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The association of presystolic wave with subclinical left-ventricular dysfunction in patients with subclinical hypothyroidism



Subclinical hypothyroidism (SCH) patients develop left-ventricular dysfunction (LVD) in an earlier stage. LVD could be detected with myocardial performance index (MPI), left -ventricular global longitudinal strain (LVGLS), and conventional and tissue-Doppler imaging (TDI). A presystolic wave (PSW) detected on late diastole is associated with LVD. We aimed to determine whether there is an association between PSW and subclinical LVD assessed by different echocardiographic methods in SCH patients.


We prospectively enrolled 105 patients diagnosed with SCH in this study. Patients were divided into two groups based on the presence of PSW. Both groups were compared with respect to demographic, clinical, and echocardiographic properties. Multivariable regression analysis was performed to detect predictors of subclinical LVD.


The study included 70 PSW-positive patients (66%, mean age: 50.2) and 35 PSW-negative patients (34%, mean age: 46.5). PSW-positive patients had a lower platelet and a higher RDW level compared to PSW-negative patients. PSW-positive patients had more frequent subclinical LVD, which was assessed by MPI, by conventional and TDI parameters, and by LVGLS. PSW velocity was significantly correlated with MPI velocity (r = 0.31, p = 0.009), TSH level (r = 0.44, p < 0.001), and with LVGLS (r = 0.33, p = 0.005). The presence of PSW was an independent predictor of subclinical LVD in multivariable logistic regression analysis detected with MPI, LVGLS, and TDI parameters (OR = 5.409, p = 0.03; OR = 4.872, p = 0.005; OR = 5.632, p = 0.014, respectively).


PSW prevalence was 66% in SCH patients. PSW velocity was significantly correlated with MPI and LVGLS. The presence of PSW was independently associated with subclinical LVD in SCH patients.

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Conceptualization: FS, TA; methodology: FS, TA; formal analysis and investigation: FS; writing—original draft preparation: FS; writing—review and editing: FS; funding acquisition: none; resources: FS, TA supervision: FS.

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Correspondence to Faysal Saylik.

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Faysal Şaylık and Tayyar Akbulut declare that they have no conflict of interest.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Van Education and Research Hospital (Date 2020/No. 21).

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Saylik, F., Akbulut, T. The association of presystolic wave with subclinical left-ventricular dysfunction in patients with subclinical hypothyroidism. J Echocardiogr (2021).

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  • Presystolic wave
  • Left-ventricular dysfunction
  • Subclinical hypothyroidism