Acute type A aortic dissection combined low total triiodothyronine 3 level affects postoperative serum creatinine_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIANG Wenjian , XU Hao ,  ZHANG Hongjia

Department of Cardiac Surgery, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P.R.China;

Corresponding author：

ZHANG Hongjia, Email: zhanghongjia722@ccmu.edu.cn

Keywords：

Thyroid hormones; acute type A aortic dissection; acute kidney injury; serum creatinine

DOI：

10.7507/1007-4848.201909040

Video：

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Objective To analyze the thyroid hormone levels in patients with acute type A aortic dissection (ATAAD) and assess its clinical significance.Methods We included 88 patients with ATAAD who underwent surgical treatment in Beijing Anzhen Hospital between January 2018 and August 2018. Meanwhile, we extracted 187 blood samples of healthy people from our laboratory (Beijing Lab for Cardiovascular Precision Medicine, Beijing, China) as control group. Examining preoperative thyroid hormone levels and perioperative serum creatine for patients and examining thyroid hormone levels for healthy people. Based on difference in thyroid hormone levels between patients and healthy people, we divide patients into abnormal thyroid hormone groups and control groups, analyzing the relationship between thyroid hormone levels and variance of postoperative serum creatinine.Results Patients with ATAAD have lower total triiodothyronine (TT3), thyrotropin (TSH), free triiodothyronine (FT3) and higher free thyroxine (FT4) levels than healthy people (respectively, P<0.001, P<0.001, P<0.001 and P<0.001). What’s more, patients with ATAAD who had low TT3 before operation had higher elevation of postoperative serum creatinine and rate of acute kidney injury(P=0.019).CONCLUSIONS Patients with ATAAD have different thyroid hormone levels than healthy people, preoperative TT3 is associated with elevation of postoperative serum creatinine and occurrence of acute kidney injury. Thyroid function measurement should be a routine preoperative examination in patients with ATAAD.

1.	Bello G1, Ceaichisciuc I, Silva S, et al. The role of thyroid dysfunction in the critically ill: a review of the literature. Minerva Anestesiol, 2010, 76(11): 919-928.
2.	Iervasi G1, Pingitore A, Landi P, et al. Low-T3 syndrome: a strong prognostic predictor of death in patients with heart disease. Circulation, 2003, 107(5): 708-713.
3.	Mitchell JE, Hellkamp AS, Mark DB, et al. Thyroid function in heart failure and impact on mortality. JACC Heart Fail, 2013, 1(1): 48-55.
4.	Qiu Z, Chen L, Cao H, et al. Analysis of risk factors for acute kidney injury after ascending aortic replacement combined with open placement of triple-branched stent graft in type A aortic dissection: a new technique versus the traditional method in a single Chinese center. Med Sci Monit, 2015, 21: 674-680.
5.	Sasabuchi Y, Kimura N, Shiotsuka J, et al. Long-term survival in patients with acute kidney injury after acute type a aortic dissection repair. Ann Thorac Surg, 2016, 102(6): 2003-2009.
6.	Lassnigg A, Schmidlin D, Mouhieddine M, et al. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol, 2004, 15(6): 1597-1605.
7.	Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care, 2007, 11(2): R31.
8.	Silaschi M, Byrne J, Wendler O. Aortic dissection: medical, interventional and surgical management. Heart, 2017, 103(1): 78-87.
9.	Chopra IJ, Solomon DH, Teco GN, et al. An inhibitor of the binding of thyroid hormones to serum proteins is present in extrathyroidal tissues. Science, 1982, 215(4531): 407-409.
10.	Kreisman SH, Hennessey JV. Consistent reversible elevations of serum creatinine levels in severe hypothyroidism. Arch Intern Med, 1999, 159(1): 79-82.
11.	Joo EY, Kim YJ, Go Y, et al. Relationship between perioperative thyroid function and acute kidney injury after thyroidectomy. Sci Rep, 2018, 8(1): 13539.
12.	Kannan L, Shaw PA, Morley MP, et al. Thyroid dysfunction in heart failure and cardiovascular outcomes. Circ Heart Fail, 2018, 11(12): e005266.
13.	Gutierrez PS, Pereira MA, Oliveira RC. Thyroid hormone levels in patients with aortic dissection: comparison with controls and correlation with the percentage of the aortic media composed of myxoid deposits. Arq Bras Cardiol, 2004, 82(2): 134-138.
14.	Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. N Engl J Med, 2001, 344(7): 501-509.
15.	Mariani LH, Berns JS. The renal manifestations of thyroid disease. J Am Soc Nephrol, 2012, 23(1): 22-26.
16.	Pingitore A, Galli E, Barison A, et al. Acute effects of triiodothyronine (T3) replacement therapy in patients with chronic heart failure and low-T3 syndrome: a randomized, placebo-controlled study. J Clin Endocrinol Metab, 2008, 93(4): 1351-1358.
17.	Chen Y, Ma WG, Zhi AH, et al. Fate of distal aorta after frozen elephant trunk and total arch replacement for type A aortic dissection in Marfan syndrome. J Thorac Cardiovasc Surg, 2018.
18.	Klemperer JD, Klein I, Gomez M, et al. Thyroid hormone treatment after coronary-artery bypass surgery. N Engl J Med, 1995, 333(23): 1522-1527.
19.	Bennett-Guerrero E, Jimenez JL, White WD, et al. Cardiovascular effects of intravenous triiodothyronine in patients undergoing coronary artery bypass graft surgery. A randomized, double-blind, placebo-controlled trial. Duke T3 study group. JAMA, 1996, 275(9): 687-692.
20.	Duranton F, Lacoste A, Faurous P, et al. Exogenous thyrotropin improves renal function in euthyroid patients, while serum creatinine levels are increased in hypothyroidism. Clin Kidney J, 2013, 6(5): 478-483.
21.	Lu Y, Guo H, Liu D, et al. Preservation of renal function by thyroid hormone replacement in elderly persons with subclinical hypothyroidism. Arch Med Sci, 2016, 12(4): 772-777.

1. Bello G1, Ceaichisciuc I, Silva S, et al. The role of thyroid dysfunction in the critically ill: a review of the literature. Minerva Anestesiol, 2010, 76(11): 919-928.
2. Iervasi G1, Pingitore A, Landi P, et al. Low-T3 syndrome: a strong prognostic predictor of death in patients with heart disease. Circulation, 2003, 107(5): 708-713.
3. Mitchell JE, Hellkamp AS, Mark DB, et al. Thyroid function in heart failure and impact on mortality. JACC Heart Fail, 2013, 1(1): 48-55.
4. Qiu Z, Chen L, Cao H, et al. Analysis of risk factors for acute kidney injury after ascending aortic replacement combined with open placement of triple-branched stent graft in type A aortic dissection: a new technique versus the traditional method in a single Chinese center. Med Sci Monit, 2015, 21: 674-680.
5. Sasabuchi Y, Kimura N, Shiotsuka J, et al. Long-term survival in patients with acute kidney injury after acute type a aortic dissection repair. Ann Thorac Surg, 2016, 102(6): 2003-2009.
6. Lassnigg A, Schmidlin D, Mouhieddine M, et al. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol, 2004, 15(6): 1597-1605.
7. Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care, 2007, 11(2): R31.
8. Silaschi M, Byrne J, Wendler O. Aortic dissection: medical, interventional and surgical management. Heart, 2017, 103(1): 78-87.
9. Chopra IJ, Solomon DH, Teco GN, et al. An inhibitor of the binding of thyroid hormones to serum proteins is present in extrathyroidal tissues. Science, 1982, 215(4531): 407-409.
10. Kreisman SH, Hennessey JV. Consistent reversible elevations of serum creatinine levels in severe hypothyroidism. Arch Intern Med, 1999, 159(1): 79-82.
11. Joo EY, Kim YJ, Go Y, et al. Relationship between perioperative thyroid function and acute kidney injury after thyroidectomy. Sci Rep, 2018, 8(1): 13539.
12. Kannan L, Shaw PA, Morley MP, et al. Thyroid dysfunction in heart failure and cardiovascular outcomes. Circ Heart Fail, 2018, 11(12): e005266.
13. Gutierrez PS, Pereira MA, Oliveira RC. Thyroid hormone levels in patients with aortic dissection: comparison with controls and correlation with the percentage of the aortic media composed of myxoid deposits. Arq Bras Cardiol, 2004, 82(2): 134-138.
14. Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. N Engl J Med, 2001, 344(7): 501-509.
15. Mariani LH, Berns JS. The renal manifestations of thyroid disease. J Am Soc Nephrol, 2012, 23(1): 22-26.
16. Pingitore A, Galli E, Barison A, et al. Acute effects of triiodothyronine (T3) replacement therapy in patients with chronic heart failure and low-T3 syndrome: a randomized, placebo-controlled study. J Clin Endocrinol Metab, 2008, 93(4): 1351-1358.
17. Chen Y, Ma WG, Zhi AH, et al. Fate of distal aorta after frozen elephant trunk and total arch replacement for type A aortic dissection in Marfan syndrome. J Thorac Cardiovasc Surg, 2018.
18. Klemperer JD, Klein I, Gomez M, et al. Thyroid hormone treatment after coronary-artery bypass surgery. N Engl J Med, 1995, 333(23): 1522-1527.
19. Bennett-Guerrero E, Jimenez JL, White WD, et al. Cardiovascular effects of intravenous triiodothyronine in patients undergoing coronary artery bypass graft surgery. A randomized, double-blind, placebo-controlled trial. Duke T3 study group. JAMA, 1996, 275(9): 687-692.
20. Duranton F, Lacoste A, Faurous P, et al. Exogenous thyrotropin improves renal function in euthyroid patients, while serum creatinine levels are increased in hypothyroidism. Clin Kidney J, 2013, 6(5): 478-483.
21. Lu Y, Guo H, Liu D, et al. Preservation of renal function by thyroid hormone replacement in elderly persons with subclinical hypothyroidism. Arch Med Sci, 2016, 12(4): 772-777.

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