. Subclinical Hypothyroidism. New Engl. J. Med. 2017; 376 (26), 2556–2565. DOI: 10.1056/nejmcp1611144.
25. Chaker L., Bianco A.C., Jonklaas J., & Peeters R.P. Hypothyroidism. The Lancet, 2017; 390 (10101), 1550–1562. DOI: 10.1016/s0140–6736(17)30703–1
26. Ranasinghe A. M., & Bonser R. S. Thyroid hormone in cardiac surgery. Vascul. Pharmacology, 2010; 52 (3–4), 131–137. DOI: 10.1016/j.vph.2009.11.004.
27. Monzani F., Dardano A., & Caraccio N. Does Treating Subclinical Hypothyroidism Improve Markers of Cardiovascular Risk? Treatments in Endocrinology, 2006; 5 (2), 65–81. DOI: 10.2165/00024677–200605020–00001
28. Biondi B. (2020). Is there any reason to treat subclinical hypo and hyperthyroidism. Annales d’Endocrinologie. DOI: 10.1016/j.ando.2020.03.003.
29. Bekkering G.E., Agoritsas T., Lytvyn L., Heen A.F., Feller M., Moutzouri E., Vermandere M. (2019). Thyroid hormones treatment for subclinical hypothyroidism: a clinical practice guideline. BMJ, l2006. DOI: 10.1136/bmj.l2006.
30. Salman Razvi, Jolanta U. Weaver, PhD, FRCP; Timothy J. Butler, MRCGP; et al Levothyroxine Treatment of Subclinical Hypothyroidism, Fatal and Nonfatal Cardiovascular Events, and Mortality Arch Intern Med. 2012; 172 (10): 811–817. DOI: 10.1001/archinternmed.2012.1159.
31. Mooijaart S. P., Du Puy R. S., Stott D. J., Kearney P. M., Rodondi N., Westendorp R. G.J. (2019). Association Between Levothyroxine Treatment and Thyroid-Related Symptoms Among Adults Aged 80 Years and Older with Subclinical Hypothyroidism. JAMA, 2019 Oct 30; 322 (20): 1–11. DOI: 10.1001/jama.2019.17274.
32. Maria de Montmollin, Martin Feller, Shanthi Beglinger (2020). L-Thyroxine Therapy for Older Adults with Subclinical Hypothyroidism and Hypothyroid Symptoms Secondary Analysis of a Randomized Trial, Ann Intel Med 2 June 2020 Volume 172, Issue 11 Page: 709–716. https://doi.org/10.7326/M19–3193
33. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. (2018). Fourth Universal Definition of Myocardial Infarction (2018). J Am Coll Cardiol, 72 (18): 2231–2264.
34. Sandoval Y., & Thygesen K. (2016). Myocardial Infarction Type 2 and Myocardial Injury. Clinical Chemistry, 63 (1), 101–107. DOI: 10.1373/clinchem.2016.255521.
35. Gaggin H. K., Liu Y., Lyass A., van Kimmenade R. R.J., Motiwala S. R., Kelly N. P., Januzzi J.L. (2016). Incident Type 2 Myocardial Infarction in a Cohort of Patients Undergoing Coronary or Peripheral Arterial Angiography Clinical Perspective. Circulation, 135 (2), 116–127. DOI: 10.1161/circulationaha.116.023052.
36. Saaby L., Poulsen T.S., Diederichsen A.C.P., Hosbond S., Larsen T.B., Schmidt H., Mickley H. (2014). Mortality Rate in Type 2 Myocardial Infarction: Observations from an Unselected Hospital Cohort. The American Journal of Medicine, 127 (4), 295–302. DOI: 10.1016/j.amjmed.2013.12.020.
37. Canty JM. Coronary blood flow and myocardial ischemia. In: Bonow RO, Mann DL, Zipes DP, Lippy P. Braunwald’s Heart Disease: A Texbook of Cardiovascular Medicine 9 th edition by Saunders, an imprint of Elsevier Inc. Pgs: 1049–75.
38. Braunwald E. Myocardial oxygen consumption: the quest for its determinants and some clinical fallout. J. Amer. Coll. Card. 1999; 34 (5), 1365–1368. DOI: 10.1016/s0735–1097(99)00428–3.
39. Rhee JW, Sabatine MS, Lilly LS. Ischemic heart disease. In: Lilly LS. Pathophysiology of Heart Disease: a collaborative project of medical students and faculty 5th edition. Lippincott Williams & Wilkins, a Wolters Kluwer business. 2010; Pgs: 135–160.
40. Sandoval Y., Smith S. W., Thordsen S. E., & Apple F. S. Supply/Demand Type 2 Myocardial Infarction. J. Amer. Coll. Card. 2014; 63 (20), 2079–2087. DOI: 10.1016/j.jacc.2014.02.541.
41. Thygesen K, Alpert JS, White HD; Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction. Universal definition of myocardial infarction. J Am Coll Cardiol 2007; 50: 2173–95.
42. Drvota V., Janson A., Norman C., Sylven C., Haggblad J., Bronnegard M., & Marcus C. (1995). Evidence for the Presence of Functional Thyrotropin Receptor in Cardiac Muscle. Biochemical and Biophysical Research Communications, 211 (2), 426–431. DOI: 10.1006/bbrc.1995.1831.
43. Schuman M. L., Peres Diaz L. S., Landa M. S., Toblli J. E., Cao G., Alvarez A. L., García S. I. (2014). Thyrotropin-releasing hormone overexpression induces structural changes of the left ventricle in the normal rat heart. American Journal of Physiology-Heart and Circulatory Physiology, 307 (11), H1667–H1674. DOI: 10.1152/ajpheart.00494.2014.
44. Diaz L.S.P., Schuman M.L., Aisicovich M., Toblli J.E., Pirola C.J., Landa M.S., & García S.I. (2018). Angiotensin II requires an intact cardiac thyrotropin-releasing hormone (TRH) system to induce cardiac hypertrophy in mouse. Journal of Molecular and Cellular Cardiology. DOI: 10.1016/j.yjmcc.2018.09.009.
45. Petunina N.A. Features of therapy for thyroid diseases in patients with cardiac pathology. Russian Medical Journal, 2005, No. 28, volume 13: P. 1927–1932.
46. Gammage M, and J Franklyn. Hypothyroidism, thyroxine treatment, and the heart. Heart (British Cardiac Society) 1997; vol. 77, 3: 189–90. DOI: 10.1136/hrt.77.3.189.
47. N. A.. Petunina, L.V. Trukhin. Hypothyroidism Russian medical journal. 2007. T. 15, No. 1. P. 1–4.
48. Stott DJ, Rodondi N, Kearney PM, et al. TRUST Study Group. Thyroid hormone therapy for older adults with subclinical hypothyroidism. N Engl J Med 2017; 376: 2534–44. 10.1056/NEJMoa1603825.
49. Kuznetsova N. B., Kuznetsov P. E. Electron transfer in biochemical reactions is the main process in the mechanism of action of hormones and hormone-like compounds. Auditorium. 2018. No. 2 (18).
50. Ojamaa K. Signaling mechanisms in thyroid hormone-induced cardiac hypertrophy. Vasc. Pharmacology, 2010; 52 (3–4), 113–119. DOI: 10.1016/j.vph.2009.11.008.
51. Fukuyama K., Ichiki T., Takeda K., Tokunou T., Iino N., Masuda S, et al. Downregulation of Vascular Angiotensin II Type 1 Receptor by Thyroid Hormone. Hypertension, 41 (3), 598–603. DOI: 10.1161/01.hyp.0000056524.35294.80.
52. Davis P., Davis F., & Mousa S. Thyroid Hormone-Induced Angiogenesis. Curr. Card. Rev., 2009; 5 (1), 12–16. DOI: 10.2174/157340309787048158.
53. Marchant C., Brown L., & Sernia C. Renin-Angiotensin System in Thyroid Dysfunction in Rats. J Cardiovasc. Pharm. 1993; 22 (3), 449–455. DOI: 10.1097/00005344–199309000–00016.
54. Emmanuel Letavernier, Lara Zafrani, Joëlle Perez, Béatrice Letavernier, JeanPhilippe Haymann, Laurent Baud, The role of calpains in myocardial remodelling and heart failure, Cardiovasc. Res. 2012; Vol 96, Issue 1: 38–45, https://doi.org/10.1093/cvr/cvs099
55. Osipova O. A., Plaksina K.G., Komisov A.A., Godlevskaya O. A. Pathogenetic mechanisms of the participation of the extracellular matrix of the myocardium in heart remodeling in patients with chronic heart failure. Scientific bulletin of BelSU. Series: Medicine. Pharmacy. 2015. No. 22 (219). URL: https://cyberleninka.
56. ru/article/n/patogeneticheskie-mehanizmy-uchastiya-mezhkletochnogo-matriksa-miokarda-v-remodelirovanii-serdtsa-u-bolnyh-hronicheskoy-serdechnoy (date of access: 03.24.2020).
57. Belaya N. V. Mechanisms of myocardial remodeling in arterial hypertension. International Medical Journal. 2006. No. 22. 15–18.
58. Hu L. W., Benvenuti L. A., Liberti E. A., Carneiro-Ramos M.S., & Barreto-Chaves M.L.M. Thyroxine-induced cardiac hypertrophy: influence of adrenergic nervous system versus renin-angiotensin system on myocyte remodeling. Am. J. Physiology-Regulatory, Integrative and Comparative Physiology, 2003; 285 (6), R1473–R1480. DOI: 10.1152/ajpregu.00269.2003.
59. Kobori H., Ichihara A., Suzuki H., Takenaka T., Miyashita Y., Hayashi M., et al. Role of the renin-angiotensin system in cardiac hypertrophy induced in rats by hyperthyroidism. Am.J. Physiology-Heart and Circulatory Physiology, 1997; 273 (2), H593–H599. DOI: 10.1152/ajpheart.1997.273.2.h593.
60. Vasyuk Yu.A., Kulikov K.G., Kudryakov O.N., Krikunova O.V., Sadulaeva I.A. Secondary mitochondrial dysfunction in acute coronary syndrome. RFK. 2007. No. 1. URL: https://cyberleninka.ru/article/n/vtorichnaya-mitohondrialnaya-disfunktsiya-pri-ostrom-koronarnom-sindrome (date of access: 03.24.2020).
61. Stepanov A.V., Baydyuk. E.V., Sakuta G.A. Characteristics of mitochondria of cardiomyocytes in rats with chronic heart failure. Cytology. 2016. No. 11 (58), 875–882.
62. Li C., Chen F., Yu X., Hu S., & Shao S. A silent myocardial infarction with normal coronary arteries associated with Graves’ disease. Heart & Lung. 2018 Vol. 48 (4), pages 347–350. DOI: 10.1016/j.hrtlng.2018.11.003.
63. Jabbar A., Ingoe L., Junejo S., Carey P., Addison C., Thomas H., Razvi S. (2020). Effect of Levothyroxine on Left Ventricular Ejection Fraction in Patients with Subclinical Hypothyroidism and Acute Myocardial Infarction. JAMA, 324 (3), 249. DOI: 10.1001/jama.2020.9389.
Review
For citations:
Ivannikov A.A., Kanibolotsky A.A., Alidzhanova Kh.G., Bratischev I.V. Pathophysiological aspects of development myocardial infarction type 2 in subclinical hypothyroidism. Medical alphabet. 2021;(42):34-41. (In Russ.) https://doi.org/10.33667/2078-5631-2021-42-34-41
Views:
483
Email this article 