Cardiothyreosis: Risk Factors and Clinical Profile

Abstract

Introduction: The diagnosis of cardiothyreosis is based on the presence of the association of thyrotoxicosis and various cardiovascular disorders such as heart failure, coronary artery disease, rhythm or conduction disorders. Data are limited on this entity in Africa which a frequency of 10% to 33% among hyperthyroidism. We aimed to evaluate these risk factors and describe its diagnostic features in Abass Ndao Hospital Center of Dakar. Patients and Methods: It was a descriptive and analytical cross sectional study conducted from 1 January 2010 to 31 December 2014, including all cases of hyperthyroidism with cardiothyreosis. Epidemiological data, cardiovascular risk factors and characteristics of cardiothyreosis were evaluated. Results: 150 cases of cardiothyreosis were collected with a prevalence of 9.8% among 1517 hyperthyroidism. Mean age was 42.6 ± 9 years and sex ratio 0.33. It was a Graves’ disease in 82.2% of cases. Time limit of cardiothyreosis appearance was 27 ± 41 months and cardiothyreosis was inaugural in 46.6%. Electrocardiogram showed an arrhythmia (38.7%), coronary insufficiency (8%). On echocardiography assessment, impairment of left ventricular ejection fraction (LVEF) was found in 18.5%. Of these, it was 34.7% of arrhythmia, 8.6% of coronary insufficiency and 65.2% of heart failure. Among patients with pulmonary artery hypertension (PAH) (57.3%), there were a rhythm disorder (38%), coronary insufficiency (5.6%) and heart failure (78.8%). Female gender was the only one at risk of arrhythmia (p = 0.01) and impaired of left ventricular ejection fraction (p = 0.007). Existence of a free T4 > 50 pmol/L (p = 0.05) were only at risk of developing pulmonary artery hypertension. Conclusion: Cardiothyreosis is a significant complication. These discovery methods call for more early diagnosis and appropriate treatment. Female gender and severity of thyrotoxicosis seem to precipitate the clinical picture. Echocardiography remains an indispensable tool for assessing cardiac consequences.