{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T13:18:16Z","timestamp":1789132696924,"version":"build-2803163510"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Medizinische Fakult\u00e4t Mannheim der Universit\u00e4t Heidelberg"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Endocrine"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to investigate the prognostic impact of thyroid function on the outcomes of patients with heart failure with mildly reduced ejection fraction (HFmrEF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Thyroid function is crucial for the optimal performance of the cardiovascular system. However, the prognostic impact of subclinical thyroid dysfunction in patients with heart failure (HF), specifically HFmrEF, remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>For the present study, patients hospitalized with HFmrEF and known thyroid function were included from 2016 to 2022. Patients were divided into four groups: euthyroid (reference group, n\u2009=\u20091186 [TSH 0.45\u20134.5 mU\/L]), subclinical hypothyroidism (n\u2009=\u200995 [TSH\u2009&gt;\u20094.5 mU\/L, fT4 7.5-23 pmol\/L]), subclinical hyperthyroidism (n\u2009=\u2009139 [TSH\u2009&lt;\u20090.45 mU\/L, fT4 7.5-23 pmol\/L]), and low T3 syndrome (n\u2009=\u2009148 [fT3\u2009\u2264\u20093.3 pmol\/L]). Patients with manifest hyper- and hypothyroidism were excluded related to the low sample size. The primary endpoint was all-cause mortality at 30 months (median follow-up). Key secondary endpoint was HF-related rehospitalization at 30 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From 1568 patients with HFmrEF, most patients presented with euthyroidism (75.6%), followed by low T3 syndrome (9.4%), subclinical hyperthyroidism (8.9%), and subclinical hypothyroidism (6.1%). The risk of all-cause mortality at 30 months was highest in patients with low T3 syndrome (51.4%), followed by subclinical hypothyroidism (38.9%) and subclinical hyperthyroidism (36.7%), whereas euthyroid patients (26.6%) had the lowest risk of long-term all-cause mortality (p\u2009=\u20090.001). In multivariable Cox regression analyses, subclinical hypothyroidism (hazard ratio [HR] 1.454, 95% confidence interval [CI] 1.001\u20132.113, p\u2009=\u20090.049), subclinical hyperthyroidism (HR 1.458, 95% CI 1.046\u20132.033, p\u2009=\u20090.026), and low T3 syndrome (HR 1.594, 95% CI 1.185\u20132.145, p\u2009=\u20090.002) were identified as independent predictors of all-cause mortality at 30 months compared to euthyroid patients. Patients with low T3 syndrome were even associated with impaired prognosis as compared to patients with subclinical hyperthyroidism (HR 1.553, 95% CI 1.088\u20132.212; p\u2009=\u20090.015). However, thyroid status was not associated with the risk of HF-related rehospitalization at 30 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In patients with HFmrEF, the presence of subclinical hypothyroidism, subclinical hyperthyroidism, and low T3 syndrome were identified as predictors of all-cause mortality, but not of HF-related rehospitalization at 30 months.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s12020-026-04660-1","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T07:56:18Z","timestamp":1783929378000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Thyroid function and outcomes in heart failure with mildly reduced ejection fraction: insights from a large, retrospective registry"],"prefix":"10.1007","volume":"91","author":[{"given":"Mohammad","family":"Abumayyaleh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Akin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Goertz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marielen","family":"Reinhardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noah","family":"Abel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Schmitt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Lau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathrin","family":"Weidner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Dudda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henning Johann","family":"Steffen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Duerschmied","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Behnes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Schupp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"key":"4660_CR1","doi-asserted-by":"publisher","first-page":"2388","DOI":"10.1093\/eurheartj\/ehn309","volume":"29","author":"K Dickstein","year":"2008","unstructured":"K. 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