Right ventricular and right atrial function and deformation in patients with subclinical hypothyroidism: a two- and three-dimensional echocardiographic study

Marijana Tadic, Sanja Ilic, Vera Celic
European Journal of Endocrinology 2014, 170 (1): 77-85

BACKGROUND: We sought to investigate right ventricular (RV) function and deformation assessed by three-dimensional echocardiography (3DE) and speckle tracking in patients with subclinical hypothyroidism (SHT), and to evaluate the influence of levothyroxine (L-T₄) therapy on RV remodeling.

METHODS: We included 50 untreated women with SHT and 45 healthy control women matched by age. The L-T₄ therapy was prescribed to all SHT patients who were followed 1 year after euthyroid status was achieved. All study participants underwent laboratory analyses which included thyroid hormone levels, and complete two-dimensional echocardiography (2DE) and 3DE examinations.

RESULTS: 3DE RV end-diastolic volume and ejection fraction were significantly reduced in the SHT patients before therapy in comparison with the healthy controls and treated SHT subjects. RV longitudinal strain, systolic, and early diastolic strain rates (SRs) were significantly decreased, whereas RV late diastolic SR was increased in the SHT patients before therapy when comparing with the controls. 2DE speckle tracking imaging revealed that L-T₄ substitution therapy significantly improved RV systolic mechanics, whereas RV diastolic deformation was not completely recovered. Right atrial (RA) function and deformation were significantly impacted by SHT. Replacement L-T₄ treatment improved but did not completely restore RA mechanics in the SHT patients.

CONCLUSION: RV and RA function and mechanics are significantly affected by SHT. L-T₄ therapy and 1-year maintenance of euthyroid status improved but did not completely recover RV and RA function and deformation in the SHT patients, which implies that right heart remodeling caused by SHT is not reversible in a 1-year period.

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