Body mass index and the development of amiodarone-induced thyrotoxicosis in adults with congenital heart disease - A cohort study

Marius N. Stan, Naser M. Ammash, Carole A. Warnes, Michael D. Brennan, Prabin Thapa, Michael R. Nannenga, Rebecca S. Bahn

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Introduction: Amiodarone-induced thyrotoxicosis (AIT) is a recognized complication of amiodarone treatment with limited management options. Its predisposing factors are incompletely defined yet a higher prevalence was reported in adults with congenital heart disease (CHD). Therefore we sought to determine the incidence and risk factors for AIT in adults with CHD. Methods: At a tertiary care center we followed a historical cohort of amiodarone-treated CHD patients for the period 1987-2009. Follow-up concluded at AIT diagnosis or with last thyroid assessment on amiodarone. Cumulative incidence of AIT was calculated. AIT association with nutritional status was hypothesized a priori. Results: AIT developed in 23/169 patients or 13.6%. The AIT incidence peaked in the 3rd year at 7.7%. AIT patients had a lower body mass index (BMI) at AMIO initiation compared with the rest of the cohort (mean ± standard deviation: 21.9 ± 2.9 vs. 25.1 ± 5.0; p < 0.001). Patients with BMI < 21 were more likely to develop thyrotoxicosis (RR = 6.1) compared to those with BMI > 25 (p < 0.001). Presence of goiter was strongly associated with AIT (RR 3.6, p = 0.002). Affected patients had a trend for higher cyanotic heart disease prevalence (34.8% vs. 17.8%, p = 0.059). On multivariate analysis body mass index and goiter remained independent predictors of outcome. Conclusions: BMI < 21 at initiation of amiodarone therapy and presence of goiter are strong predictors of AIT in this population. Its incidence is time dependent. These predictors can be used clinically in assessing overall impact of amiodarone therapy in congenital heart disease patients.

Original languageEnglish (US)
Pages (from-to)821-826
Number of pages6
JournalInternational Journal of Cardiology
Volume167
Issue number3
DOIs
StatePublished - Aug 10 2013

Fingerprint

Thyrotoxicosis
Amiodarone
Heart Diseases
Body Mass Index
Cohort Studies
Goiter
Incidence
Nutritional Status
Tertiary Care Centers
Causality

Keywords

  • Amiodarone
  • Body mass index
  • Congenital heart defects
  • Cyanosis
  • Drug toxicity
  • Hyperthyroidism

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Body mass index and the development of amiodarone-induced thyrotoxicosis in adults with congenital heart disease - A cohort study. / Stan, Marius N.; Ammash, Naser M.; Warnes, Carole A.; Brennan, Michael D.; Thapa, Prabin; Nannenga, Michael R.; Bahn, Rebecca S.

In: International Journal of Cardiology, Vol. 167, No. 3, 10.08.2013, p. 821-826.

Research output: Contribution to journalArticle

Stan, Marius N. ; Ammash, Naser M. ; Warnes, Carole A. ; Brennan, Michael D. ; Thapa, Prabin ; Nannenga, Michael R. ; Bahn, Rebecca S. / Body mass index and the development of amiodarone-induced thyrotoxicosis in adults with congenital heart disease - A cohort study. In: International Journal of Cardiology. 2013 ; Vol. 167, No. 3. pp. 821-826.
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abstract = "Introduction: Amiodarone-induced thyrotoxicosis (AIT) is a recognized complication of amiodarone treatment with limited management options. Its predisposing factors are incompletely defined yet a higher prevalence was reported in adults with congenital heart disease (CHD). Therefore we sought to determine the incidence and risk factors for AIT in adults with CHD. Methods: At a tertiary care center we followed a historical cohort of amiodarone-treated CHD patients for the period 1987-2009. Follow-up concluded at AIT diagnosis or with last thyroid assessment on amiodarone. Cumulative incidence of AIT was calculated. AIT association with nutritional status was hypothesized a priori. Results: AIT developed in 23/169 patients or 13.6{\%}. The AIT incidence peaked in the 3rd year at 7.7{\%}. AIT patients had a lower body mass index (BMI) at AMIO initiation compared with the rest of the cohort (mean ± standard deviation: 21.9 ± 2.9 vs. 25.1 ± 5.0; p < 0.001). Patients with BMI < 21 were more likely to develop thyrotoxicosis (RR = 6.1) compared to those with BMI > 25 (p < 0.001). Presence of goiter was strongly associated with AIT (RR 3.6, p = 0.002). Affected patients had a trend for higher cyanotic heart disease prevalence (34.8{\%} vs. 17.8{\%}, p = 0.059). On multivariate analysis body mass index and goiter remained independent predictors of outcome. Conclusions: BMI < 21 at initiation of amiodarone therapy and presence of goiter are strong predictors of AIT in this population. Its incidence is time dependent. These predictors can be used clinically in assessing overall impact of amiodarone therapy in congenital heart disease patients.",
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AU - Stan, Marius N.

AU - Ammash, Naser M.

AU - Warnes, Carole A.

AU - Brennan, Michael D.

AU - Thapa, Prabin

AU - Nannenga, Michael R.

AU - Bahn, Rebecca S.

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N2 - Introduction: Amiodarone-induced thyrotoxicosis (AIT) is a recognized complication of amiodarone treatment with limited management options. Its predisposing factors are incompletely defined yet a higher prevalence was reported in adults with congenital heart disease (CHD). Therefore we sought to determine the incidence and risk factors for AIT in adults with CHD. Methods: At a tertiary care center we followed a historical cohort of amiodarone-treated CHD patients for the period 1987-2009. Follow-up concluded at AIT diagnosis or with last thyroid assessment on amiodarone. Cumulative incidence of AIT was calculated. AIT association with nutritional status was hypothesized a priori. Results: AIT developed in 23/169 patients or 13.6%. The AIT incidence peaked in the 3rd year at 7.7%. AIT patients had a lower body mass index (BMI) at AMIO initiation compared with the rest of the cohort (mean ± standard deviation: 21.9 ± 2.9 vs. 25.1 ± 5.0; p < 0.001). Patients with BMI < 21 were more likely to develop thyrotoxicosis (RR = 6.1) compared to those with BMI > 25 (p < 0.001). Presence of goiter was strongly associated with AIT (RR 3.6, p = 0.002). Affected patients had a trend for higher cyanotic heart disease prevalence (34.8% vs. 17.8%, p = 0.059). On multivariate analysis body mass index and goiter remained independent predictors of outcome. Conclusions: BMI < 21 at initiation of amiodarone therapy and presence of goiter are strong predictors of AIT in this population. Its incidence is time dependent. These predictors can be used clinically in assessing overall impact of amiodarone therapy in congenital heart disease patients.

AB - Introduction: Amiodarone-induced thyrotoxicosis (AIT) is a recognized complication of amiodarone treatment with limited management options. Its predisposing factors are incompletely defined yet a higher prevalence was reported in adults with congenital heart disease (CHD). Therefore we sought to determine the incidence and risk factors for AIT in adults with CHD. Methods: At a tertiary care center we followed a historical cohort of amiodarone-treated CHD patients for the period 1987-2009. Follow-up concluded at AIT diagnosis or with last thyroid assessment on amiodarone. Cumulative incidence of AIT was calculated. AIT association with nutritional status was hypothesized a priori. Results: AIT developed in 23/169 patients or 13.6%. The AIT incidence peaked in the 3rd year at 7.7%. AIT patients had a lower body mass index (BMI) at AMIO initiation compared with the rest of the cohort (mean ± standard deviation: 21.9 ± 2.9 vs. 25.1 ± 5.0; p < 0.001). Patients with BMI < 21 were more likely to develop thyrotoxicosis (RR = 6.1) compared to those with BMI > 25 (p < 0.001). Presence of goiter was strongly associated with AIT (RR 3.6, p = 0.002). Affected patients had a trend for higher cyanotic heart disease prevalence (34.8% vs. 17.8%, p = 0.059). On multivariate analysis body mass index and goiter remained independent predictors of outcome. Conclusions: BMI < 21 at initiation of amiodarone therapy and presence of goiter are strong predictors of AIT in this population. Its incidence is time dependent. These predictors can be used clinically in assessing overall impact of amiodarone therapy in congenital heart disease patients.

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