Efficacy and safety of Triiodothyronine (T3) treatment in Cardiac Surgery or Cardiovascular Diseases - a Systematic Review and Meta-analysis of Randomized Controlled Trials.

Tharmapoopathy, Mathuri; Thavarajah, Abishan; Kenny, Ryan Pw; Pingitore, Alessandro; Iervasi, Giorgio; Dark, John; Bano, Arjola; Razvi, Salman (2022). Efficacy and safety of Triiodothyronine (T3) treatment in Cardiac Surgery or Cardiovascular Diseases - a Systematic Review and Meta-analysis of Randomized Controlled Trials. Thyroid, 32(8), pp. 879-896. Mary Ann Liebert 10.1089/thy.2021.0609

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BACKGROUND

Low levels of the active thyroid hormone triiodothyronine (T3) in cardiac patients are associated with worse outcomes. The aim of this analysis was to assess if T3 treatment is beneficial and safe in patients undergoing cardiac surgery or those with cardiovascular diseases in whom there is observed or expected reduction in serum T3 levels.

METHODS

A systematic review and meta-analysis of randomized controlled trials (RCTs) was performed as per the PRISMA guidelines. Pubmed, Embase and Web of Science databases were searched for RCTs published between 1st January 1960 and 30th March 2022 that evaluated the effects of T3 therapy in patients undergoing cardiac surgery or with cardiovascular diseases. The primary outcomes were measures of cardiac function. Weighted mean difference (MD) or relative risk were calculated using a random effects model. PROSPERO registration no. CRD42020211966 Results: Of the 3181 full-text articles screened, 34 studies with 2547 participants (number ranging between 13 to 223, mean ages between 0.5 to 73 years, mean percentage of women between 7 to 64%) were included. In 12 RCTs with 1093 adults undergoing cardiac surgery T3 therapy was associated with improvement in cardiac index (MD [95% CI], 0.24 [0.08 to 0.40] L/min/m2, I2=74%). The quality of evidence was high to moderate. In 3 RCTs with 188 children undergoing cardiac surgery, 3 RCTs with 131 adult cardiac donors, 3 RCTs with 83 adult patients with heart failure, and 2 RCTs with 89 adults with acute myocardial infarction, T3 therapy did not improve cardiac index or left ventricular function; the quality of evidence ranged from high (paediatric cardiac surgery) to low (other groups). No detrimental effect of T3 therapy was observed on heart rate, risk of in-hospital atrial fibrillation or mortality.

CONCLUSIONS

Short-term T3 therapy is safe and trials in adults undergoing cardiac surgical procedures to evaluate longer term clinical endpoints are required. Current data does not support the routine use of T3 therapy in children undergoing cardiac surgery or in cardiac donors. Adequately designed trials are required to determine if T3 therapy improves cardiac function and clinical outcomes in patients with heart failure or acute myocardial infarction.

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