ArticleFrontiers in endocrinology2026
Thyroid dysfunction and risk of atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy: a multicenter cohort study.
Article in Frontiers in endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Atrial fibrillation (AF) is a common and clinically important arrhythmia in patients with hypertrophic obstructive cardiomyopathy (HOCM). Thyroid dysfunction influences atrial electrophysiology and remodeling; however, its association with AF in HOCM remains poorly defined. Methods: We retrospectively analyzed 755 consecutive patients with HOCM (mean age 48.65 ± 14.12 years; 60.0% male) from three tertiary centers (2019-2024). Patients were categorized by thyroid-stimulating hormone (TSH) levels as <0.55, 0.55-2.49 (reference), 2.50-9.99, and ≥10.00 mIU/L. Multivariable logistic regression and restricted cubic spline analyses were performed. Supplementary Cox proportional hazards regression was performed as a sensitivity analysis using exact event timing. Results: During 12-month follow-up, 107 patients developed incident AF (cumulative incidence, 14.2%). After multivariable adjustment, elevated TSH was independently associated with AF (TSH 2.50-9.99 mIU/L: OR 1.981, 95% CI 1.126-3.512; TSH ≥10.00 mIU/L: OR 4.306, 95% CI 1.061-17.485). Supplementary Cox regression yielded consistent results (TSH 2.50-9.99 mIU/L: HR 1.824, 95% CI 1.087-3.061; TSH ≥10.00 mIU/L: HR 3.685, 95% CI 1.018-13.337). Restricted cubic spline analysis demonstrated a U-shaped association between TSH and AF risk. Conclusions: In this multicenter retrospective cohort of patients with HOCM, both subclinical and overt hypothyroidism were associated with a higher risk of incident AF. Our findings indicate that thyroid function status may be associated with AF risk and could potentially contribute to risk stratification; prospective interventional studies are warranted to determine whether thyroid optimization can reduce AF risk.
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