Predictive Value of Free Triiodothyronine to Free Thyroxine Ratio in Euthyroid Patients With Myocardial Infarction With Nonobstructive Coronary Arteries
BackgroundThyroid function is closely involved in cardiovascular diseases. The free triiodothyronine (fT3) to free thyroxine (fT4) ratio has been reported as a risk factor for coronary artery disease, but its prognostic value in euthyroid patients with myocardial infarction with nonobstructive coron...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2021-07-01
|
| Series: | Frontiers in Endocrinology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2021.708216/full |
| _version_ | 1818456013397819392 |
|---|---|
| author | Side Gao Wenjian Ma Sizhuang Huang Xuze Lin Mengyue Yu |
| author_facet | Side Gao Wenjian Ma Sizhuang Huang Xuze Lin Mengyue Yu |
| author_sort | Side Gao |
| collection | DOAJ |
| description | BackgroundThyroid function is closely involved in cardiovascular diseases. The free triiodothyronine (fT3) to free thyroxine (fT4) ratio has been reported as a risk factor for coronary artery disease, but its prognostic value in euthyroid patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) remains unclear.MethodsA total of 1162 euthyroid patients with MINOCA were enrolled and divided according to decreased tertiles of fT3/fT4 ratio. The study endpoint was major adverse cardiovascular events (MACE), including all-cause death, nonfatal MI, nonfatal stroke, revascularization, and hospitalization for unstable angina or heart failure. Kaplan-Meier, Cox regression, and receiver-operating characteristic analyses were performed.ResultsPatients with lower fT3/fT4 tertile levels had a significantly higher incidence of MACE (10.0%, 13.9%, 18.2%; p=0.005) over the median follow-up of 41.7 months. The risk of MACE increased with the decreasing fT3/fT4 tertiles even after multivariate adjustment (tertile1 as reference, tertile2: HR 1.58, 95% CI: 1.05-2.39, p=0.030; tertile3: HR 2.06, 95% CI: 1.17-3.11, p=0.006). Lower level of fT3/fT4 ratio remained a robust predictor of MACE in overall (HR 1.64, 95% CI: 1.18-2.29, p=0.003) and in subgroups. When adding fT3/fT4 ratio [area under the curve (AUC) 0.61] into the thrombolysis in myocardial infarction (TIMI) risk score (AUC 0.69), the combined model (AUC 0.74) yielded a significant improvement in discrimination for MACE (ΔAUC 0.05, p=0.023).ConclusionsLow level of fT3/fT4 ratio was strongly associated with a poor prognosis in euthyroid patients with MINOCA. Routine assessment of fT3/fT4 ratio may facilitate risk stratification in this specific population. |
| first_indexed | 2024-12-14T22:19:55Z |
| format | Article |
| id | doaj.art-6f686559760c4b0083d0326e09a0cba6 |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-12-14T22:19:55Z |
| publishDate | 2021-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj.art-6f686559760c4b0083d0326e09a0cba62022-12-21T22:45:31ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922021-07-011210.3389/fendo.2021.708216708216Predictive Value of Free Triiodothyronine to Free Thyroxine Ratio in Euthyroid Patients With Myocardial Infarction With Nonobstructive Coronary ArteriesSide GaoWenjian MaSizhuang HuangXuze LinMengyue YuBackgroundThyroid function is closely involved in cardiovascular diseases. The free triiodothyronine (fT3) to free thyroxine (fT4) ratio has been reported as a risk factor for coronary artery disease, but its prognostic value in euthyroid patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) remains unclear.MethodsA total of 1162 euthyroid patients with MINOCA were enrolled and divided according to decreased tertiles of fT3/fT4 ratio. The study endpoint was major adverse cardiovascular events (MACE), including all-cause death, nonfatal MI, nonfatal stroke, revascularization, and hospitalization for unstable angina or heart failure. Kaplan-Meier, Cox regression, and receiver-operating characteristic analyses were performed.ResultsPatients with lower fT3/fT4 tertile levels had a significantly higher incidence of MACE (10.0%, 13.9%, 18.2%; p=0.005) over the median follow-up of 41.7 months. The risk of MACE increased with the decreasing fT3/fT4 tertiles even after multivariate adjustment (tertile1 as reference, tertile2: HR 1.58, 95% CI: 1.05-2.39, p=0.030; tertile3: HR 2.06, 95% CI: 1.17-3.11, p=0.006). Lower level of fT3/fT4 ratio remained a robust predictor of MACE in overall (HR 1.64, 95% CI: 1.18-2.29, p=0.003) and in subgroups. When adding fT3/fT4 ratio [area under the curve (AUC) 0.61] into the thrombolysis in myocardial infarction (TIMI) risk score (AUC 0.69), the combined model (AUC 0.74) yielded a significant improvement in discrimination for MACE (ΔAUC 0.05, p=0.023).ConclusionsLow level of fT3/fT4 ratio was strongly associated with a poor prognosis in euthyroid patients with MINOCA. Routine assessment of fT3/fT4 ratio may facilitate risk stratification in this specific population.https://www.frontiersin.org/articles/10.3389/fendo.2021.708216/fullthyroid functionFT3/FT4 ratiomyocardial infarction with nonobstructive coronary arteries (MINOCA)cardiovascular outcomes (CV outcomes)euthyroid |
| spellingShingle | Side Gao Wenjian Ma Sizhuang Huang Xuze Lin Mengyue Yu Predictive Value of Free Triiodothyronine to Free Thyroxine Ratio in Euthyroid Patients With Myocardial Infarction With Nonobstructive Coronary Arteries Frontiers in Endocrinology thyroid function FT3/FT4 ratio myocardial infarction with nonobstructive coronary arteries (MINOCA) cardiovascular outcomes (CV outcomes) euthyroid |
| title | Predictive Value of Free Triiodothyronine to Free Thyroxine Ratio in Euthyroid Patients With Myocardial Infarction With Nonobstructive Coronary Arteries |
| title_full | Predictive Value of Free Triiodothyronine to Free Thyroxine Ratio in Euthyroid Patients With Myocardial Infarction With Nonobstructive Coronary Arteries |
| title_fullStr | Predictive Value of Free Triiodothyronine to Free Thyroxine Ratio in Euthyroid Patients With Myocardial Infarction With Nonobstructive Coronary Arteries |
| title_full_unstemmed | Predictive Value of Free Triiodothyronine to Free Thyroxine Ratio in Euthyroid Patients With Myocardial Infarction With Nonobstructive Coronary Arteries |
| title_short | Predictive Value of Free Triiodothyronine to Free Thyroxine Ratio in Euthyroid Patients With Myocardial Infarction With Nonobstructive Coronary Arteries |
| title_sort | predictive value of free triiodothyronine to free thyroxine ratio in euthyroid patients with myocardial infarction with nonobstructive coronary arteries |
| topic | thyroid function FT3/FT4 ratio myocardial infarction with nonobstructive coronary arteries (MINOCA) cardiovascular outcomes (CV outcomes) euthyroid |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2021.708216/full |
| work_keys_str_mv | AT sidegao predictivevalueoffreetriiodothyroninetofreethyroxineratioineuthyroidpatientswithmyocardialinfarctionwithnonobstructivecoronaryarteries AT wenjianma predictivevalueoffreetriiodothyroninetofreethyroxineratioineuthyroidpatientswithmyocardialinfarctionwithnonobstructivecoronaryarteries AT sizhuanghuang predictivevalueoffreetriiodothyroninetofreethyroxineratioineuthyroidpatientswithmyocardialinfarctionwithnonobstructivecoronaryarteries AT xuzelin predictivevalueoffreetriiodothyroninetofreethyroxineratioineuthyroidpatientswithmyocardialinfarctionwithnonobstructivecoronaryarteries AT mengyueyu predictivevalueoffreetriiodothyroninetofreethyroxineratioineuthyroidpatientswithmyocardialinfarctionwithnonobstructivecoronaryarteries |