Impaired cardiac reserve and exercise capacity in patients receiving long-term thyrotropin suppressive therapy with levothyroxine(102 visite) Biondi B, Fazio S, Cuocolo A, Sabatini D, Nicolai E, Lombardi G, Salvatore M, Sacca L
Parole chiave: Beta Adrenergic Receptor Blocking Agent, Bisoprolol, Levothyroxine, Liothyronine, Thyrotropin, Adult, Article, Bicycle Ergometry, Clinical Article, Clinical Trial, Controlled Clinical Trial, Controlled Study, Exercise Tolerance, Female, Goiter, Heart Left Ventricle Function, Human, Long Term Care, Priority Journal, Scintiangiography, Thyroid Carcinoma, Thyroid Disease, Adrenergic Beta-Antagonists, Middle Aged, Ventricular Function,
Affiliazioni:
Depts. Int. Med., Endocrinol., N., Univ. Federico II Medical School, Naples, Italy Medicina Interna, Via Pansini 5, 80131 Naples, Italy
Riferimenti:
Mandel, S.J., Brent, G.A., Larsen, P.R., Levothyroxine therapy in patients with thyroid disease (1993) Ann Intern Med, 119, pp. 492-50
Hennessey, J.V., Evaul, J.E., Tseng, Y.C., Burman, K.D., Wartofsky, L., L-Thyroxine dosage: A reevaluation of therapy with contemporary preparations (1986) Ann Intern Med, 105, pp. 11-15
Ross, D.S., Daniels, G.H., Gouveia, D., The use and limitations of a chemiluminescent thyrotropin assay as a single thyroid function test in an out-patient endocrine clinic (1990) J Clin Endocrinol Metab, 71, pp. 764-769
Ross, D.S., Neer, R.M., Ridgway, E.C., Daniels, G.H., Subclinical hyperthyroidism and reduced bone density as a possible result of prolonged suppression of the pituitary-thyroid axis with l-thyroxine (1987) Am J Med, 82, pp. 1167-1170
Paul, T.L., Kerrigan, J., Kelly, A.M., Braverman, L.E., Baran, D.T., Long-term l-thyroxine therapy is associated with decreased hip bone density in premenopausal women (1988) JAMA, 259, pp. 3137-3141
Faber, J., Galloe, A.M., Changes in bone mass during prolonged subclinical hyperthyroidism due to l-thyroxine treatment: A meta-analysis (1994) Eur J Endocrinol, 130, pp. 350-356
Biondi, B., Fazio, S., Carella, C., Cardiac effects of long term thyrotropin-suppressive therapy with levothyroxine (1993) J Clin Endocrinol Metab, 77, pp. 334-338
Fazio, S., Biondi, B., Carella, C., Diastolic dysfunction in patients on thyrotropin-suppressive therapy with levothyroxine: Beneficial effect of β-blockade (1995) J Clin Endocrinol Metab, 80, pp. 2222-2226
Bonow, R.O., Udelson, J.E., Left ventricular diastolic dysfunction as a cause of congestive heart failure (1992) Ann Intern Med, 117, pp. 502-510
Klein, I., Trzepacz, P., Roberts, M., Levey, G.S., Symptom rating scale for assessing hyperthyroidism (1988) Arch Intern Med, 148, pp. 387-390
Kannel, W.B., Sorlie, P., Some health benefits of physical activity. The Framingham study (1979) Arch Intern Med, 139, pp. 857-861
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Sawin, C.T., Geller, A., Wolf, P.A., Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons (1994) N Engl J Med, 331, pp. 1249-1252
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Parisi, A.F., Hamilton, B.P., Thomas, C.N., Mazzaferri, E.L., The short cardiac pre-ejection period: An index to thyrotoxicosis (1974) Circulation, 49, pp. 900-904
Cohen, M.V., Schulman, I.C., Spenillo, A., Surks, M.I., Effects of thyroid hormone on left ventricular function in patients treated for thyrotoxicosis (1981) Am J Cardiol, 48, pp. 33-38
Shafer, R.B., Bianco, J.A., Assessment of cardiac reserve in patients with hyperthyroidism (1980) Chest, 78, pp. 269-273
Forfar, J.C., Muir, A.L., Sawers, S.A., Toft, A.D., Abnormal left ventricular function in hyperthyroidism (1982) N Engl J Med, 307, pp. 1165-1170
Feldman, T., Borow, K.M., Same, D.H., Neumann, A., Lang, R.M., Myocardial mechanics in hyperthyroidism: Importance of left ventricular loading conditions, heart rate and contractile state (1986) J Am Coll Cardiol, 7, pp. 967-974
Iskandrian, A.S., Rose, L., Hakki, A.-H., Segal, B.L., Kane, S.A., Cardiac performance in thyrotoxicosis: Analysis of 10 untreated patients (1983) Am J Cardiol, 51, pp. 349-352
Bevilacqua, M., Savonitto, S., Bosisio, E., Role of the Frank-Starling mechanism in maintaining cardiac output during increasing levels of treadmill exercise in beta-blocked normal men (1989) Am J Cardiol, 63, pp. 853-857
Clifton, G.D., Harrison, M.R., DeMaria, A.N., Influence of beta-adrenergic blockade upon hemodynamic response to exercise assessed by Doppler echocardiography (1990) Am Heart J, 120, pp. 579-585
Martin III, W.H., Spina, R.J., Korte, E., Mechanisms of impaired exercise capacity in short duration experimental hyperthyroidism (1991) J Clin Invest, 88, pp. 2047-2053
Olson, B.R., Klein, I., Benner, R., Burdett, R., Trzepacz, P., Levey, G.S., Hyperthyroid myopathy and response to treatment (1991) Thyroid, 1, pp. 137-141
Twentyman, O.P., Disley, A., Gribbin, H.R., Alberti, K.G., Tattersfield, A.E., Effect of beta-adrenergic blockade on respiratory and metabolic responses to exercise (1931) J Appl Physiol, 51, pp. 788-793
Lundborg, P., Åström, H., Bengtsson, C., Effect of beta-adrenoceptor blockade on exercise performance and metabolism (1981) Clin Sci, 61, pp. 299-305
Smith, R.S., Warren, D.J., Effect of acute oral beta-adrenergic blockade on muscle blood flow in man (1982) Cardiovasc Res, 16, pp. 205-208
Challiss, R.A.J., Hayes, D.J., Radda, G.K., A 31P-n.m.r. study of the acute effects of β-blockade on the bioenergetics of skeletal muscle during contractien (1987) Biochem J, 246, pp. 163-172
Mandel, S. J., Brent, G. A., Larsen, P. R., Levothyroxine therapy in patients with thyroid disease (1993) Ann Intern Med, 119, pp. 492-50
Hennessey, J. V., Evaul, J. E., Tseng, Y. C., Burman, K. D., Wartofsky, L., L-Thyroxine dosage: A reevaluation of therapy with contemporary preparations (1986) Ann Intern Med, 105, pp. 11-15
Ross, D. S., Daniels, G. H., Gouveia, D., The use and limitations of a chemiluminescent thyrotropin assay as a single thyroid function test in an out-patient endocrine clinic (1990) J Clin Endocrinol Metab, 71, pp. 764-769
Ross, D. S., Neer, R. M., Ridgway, E. C., Daniels, G. H., Subclinical hyperthyroidism and reduced bone density as a possible result of prolonged suppression of the pituitary-thyroid axis with l-thyroxine (1987) Am J Med, 82, pp. 1167-1170
Paul, T. L., Kerrigan, J., Kelly, A. M., Braverman, L. E., Baran, D. T., Long-term l-thyroxine therapy is associated with decreased hip bone density in premenopausal women (1988) JAMA, 259, pp. 3137-3141
Bonow, R. O., Udelson, J. E., Left ventricular diastolic dysfunction as a cause of congestive heart failure (1992) Ann Intern Med, 117, pp. 502-510
Kannel, W. B., Sorlie, P., Some health benefits of physical activity. The Framingham study (1979) Arch Intern Med, 139, pp. 857-861
Utiger, R. D., Subclinical hyperthyroidism - Just a low serum thyrotropin concentration or something more? (1994) N Engl J Med, 331, pp. 1302-1303
Sawin, C. T., Geller, A., Wolf, P. A., Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons (1994) N Engl J Med, 331, pp. 1249-1252
Merillon, J. P., Passa, P. H., Chastre, J., Gourgon, R., Left ventricular function and hyperthyroidism (1981) Br Heart J, 46, pp. 137-143
Amidi, M., Leon, D. F., DeGroot, W. J., Kroetz, F. W., Leonard, J. J., Effect of the thyroid state on myocardial contractility and ventricular ejection rate in man (1968) Circulation, 38, pp. 229-239
Parisi, A. F., Hamilton, B. P., Thomas, C. N., Mazzaferri, E. L., The short cardiac pre-ejection period: An index to thyrotoxicosis (1974) Circulation, 49, pp. 900-904
Cohen, M. V., Schulman, I. C., Spenillo, A., Surks, M. I., Effects of thyroid hormone on left ventricular function in patients treated for thyrotoxicosis (1981) Am J Cardiol, 48, pp. 33-38
Shafer, R. B., Bianco, J. A., Assessment of cardiac reserve in patients with hyperthyroidism (1980) Chest, 78, pp. 269-273
Forfar, J. C., Muir, A. L., Sawers, S. A., Toft, A. D., Abnormal left ventricular function in hyperthyroidism (1982) N Engl J Med, 307, pp. 1165-1170
Iskandrian, A. S., Rose, L., Hakki, A. -H., Segal, B. L., Kane, S. A., Cardiac performance in thyrotoxicosis: Analysis of 10 untreated patients (1983) Am J Cardiol, 51, pp. 349-352
Clifton, G. D., Harrison, M. R., DeMaria, A. N., Influence of beta-adrenergic blockade upon hemodynamic response to exercise assessed by Doppler echocardiography (1990) Am Heart J, 120, pp. 579-585
Martin III, W. H., Spina, R. J., Korte, E., Mechanisms of impaired exercise capacity in short duration experimental hyperthyroidism (1991) J Clin Invest, 88, pp. 2047-2053
Olson, B. R., Klein, I., Benner, R., Burdett, R., Trzepacz, P., Levey, G. S., Hyperthyroid myopathy and response to treatment (1991) Thyroid, 1, pp. 137-141
Twentyman, O. P., Disley, A., Gribbin, H. R., Alberti, K. G., Tattersfield, A. E., Effect of beta-adrenergic blockade on respiratory and metabolic responses to exercise (1931) J Appl Physiol, 51, pp. 788-793
Lundborg, P., str m, H., Bengtsson, C., Effect of beta-adrenoceptor blockade on exercise performance and metabolism (1981) Clin Sci, 61, pp. 299-305
Smith, R. S., Warren, D. J., Effect of acute oral beta-adrenergic blockade on muscle blood flow in man (1982) Cardiovasc Res, 16, pp. 205-208
Challiss, R. A. J., Hayes, D. J., Radda, G. K., A 31P-n. m. r. study of the acute effects of -blockade on the bioenergetics of skeletal muscle during contractien (1987) Biochem J, 246, pp. 163-172
To assess cardiac function and exercise tolerance in patients receiving long term TSH-suppressive therapy with levothyroxine (L-T4), we studied maximal exercise capacity with a bicycle ergometer and left ventricular function at rest and during physical exercise by radionuclide angiography. The evaluation was performed in 10 patients receiving L-T4 therapy (2.31 ± 0.13 μg/kg) for 5-9 yr, presenting with effort dyspnea and symptoms of adrenergic overactivity, and 10 matched control subjects. The patients were reassessed after 4 months of administration of the selective β-adrenergic blocker bisoprolol (4.25 ± 0.4 mg/day); L-T4 therapy remained unchanged. The results showed that at rest, left ventricular diastolic filling was impaired in the patients (P < 0.05), whereas systolic function was unaltered. During submaximal physical exercise, left ventricular ejection fraction increased in the controls from 58 ± 2% to 65 ± 2% (P < 0.001), whereas in the patients it fell from 63 ± 2% to 53 ± 2% (P < 0.01), mainly because of increased end-systolic left ventricular volume (P < 0.05). Exercise capacity was markedly reduced in the patients in terms of both peak workload (P < 0.001) and exercise duration (P < 0.001). β-Adrenergic blockade prevented both the fall in ejection fraction and the increase in end-systolic volume during exercise, and improved exercise tolerance. In conclusion, our data show that long term TSH-suppressive therapy with L-T4 is not as harmless as believed, because it may cause marked impairment of cardiac functional reserve and physical exercise capacity. Administration of a β-blocking drug for 4 months caused significant improvement of cardiac performance and exercise tolerance.
Hesse B, Tagil K, Cuocolo A, Anagnostopoulos C, Bardies M, Bax J, Bengel F, Busemann Sokole E, Davies G, Dondi M, Edenbrandt L, Franken P, Kjaer A, Knuuti J, Lassmann M, Ljungberg M, Marcassa C, Marie PY, Mckiddie F, O'connor M, Prvuolovich E, Underwood R * 3. 0 T perfusion MR imaging(305 visite) Rivista Di Neuroradiologia (ISSN: 1120-9976), 2004; 17(6): 807-812. Impact Factor:0.023 DettagliEsporta in BibTeXEsporta in EndNote
313 Records (302 escludendo Abstract e Conferenze). Impact factor totale: 974.14 (941.384 escludendo Abstract e Conferenze). Impact factor a 5 anni totale: 1100.77 (1058.089 escludendo Abstract e Conferenze).
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