Abnormal Left Ventricular Function in Hyperthyroidism: Evidence for a Possible Reversible Cardiomyopathy
We assessed the effects of exercise and beta-adrenoceptor blockade on left ventricular ejection fraction (LVEF) measured by radionuclide ventriculography in nine patients with uncomplicated hyperthyroidism. Patients were studied in both the hyperthyroid and euthyroid states. The hyperthyroid state w...
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| Veröffentlicht in: | The New England journal of medicine 1982-11, Vol.307 (19), p.1165-1170 |
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| creator | Forfar, John Colin Muir, Alexander Laird Sawers, Stewart Allison Toft, Anthony Douglas |
| description | We assessed the effects of exercise and beta-adrenoceptor blockade on left ventricular ejection fraction (LVEF) measured by radionuclide ventriculography in nine patients with uncomplicated hyperthyroidism. Patients were studied in both the hyperthyroid and euthyroid states. The hyperthyroid state was characterized by a high LVEF at rest but — paradoxically — by a significant fall (P |
| doi_str_mv | 10.1056/NEJM198211043071901 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_74217269</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>74217269</sourcerecordid><originalsourceid>FETCH-LOGICAL-c403t-c62e08fcd3998a1f752599d9398f5fac2d7e3bae57c8c81e5d61a5957af00a513</originalsourceid><addsrcrecordid>eNp9kE1LAzEQhoMotVZ_gQgLghdZzeRjkxyLVKtUvajXkGazuGWTrcnuof_eLS0eRJzLHOZ5X4YHoXPAN4B5cfsye3oGJQkAZhQLUBgO0Bg4pTljuDhEY4yJzJlQ9BidpLTCwwBTIzQSQIAzNkZ8ugxt9KbJFq7qsg8XuljbvjExu--D7eo2ZHXI5pu1i93nJrZ1WSd_io4q0yR3tt8T9H4_e7ub54vXh8e76SK3DNMutwVxWFa2pEpJA5XghCtVKqpkxStjSSkcXRrHhZVWguNlAYYrLkyFseFAJ-hq17uO7VfvUqd9naxrGhNc2yctGAFBCjWAl7_AVdvHMPymQQrG6OBgS9EdZWObUnSVXsfam7jRgPVWqf5D6ZC62Hf3S-_Kn8ze4XC_3t29Tzq4lf-37RviK3v7</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1874437939</pqid></control><display><type>article</type><title>Abnormal Left Ventricular Function in Hyperthyroidism: Evidence for a Possible Reversible Cardiomyopathy</title><source>MEDLINE</source><source>ProQuest Central UK/Ireland</source><creator>Forfar, John Colin ; Muir, Alexander Laird ; Sawers, Stewart Allison ; Toft, Anthony Douglas</creator><creatorcontrib>Forfar, John Colin ; Muir, Alexander Laird ; Sawers, Stewart Allison ; Toft, Anthony Douglas</creatorcontrib><description>We assessed the effects of exercise and beta-adrenoceptor blockade on left ventricular ejection fraction (LVEF) measured by radionuclide ventriculography in nine patients with uncomplicated hyperthyroidism. Patients were studied in both the hyperthyroid and euthyroid states. The hyperthyroid state was characterized by a high LVEF at rest but — paradoxically — by a significant fall (P<0.01) in LVEF during exercise. At the same workload and at the same heart rate, patients had a restoration of the normal rise in LVEF during exercise when they were euthyroid. The LVEF was greater during exercise (P<0.02) when the patients were euthyroid than when they were hyperthyroid.
Pretreatment with propranolol caused similar reductions in resting LVEF in the hyperthyroid and euthyroid states; the drug attenuated the rise in LVEF during exercise when the patients were euthyroid, but did not influence the exercise-induced reduction in LVEF in hyperthyroidism.
The abnormal left ventricular function observed during exercise in hyperthyroidism suggests a reversible functional cardiomyopathy, independent of beta-adrenoceptor activation, that is presumably a direct effect of an excess in circulating thyroid hormones. (N Engl J Med. 1982; 307:1165–70.)
The mechanism of altered myocardial function in hyperthyroidism has been the subject of clinical and experimental investigation over several decades.
1
Despite the striking similarities between the effects of excessive circulating thyroid hormones and those of enhanced sympathoadrenal activity, recent investigations have failed to demonstrate adrenergic hypersensitivity or excess circulating catecholamines in hyperthyroid states.
2
3
4
5
However, the demonstrations of increased beta-adrenoceptor density in the hearts of hyperthyroid animals
6
and of augmented cyclic AMP responses to hypoglycemia in hyperthyroid patients
7
suggest the possibility of increased catecholamine responsiveness in this condition.
Nonspecific cardiac symptoms such as fatigue and dyspnea on exertion are common in . . .</description><identifier>ISSN: 0028-4793</identifier><identifier>EISSN: 1533-4406</identifier><identifier>DOI: 10.1056/NEJM198211043071901</identifier><identifier>PMID: 7121544</identifier><language>eng</language><publisher>United States: Massachusetts Medical Society</publisher><subject>Adrenergic receptors ; Adult ; Blood Pressure ; Cardiac Output ; Cardiology ; Cardiomyopathies - etiology ; Cardiomyopathy ; Female ; Heart - physiopathology ; Heart failure ; Heart Rate ; Heart Ventricles - diagnostic imaging ; Humans ; Hyperthyroidism ; Hyperthyroidism - complications ; Hyperthyroidism - physiopathology ; Male ; Middle Aged ; Patients ; Physical Exertion ; Physical training ; Plasma ; Propranolol ; Propranolol - pharmacology ; Radionuclide Imaging ; Space life sciences ; Stroke Volume ; Thyroid diseases ; Thyroid hormones ; Ventricle ; Workloads</subject><ispartof>The New England journal of medicine, 1982-11, Vol.307 (19), p.1165-1170</ispartof><rights>Copyright Massachusetts Medical Society Nov 4, 1982</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c403t-c62e08fcd3998a1f752599d9398f5fac2d7e3bae57c8c81e5d61a5957af00a513</citedby><cites>FETCH-LOGICAL-c403t-c62e08fcd3998a1f752599d9398f5fac2d7e3bae57c8c81e5d61a5957af00a513</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1874437939?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/7121544$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Forfar, John Colin</creatorcontrib><creatorcontrib>Muir, Alexander Laird</creatorcontrib><creatorcontrib>Sawers, Stewart Allison</creatorcontrib><creatorcontrib>Toft, Anthony Douglas</creatorcontrib><title>Abnormal Left Ventricular Function in Hyperthyroidism: Evidence for a Possible Reversible Cardiomyopathy</title><title>The New England journal of medicine</title><addtitle>N Engl J Med</addtitle><description>We assessed the effects of exercise and beta-adrenoceptor blockade on left ventricular ejection fraction (LVEF) measured by radionuclide ventriculography in nine patients with uncomplicated hyperthyroidism. Patients were studied in both the hyperthyroid and euthyroid states. The hyperthyroid state was characterized by a high LVEF at rest but — paradoxically — by a significant fall (P<0.01) in LVEF during exercise. At the same workload and at the same heart rate, patients had a restoration of the normal rise in LVEF during exercise when they were euthyroid. The LVEF was greater during exercise (P<0.02) when the patients were euthyroid than when they were hyperthyroid.
Pretreatment with propranolol caused similar reductions in resting LVEF in the hyperthyroid and euthyroid states; the drug attenuated the rise in LVEF during exercise when the patients were euthyroid, but did not influence the exercise-induced reduction in LVEF in hyperthyroidism.
The abnormal left ventricular function observed during exercise in hyperthyroidism suggests a reversible functional cardiomyopathy, independent of beta-adrenoceptor activation, that is presumably a direct effect of an excess in circulating thyroid hormones. (N Engl J Med. 1982; 307:1165–70.)
The mechanism of altered myocardial function in hyperthyroidism has been the subject of clinical and experimental investigation over several decades.
1
Despite the striking similarities between the effects of excessive circulating thyroid hormones and those of enhanced sympathoadrenal activity, recent investigations have failed to demonstrate adrenergic hypersensitivity or excess circulating catecholamines in hyperthyroid states.
2
3
4
5
However, the demonstrations of increased beta-adrenoceptor density in the hearts of hyperthyroid animals
6
and of augmented cyclic AMP responses to hypoglycemia in hyperthyroid patients
7
suggest the possibility of increased catecholamine responsiveness in this condition.
Nonspecific cardiac symptoms such as fatigue and dyspnea on exertion are common in . . .</description><subject>Adrenergic receptors</subject><subject>Adult</subject><subject>Blood Pressure</subject><subject>Cardiac Output</subject><subject>Cardiology</subject><subject>Cardiomyopathies - etiology</subject><subject>Cardiomyopathy</subject><subject>Female</subject><subject>Heart - physiopathology</subject><subject>Heart failure</subject><subject>Heart Rate</subject><subject>Heart Ventricles - diagnostic imaging</subject><subject>Humans</subject><subject>Hyperthyroidism</subject><subject>Hyperthyroidism - complications</subject><subject>Hyperthyroidism - physiopathology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>Physical Exertion</subject><subject>Physical training</subject><subject>Plasma</subject><subject>Propranolol</subject><subject>Propranolol - pharmacology</subject><subject>Radionuclide Imaging</subject><subject>Space life sciences</subject><subject>Stroke Volume</subject><subject>Thyroid diseases</subject><subject>Thyroid hormones</subject><subject>Ventricle</subject><subject>Workloads</subject><issn>0028-4793</issn><issn>1533-4406</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1982</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kE1LAzEQhoMotVZ_gQgLghdZzeRjkxyLVKtUvajXkGazuGWTrcnuof_eLS0eRJzLHOZ5X4YHoXPAN4B5cfsye3oGJQkAZhQLUBgO0Bg4pTljuDhEY4yJzJlQ9BidpLTCwwBTIzQSQIAzNkZ8ugxt9KbJFq7qsg8XuljbvjExu--D7eo2ZHXI5pu1i93nJrZ1WSd_io4q0yR3tt8T9H4_e7ub54vXh8e76SK3DNMutwVxWFa2pEpJA5XghCtVKqpkxStjSSkcXRrHhZVWguNlAYYrLkyFseFAJ-hq17uO7VfvUqd9naxrGhNc2yctGAFBCjWAl7_AVdvHMPymQQrG6OBgS9EdZWObUnSVXsfam7jRgPVWqf5D6ZC62Hf3S-_Kn8ze4XC_3t29Tzq4lf-37RviK3v7</recordid><startdate>19821104</startdate><enddate>19821104</enddate><creator>Forfar, John Colin</creator><creator>Muir, Alexander Laird</creator><creator>Sawers, Stewart Allison</creator><creator>Toft, Anthony Douglas</creator><general>Massachusetts Medical Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0TZ</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8AO</scope><scope>8C1</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BEC</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K0Y</scope><scope>LK8</scope><scope>M0R</scope><scope>M0T</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2P</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>19821104</creationdate><title>Abnormal Left Ventricular Function in Hyperthyroidism</title><author>Forfar, John Colin ; Muir, Alexander Laird ; Sawers, Stewart Allison ; Toft, Anthony Douglas</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c403t-c62e08fcd3998a1f752599d9398f5fac2d7e3bae57c8c81e5d61a5957af00a513</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1982</creationdate><topic>Adrenergic receptors</topic><topic>Adult</topic><topic>Blood Pressure</topic><topic>Cardiac Output</topic><topic>Cardiology</topic><topic>Cardiomyopathies - etiology</topic><topic>Cardiomyopathy</topic><topic>Female</topic><topic>Heart - physiopathology</topic><topic>Heart failure</topic><topic>Heart Rate</topic><topic>Heart Ventricles - diagnostic imaging</topic><topic>Humans</topic><topic>Hyperthyroidism</topic><topic>Hyperthyroidism - complications</topic><topic>Hyperthyroidism - physiopathology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Patients</topic><topic>Physical Exertion</topic><topic>Physical training</topic><topic>Plasma</topic><topic>Propranolol</topic><topic>Propranolol - pharmacology</topic><topic>Radionuclide Imaging</topic><topic>Space life sciences</topic><topic>Stroke Volume</topic><topic>Thyroid diseases</topic><topic>Thyroid hormones</topic><topic>Ventricle</topic><topic>Workloads</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Forfar, John Colin</creatorcontrib><creatorcontrib>Muir, Alexander Laird</creatorcontrib><creatorcontrib>Sawers, Stewart Allison</creatorcontrib><creatorcontrib>Toft, Anthony Douglas</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Pharma and Biotech Premium PRO</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>eLibrary</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>New England Journal of Medicine</collection><collection>ProQuest Biological Science Collection</collection><collection>Consumer Health Database</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The New England journal of medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Forfar, John Colin</au><au>Muir, Alexander Laird</au><au>Sawers, Stewart Allison</au><au>Toft, Anthony Douglas</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Abnormal Left Ventricular Function in Hyperthyroidism: Evidence for a Possible Reversible Cardiomyopathy</atitle><jtitle>The New England journal of medicine</jtitle><addtitle>N Engl J Med</addtitle><date>1982-11-04</date><risdate>1982</risdate><volume>307</volume><issue>19</issue><spage>1165</spage><epage>1170</epage><pages>1165-1170</pages><issn>0028-4793</issn><eissn>1533-4406</eissn><abstract>We assessed the effects of exercise and beta-adrenoceptor blockade on left ventricular ejection fraction (LVEF) measured by radionuclide ventriculography in nine patients with uncomplicated hyperthyroidism. Patients were studied in both the hyperthyroid and euthyroid states. The hyperthyroid state was characterized by a high LVEF at rest but — paradoxically — by a significant fall (P<0.01) in LVEF during exercise. At the same workload and at the same heart rate, patients had a restoration of the normal rise in LVEF during exercise when they were euthyroid. The LVEF was greater during exercise (P<0.02) when the patients were euthyroid than when they were hyperthyroid.
Pretreatment with propranolol caused similar reductions in resting LVEF in the hyperthyroid and euthyroid states; the drug attenuated the rise in LVEF during exercise when the patients were euthyroid, but did not influence the exercise-induced reduction in LVEF in hyperthyroidism.
The abnormal left ventricular function observed during exercise in hyperthyroidism suggests a reversible functional cardiomyopathy, independent of beta-adrenoceptor activation, that is presumably a direct effect of an excess in circulating thyroid hormones. (N Engl J Med. 1982; 307:1165–70.)
The mechanism of altered myocardial function in hyperthyroidism has been the subject of clinical and experimental investigation over several decades.
1
Despite the striking similarities between the effects of excessive circulating thyroid hormones and those of enhanced sympathoadrenal activity, recent investigations have failed to demonstrate adrenergic hypersensitivity or excess circulating catecholamines in hyperthyroid states.
2
3
4
5
However, the demonstrations of increased beta-adrenoceptor density in the hearts of hyperthyroid animals
6
and of augmented cyclic AMP responses to hypoglycemia in hyperthyroid patients
7
suggest the possibility of increased catecholamine responsiveness in this condition.
Nonspecific cardiac symptoms such as fatigue and dyspnea on exertion are common in . . .</abstract><cop>United States</cop><pub>Massachusetts Medical Society</pub><pmid>7121544</pmid><doi>10.1056/NEJM198211043071901</doi><tpages>6</tpages></addata></record> |
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| identifier | ISSN: 0028-4793 |
| ispartof | The New England journal of medicine, 1982-11, Vol.307 (19), p.1165-1170 |
| issn | 0028-4793 1533-4406 |
| language | eng |
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| subjects | Adrenergic receptors Adult Blood Pressure Cardiac Output Cardiology Cardiomyopathies - etiology Cardiomyopathy Female Heart - physiopathology Heart failure Heart Rate Heart Ventricles - diagnostic imaging Humans Hyperthyroidism Hyperthyroidism - complications Hyperthyroidism - physiopathology Male Middle Aged Patients Physical Exertion Physical training Plasma Propranolol Propranolol - pharmacology Radionuclide Imaging Space life sciences Stroke Volume Thyroid diseases Thyroid hormones Ventricle Workloads |
| title | Abnormal Left Ventricular Function in Hyperthyroidism: Evidence for a Possible Reversible Cardiomyopathy |
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