Low T3 Would Indicate Adverse Outcomes for Inpatients with Decompensated Heart Failure

espanolIntroduccion: El sindrome de T3 baja se asocia con niveles elevados de interleucinas y citoquinas circulantes, lo que refuerzala hipotesis de una estrecha relacion entre el sistema neuroendocrino y ciertos mecanismos inflamatorios e inmunologicos,involucrados en la insuficiencia cardiaca.Objetivo: Evaluar la evolucion de pacientes ingresados por insuficiencia cardiaca descompensada segun niveles de T3 al ingreso,y eventos durante la hospitalizacion y en el seguimiento.Material y metodos: Estudio prospectivo, observacional, analitico de 524 pacientes internados por primera vez con diagnosticode insuficiencia cardiaca descompensada. Se evaluo la mortalidad intrahospitalaria, y al seguimiento y readmisiones de acuerdocon niveles de T3 normal o disminuida al ingreso. Se excluyeron 91 pacientes con distiroidismo conocido, hipotiroidismo ohipertiroidismo, cirugia tiroidea previa, sepsis o sindrome coronario agudo. Se realizo un analisis de subgrupo de pacientessegun recibieran cronicamente amiodarona y se evaluaron variables pronosticas.Resultados: De 433 pacientes analizados, el 40,0% presentaban bajos niveles de T3 (BT3). La edad, albumina, TFG y edadmayor de 75 anos, fueron predictores independientes de BT3. Si bien se observo un aumento en ambos grupos en la adecuacionde tratamientos recomendados por las guias, el grupo de BT3 mostro significativamente tasas menores de estos con respectoa aquellos con T3 normal (BT3 vs. NT3: betabloqueantes 81,5% vs. 89,4%, p = 0,02; IECA/ARAII 78,5% vs. 87,9% p EnglishBackground: Low T3 syndrome is associated with elevated circulating levels of cytokines and interleukins, reinforcing thehypothesis of a close relation between the neuroendocrine system and certain inflammatory and immunological mechanismsinvolved in heart failure.Objective: To assess the progress of patients admitted for decompensated heart failure according to T3 levels on admission,and events during hospitalization and follow-up.Materials and methods: It was a prospective, observational, analytical study of 524 patients hospitalized for the first timewith a diagnosis of decompensated heart failure. In-hospital and follow-up mortality and readmissions were evaluated accordingto normal or low T3 levels on admission. Ninety-one patients with known dysthyroidism, hypo or hyperthyroidism,previous thyroid surgery, sepsis or acute coronary syndrome were excluded. A subgroup analysis of patients receiving chronicamiodarone therapy was conducted, and prognostic variables were evaluated.Results: Of the 433 patients analyzed, 40.0% had low T3 (LT3) levels. Age, albumin level, age >75 years, and glomerularfiltration rate (GFR) were independent predictors of LT3. While adaptation of guideline-recommended treatments increasedin both groups, treatment rates in the LT3 group were significantly lower than those in the normal T3 (NT3) group (LT3vs. NT3: Betablockers 81.5% vs. 89.4%, p=0.02; ACEI/ARA II 78.5% vs. 87.9%, p=0.001; anti-aldosterone agents 29.2% vs.40.5%; p=0.019). Hospital mortality was higher in the LT3 group (5.8 vs. 1.5%), with no difference in rehospitalizations ormortality rates at follow-up. Of the subgroup of patients without amiodarone on admission (353), 37.8% had LT3. Patientsin this subgroup were found to have significant differences in follow-up and in-hospital mortality (5.3% in LT3 vs. 0.9% inNT3, p=0.03, and 40.2% vs. 26.6%, p=0.023) respectively.Conclusions: Decompensated heart failure patients with LT3 on admission would represent a subgroup with more severedisease and worse prognosis during hospitalization.