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Article: Amiodarone-induced thyrotoxicosis is a predictor of adverse cardiovascular outcome

TitleAmiodarone-induced thyrotoxicosis is a predictor of adverse cardiovascular outcome
Authors
Issue Date2009
PublisherThe Endocrine Society. The Journal's web site is located at http://jcem.endojournals.org
Citation
Journal Of Clinical Endocrinology And Metabolism, 2009, v. 94 n. 1, p. 109-114 How to Cite?
AbstractBackground: Amiodarone-induced thyrotoxicosis (AIT) is a clinical condition that is notoriously difficult to manage; the relative risk of adverse cardiovascular events in these patients compared with euthyroid patients is largely unknown. Objective: We compared the clinical characteristics and major adverse cardiovascular events (MACE) in AIT and euthyroid patients. Method: Patients at a tertiary referral center who had been prescribed amiodarone for at least 3 months were retrospectively analyzed. Baseline clinical characteristics, laboratory parameters, and outcome events were evaluated. MACE was defined as cardiovascular mortality, myocardial infarction, stroke and heart failure, or ventricular arrhythmias that required hospitalization. Results: A total of 354 patients (61.8 ± 14.1 yr; 64.7% male) with a mean follow-up of 48.6 ± 26.7 months were studied. AIT, euthyroid status, and amiodarone-induced hypothyroidism were identified in 57 (16.1%), 224 (63.3%), and 73 (20.6%) patients, respectively. No differences in baseline clinical characteristics were observed between AIT and euthyroid patients. Nonetheless AIT patients demonstrated a higher MACE rate (31.6 vs. 10.7%, P < 0.01), mostly driven by a higher rate of ventricular arrhythmias that required admission (7.0 vs. 1.3%, P = 0.03). Cox-regression multivariate analysis revealed that AIT (hazard ratio 2.68; confidence interval 1.53-4.68; P < 0.01) and left ventricular ejection fraction less than 45% (hazard ratio 2.52; confidence interval 1.43-4.42; P < 0.01) were independent predictors of MACE. Conclusion: In patients prescribed long-term amiodarone therapy, occurrence of AIT is associated with a 2.7-fold increased risk of MACE. Regular and close biochemical surveillance is thus advisable to identify and treat this high-risk group of patients. Copyright © 2009 by The Endocrine Society.
Persistent Identifierhttp://hdl.handle.net/10722/163222
ISSN
2015 Impact Factor: 5.531
2015 SCImago Journal Rankings: 2.940
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorYiu, KHen_US
dc.contributor.authorJim, MHen_US
dc.contributor.authorSiu, CWen_US
dc.contributor.authorLee, CHen_US
dc.contributor.authorYuen, Men_US
dc.contributor.authorMok, Men_US
dc.contributor.authorShea, YFen_US
dc.contributor.authorFan, Ken_US
dc.contributor.authorTse, HFen_US
dc.contributor.authorChow, WHen_US
dc.date.accessioned2012-09-05T05:28:54Z-
dc.date.available2012-09-05T05:28:54Z-
dc.date.issued2009en_US
dc.identifier.citationJournal Of Clinical Endocrinology And Metabolism, 2009, v. 94 n. 1, p. 109-114en_US
dc.identifier.issn0021-972Xen_US
dc.identifier.urihttp://hdl.handle.net/10722/163222-
dc.description.abstractBackground: Amiodarone-induced thyrotoxicosis (AIT) is a clinical condition that is notoriously difficult to manage; the relative risk of adverse cardiovascular events in these patients compared with euthyroid patients is largely unknown. Objective: We compared the clinical characteristics and major adverse cardiovascular events (MACE) in AIT and euthyroid patients. Method: Patients at a tertiary referral center who had been prescribed amiodarone for at least 3 months were retrospectively analyzed. Baseline clinical characteristics, laboratory parameters, and outcome events were evaluated. MACE was defined as cardiovascular mortality, myocardial infarction, stroke and heart failure, or ventricular arrhythmias that required hospitalization. Results: A total of 354 patients (61.8 ± 14.1 yr; 64.7% male) with a mean follow-up of 48.6 ± 26.7 months were studied. AIT, euthyroid status, and amiodarone-induced hypothyroidism were identified in 57 (16.1%), 224 (63.3%), and 73 (20.6%) patients, respectively. No differences in baseline clinical characteristics were observed between AIT and euthyroid patients. Nonetheless AIT patients demonstrated a higher MACE rate (31.6 vs. 10.7%, P < 0.01), mostly driven by a higher rate of ventricular arrhythmias that required admission (7.0 vs. 1.3%, P = 0.03). Cox-regression multivariate analysis revealed that AIT (hazard ratio 2.68; confidence interval 1.53-4.68; P < 0.01) and left ventricular ejection fraction less than 45% (hazard ratio 2.52; confidence interval 1.43-4.42; P < 0.01) were independent predictors of MACE. Conclusion: In patients prescribed long-term amiodarone therapy, occurrence of AIT is associated with a 2.7-fold increased risk of MACE. Regular and close biochemical surveillance is thus advisable to identify and treat this high-risk group of patients. Copyright © 2009 by The Endocrine Society.en_US
dc.languageengen_US
dc.publisherThe Endocrine Society. The Journal's web site is located at http://jcem.endojournals.orgen_US
dc.relation.ispartofJournal of Clinical Endocrinology and Metabolismen_US
dc.rightsJournal of Clinical Endocrinology and Metabolism. Copyright © The Endocrine Society.-
dc.subject.meshAdulten_US
dc.subject.meshAgeden_US
dc.subject.meshAmiodarone - Adverse Effectsen_US
dc.subject.meshAnti-Arrhythmia Agents - Adverse Effectsen_US
dc.subject.meshCardiovascular Diseases - Mortalityen_US
dc.subject.meshFemaleen_US
dc.subject.meshHumansen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshMultivariate Analysisen_US
dc.subject.meshRetrospective Studiesen_US
dc.subject.meshThyrotoxicosis - Chemically Induceden_US
dc.subject.meshVentricular Function, Left - Drug Effectsen_US
dc.titleAmiodarone-induced thyrotoxicosis is a predictor of adverse cardiovascular outcomeen_US
dc.typeArticleen_US
dc.identifier.emailYiu, KH:khkyiu@hku.hken_US
dc.identifier.emailSiu, CW:cwdsiu@hkucc.hku.hken_US
dc.identifier.emailTse, HF:hftse@hkucc.hku.hken_US
dc.identifier.authorityYiu, KH=rp01490en_US
dc.identifier.authoritySiu, CW=rp00534en_US
dc.identifier.authorityTse, HF=rp00428en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1210/jc.2008-1907en_US
dc.identifier.pmid18940876-
dc.identifier.scopuseid_2-s2.0-58149396249en_US
dc.identifier.hkuros153471-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-58149396249&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume94en_US
dc.identifier.issue1en_US
dc.identifier.spage109en_US
dc.identifier.epage114en_US
dc.identifier.eissn1945-7197-
dc.identifier.isiWOS:000262260200019-
dc.publisher.placeUnited Statesen_US
dc.identifier.f10001145195-
dc.identifier.scopusauthoridYiu, KH=35172267800en_US
dc.identifier.scopusauthoridJim, MH=6603860344en_US
dc.identifier.scopusauthoridSiu, CW=7006550690en_US
dc.identifier.scopusauthoridLee, CH=8087416700en_US
dc.identifier.scopusauthoridYuen, M=36719452400en_US
dc.identifier.scopusauthoridMok, M=25951401500en_US
dc.identifier.scopusauthoridShea, YF=54892629000en_US
dc.identifier.scopusauthoridFan, K=7202978353en_US
dc.identifier.scopusauthoridTse, HF=7006070805en_US
dc.identifier.scopusauthoridChow, WH=7402281062en_US

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