Clinical, pathogenetic, and diagnostic features of heart failure in patients with coronary heart disease and thyrotoxicosis

Aim. To assess the diagnostic significance of chronic heart failure (CHF) criteria and to study the features of structural and functional remodeling of the left heart in patients with coronary artery disease (CAD) and thyrotoxicosis.Material and methods. We examined 131 patients aged 45-65 years with CAD, CHF and/or thyrotoxicosis. The clinical state of patients, exercise tolerance, NT-proBNP level were evaluated. Holter ECG monitoring and Doppler echocardiography (echo) were performed.Results. Heart rhythm disturbances (atrial fibrillation, sinus tachycardia, supraventricular extrasystole), more severe vegetative imbalance with sympathetic predominance in patients with CAD, CHF and thyrotoxicosis were determined moreoften than in patients with CAD and CHF without thyrotoxicosis. Elevated levels of NT-proBNP (more than 125 pg/ml) were found in both patients with CHF and patients with thyrotoxicosis, regardless of the presence of cardiovascular disease. NT-proBNP levels in patients with CAD and thyrotoxicosis without CHF has exceeded the threshold value of 2,8 times (p=0,001). The highest level of NT-proBNP was found in patients with CAD, CHF and thyrotoxicosis. A higher threshold value of NT-proBNP (556,4 pg/ml according to the results of this study) in HFpEF and HFmrEF patients with CAD and thyrotoxicosis was determined. Analysis of echo parameters in patients with CAD, CHF and thyrotoxicosis revealed significantly lower values of linear and volumetric LV parameters, type I LV diastolic dysfunction(100%), HFmrEF (48%), more frequent occurrence of LV concentric hypertrophy (84%).Conclusion. For HF diagnosis in patients with CAD and thyrotoxicosis, it is necessary to take into account the clinical features, heart rate variability, LV remodeling, as well as to use a higher threshold level of NT-proBNP