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Thyroid and Heart Failure pp 225–241Cite as

Synthetic Thyroid Hormone and Thyroid Hormone Analogues for Treatment of Heart Failure

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Abstract

Heart failure (HF) should be seen in a unique scenario of altered systemic homeostasis, in which heart dysfunction, peripheral organ dysfunction, and derangement of the neuroendocrine and immune systems represent chronic crosstalking between stress stimuli, with continuous activation of the stress response. The thyroid hormone (TH) system is profoundly involved in cardiovascular and systemic homeostasis. In HF, the most frequent alteration of TH metabolism is a low-triiodothyronine state, which may participate directly in progression of HF. Initial results have shown that TH replacement therapy in patients with HF improves cardiac performance, hemodynamic and exercise performance. It also induces deactivation of the neuroendocrine profile, as a result of the significant reductions in vasoconstrictor/sodium-retaining norepinephrine and aldosterone. It in the plasma levels of their counterpart, N-terminal pro B-type natriuretic peptide (NT-proBNP). Depending on the pathophysiology of the HF, two strategies of TH replacement therapy have been suggested: (1) the cardiosystemic strategy, which involves administration of synthetic T4 or T3, and (2) the cardioselective one, using TH analogues, in particular 3,5-diiodothyropropionic acid (DITPA). The rationale of these two approaches is based on the pathophysiology of HF progression, which is linked to progressive impairment of systolic-diastolic cardiac function, but also to systemic disturbance, which frequently progresses independently of deteriorating cardiac function.

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  1. C.N.R. Clinical Physiology Institute, S. Cataldo Research Campus, Pisa, Italy

    Alessandro Pingitore MD, PhD & Francesca Forini PhD

  2. The Sant’Anna School of Advanced Studies of Pisa, University of Pisa, Pisa, Italy

    Vincenzo Lionetti MD, PhD

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  1. C.N.R. Clinical Physiology Institute, S. Cataldo Research Campus, Pisa, Italy

    Giorgio Iervasi  & Alessandro Pingitore  & 

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© 2009 Springer-Verlag Italia

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Pingitore, A., Lionetti, V., Forini, F. (2009). Synthetic Thyroid Hormone and Thyroid Hormone Analogues for Treatment of Heart Failure. In: Iervasi, G., Pingitore, A. (eds) Thyroid and Heart Failure. Springer, Milano. https://doi.org/10.1007/978-88-470-1143-4_20

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  • DOI: https://doi.org/10.1007/978-88-470-1143-4_20

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-1142-7

  • Online ISBN: 978-88-470-1143-4

  • eBook Packages: MedicineMedicine (R0)

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