Evidence map›Paper›PMID 30562095›Full record

Observational studyCirculation. Heart failure2018

Thyroid Dysfunction in Heart Failure and Cardiovascular Outcomes.

Lakshmi Kannan, Pamela A Shaw, Michael P Morley, Jeffrey Brandimarto, James C Fang, Nancy K Sweitzer, Thomas P Cappola, Anne R Cappola

Open access · bronzeAbstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Circulation. Heart failure, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 123 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
123citing papers in PubMed, 7 pooled it
12.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

123 citing papers in PubMed, 7 syntheses or guidelines pooled it, 236 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Guideline
  6. Pooled it
  7. Pooled it
  8. Trial
  9. Article
  10. Article
  11. Article
  12. Review
  13. Article
  14. Article
  15. Article
  16. Article
  17. Article
  18. Measuring Hypothyroidism Disease Control Using a TSH-based "Time-in-range".The Journal of clinical endocrinology and metabolism · 2026
    Article
  19. Observational
  20. Article

63 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 4 institutions in 1 country.

Lakshmi KannanDivision of Endocrinology, Diabetes, and Metabolism (L.K., A.R.C.) at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
Pamela A ShawDepartment of Biostatistics, Epidemiology, and Informatics (P.A.S.) at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
Michael P Morleythe Cardiovascular Institute (M.P.M., J.B., T.P.C.) at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
Jeffrey Brandimartothe Cardiovascular Institute (M.P.M., J.B., T.P.C.) at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
James C FangDivision of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City (J.C.F.).
Nancy K SweitzerDivision of Cardiology, University of Arizona College of Medicine, Tucson (N.K.S.).
Thomas P CappolaDivision of Cardiovascular Medicine (T.P.C.) at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
Anne R CappolaDivision of Endocrinology, Diabetes, and Metabolism (L.K., A.R.C.) at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
University of Pennsylvania · USCardiovascular Institute of the South · USUniversity of Arizona · USUniversity of Utah · US

Funding

Genomics of myocardial transcription factors in cardiac remodelingR01HL088577 · NHLBI · UNIVERSITY OF PENNSYLVANIA · PI CAPPOLA, THOMAS P. · 2007 to 2013
$5.3M
Midcareer Investigator Award in Patient-Oriented Research in AgingK24AG042765 · NIA · UNIVERSITY OF PENNSYLVANIA · PI CAPPOLA, ANNE R · 2013 to 2024
$1.7M
NHLBI NIH HHS R01 HL088577NIA NIH HHS K24 AG042765
6 · The paper itself

Abstract

backgroundThe effects of thyroid dysfunction in patients with preexisting heart failure have not been adequately studied. We examined the prevalence of thyroid dysfunction and associations with cardiovascular outcomes in a large, prospective cohort of outpatients with preexisting heart failure. METHODS AND

resultsWe examined associations between thyroid dysfunction and New York Heart Association class, atrial fibrillation, and a composite end point of ventricular assist device placement, heart transplantation, or death in 1365 participants with heart failure enrolled in the Penn Heart Failure Study. Mean age was 57 years, 35% were women, and the majority had New York Heart Association class II (45%) or III (32%) symptoms. More severe heart failure was associated with higher thyroid-stimulating hormone (TSH), higher free thyroxine (FT4), and lower total triiodothyronine (TT3) concentrations ( P<0.001 all models). Atrial fibrillation was positively associated with higher levels of FT4 alone ( P≤0.01 all models). There were 462 composite end points over a median 4.2 years of follow-up. In adjusted models, compared with euthyroidism, subclinical hypothyroidism (TSH 4.51-19.99 mIU/L with normal FT4) was associated with an increased risk of the composite end point overall (hazard ratio, 1.82; 95% CI, 1.27-2.61; P=0.001) and in the subgroup with TSH ≥7.00 mIU/L (hazard ratio, 3.25; 95% CI, 1.96-5.39; P<0.001), but not in the subgroup with TSH 4.51-6.99 mIU/L (hazard ratio, 1.26; 95% CI, 0.78-2.06; P=0.34). Isolated low T3 was also associated with the composite end point (hazard ratio, 2.12; 95% CI, 1.65-2.72; P<0.001).

conclusionsIn patients with preexisting heart failure, subclinical hypothyroidism with TSH ≥7 mIU/L and isolated low T3 levels are associated with poor prognosis. Clinical trials are needed to explore therapeutic effects of T4 and T3 administration in heart failure.

Indexed as

AdultAgedAsymptomatic DiseasesBiomarkersComorbidityFemaleHeart FailureHumansHypothyroidismMaleMiddle AgedPrevalencePrognosisProspective StudiesRisk FactorsSeverity of Illness IndexBiomarkersThyrotropinThyroxineTriiodothyronineatrial fibrillationeuthyroid sick syndromesheart failureheart transplantationhypothyroidismthyroid diseases

Identifiers

PMID30562095
PMCPMC6352308
OpenAlexW2904496087

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.