Analysis of the correlation between preoperative free thyroxine levels and the risk of new-onset atrial fibrillation after cardiac valve surgery
10.3760/cma.j.cn112434-20240205-00040
- VernacularTitle:甲状腺功能与心脏瓣膜术后新发房颤风险的关联性分析
- Author:
Xiaodong ZHANG
1
;
Jingjing NIU
;
Honglei ZHAO
Author Information
1. 临沂市中心医院心脏大血管外科，临沂 276401
- Keywords:
Thyroid function;
Heart valve surgery;
Atrial fibrillation;
Free thyroxine
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2024;40(8):473-479
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the relationship between preoperative free thyroxine (FT4) levels and the risk of new-onset atrial fibrillation (AF) after cardiac valve surgery in patients with normal thyroid function, and to identify high-risk individuals for postoperative AF among patients undergoing cardiac valve surgery.Methods:This retrospective study enrolled patients(≥18 years old)with valvular heart disease who underwent heart valve replacement or valvoplasty surgery from December 2019 to January 2023 in Beijing Anzhen Hospital. Patients with thyroid function tests exceeding the normal reference range(7.64-16.03 pmol/L) were excluded, resulting in a final cohort of 2 645 patients, including 1 597 males and 1 048 females; aged 18-83 years, with a median age of 56 (46, 64) years. Among them, 1 891 patients (71.5%) had hypertension, and 176 (6.7%) had type 2 diabetes. The patients were divided into four groups based on quartiles of FT4 levels: Group 1 (n=661) with FT4 levels of 7.64-10.33 pmol/L, Group 2 (n=661) with 10.33-11.36pmol/L, Group 3 (n=661) with 11.36-12.54 pmol/L, and Group 4(n=662) with 12.54-13.66pmol/L. The risk of postoperative AF was compared among the four groups, and logistic regression was used to adjust for relevant risk factors. The odds ratio ( OR) and 95% confidence interval( CI) for postoperative AF across different groups were analyzed. Subgroup analyses were performed based on age, gender, hypertension status, and B-type natriuretic peptide (BNP) levels to compare the association between FT4 levels and new-onset AF within different subgroups. Results:Statistically significant differences were observed among the four groups in terms of age, body mass index, hypertension, hyperlipidemia, BNP, glomerular filtration rate, triglyceride, and total cholesterol levels ( P<0.05), while no significant differences were found in other indicators( P<0.05). Using the lowest FT4 group as the baseline, a higher risk of postoperative new-onset AF was observed in groups with higher FT4 levels, with a significant trend of incremental increase in postoperative AF with rising FT4 levels. Similar trends were observed across subgroups stratified by age, gender, hypertension status, and BNP levels. The Youden index indicated a cut-off value of 11.485pmol/L for FT4. Conclusion:Among patients with normal thyroid function and valvular heart disease, preoperative higher FT4 levels are significantly associated with an increased risk of new-onset AF after cardiac valve surgery. Close monitoring for postoperative AF risk is recommended for patients with preoperative FT4 levels exceeding 11.485 pmol/L, even if the thyroid function is still within the normal.
