Objective Graves’ disease (GD) can both aggravate pre-existing cardiac disease and cause de novo heart failure (HF), but large-scale studies are lacking. We aimed to investigate the incidence, risk factors and outcomes of incident GD-related HF. Methods Patients with GD (2009–2019) were retrospectively included. HF with reduced ejection fraction (HFrEF) was defined by left ventricular ejection fraction <50% and Framingham criteria, while HF with preserved ejection fraction (HFpEF) was defined according to the HFA-PEFF criteria. HF due to ischaemia, valve disorder or other structural heart disease was excluded. Proportional hazards regression was used to analyse risk factors and outcomes. Results Of 1371 patients with GD, HF occurred in 74 (5.4%) patients (31 (2.3%) HFrEF; 43 (3.1%) HFpEF). In HFrEF, atrial fibrillation (AF) (HR 10.5 (3.0–37.3), p<0.001) and thyrotropin receptor antibody (TRAb) level (HR 1.05 (1.01–1.09) per unit, p=0.007) were independent risk factors. In HFpEF, the independent risk factors were chronic obstructive pulmonary disease (HR 7.2 (3.5–14.6), p<0.001), older age (HR 1.5 (1.2–2.0) per 10 years, p=0.001), overt hyperthyroidism (HR 6.4 (1.5–27.1), p=0.01), higher body mass index (BMI) (HR 1.07 (1.03–1.10) per unit, p=0.001) and hypertension (HR 3.1 (1.3–7.2), p=0.008). The risk of cardiovascular hospitalisations was higher in both HFrEF (HR 10.3 (5.5–19.4), p<0.001) and HFpEF (HR 6.7 (3.7–12.2), p<0.001). However, only HFrEF was associated with an increased risk of all-cause mortality (HR 5.17 (1.3–19.9), p=0.02) and ventricular tachycardia/fibrillation (HR 64.3 (15.9–259.7), p<0.001). Conclusion De novo HF occurs in 5.4% of patients with GD and is associated with increased risk of cardiovascular hospitalisations and mortality. Risk factors include AF, higher TRAb, higher BMI and overt hyperthyroidism. Data are available upon reasonable request.

中文翻译：

---

Graves 病患者心力衰竭的发病率、危险因素、自然病程和结局

目的格雷夫斯病（GD）既可加重原有心脏病，又可引起新发心力衰竭（HF），但缺乏大规模研究。我们旨在调查 GD 相关心衰的发生率、危险因素和结局。方法 回顾性纳入 GD 患者（2009-2019 年）。射血分数降低的 HF (HFrEF) 定义为左心室射血分数 <50% 和 Framingham 标准，而射血分数保留的 HF (HFpEF) 定义为 HFA-PEFF 标准。由于缺血、瓣膜疾病或其他结构性心脏病引起的心力衰竭被排除在外。比例风险回归用于分析风险因素和结果。结果 在 1371 例 GD 患者中，74 例 (5.4%) 患者（31 例 (2.3%) HFrEF；43 例 (3.1%) HFpEF）发生 HF。在 HFrEF 中，心房颤动 (AF) (HR 10.5 (3.0–37.3)，p<0.001）和促甲状腺激素受体抗体（TRAb）水平（HR 1.05（1.01-1.09）/单位，p=0.007）是独立的危险因素。在 HFpEF 中，独立危险因素是慢性阻塞性肺疾病（HR 7.2 (3.5-14.6)，p<0.001）、年龄较大（HR 1.5 (1.2-2.0) 每 10 年，p=0.001）、明显的甲状腺功能亢进（HR 6.4 (1.5–27.1), p=0.01)，更高的体重指数 (BMI) (HR 1.07 (1.03–1.10) 每单位，p=0.001) 和高血压 (HR 3.1 (1.3–7.2), p=0.008)。HFrEF (HR 10.3 (5.5–19.4), p<0.001) 和 HFpEF (HR 6.7 (3.7–12.2), p<0.001) 的心血管住院风险均较高。然而，只有 HFrEF 与全因死亡率（HR 5.17（1.3-19.9），p=0.02）和室性心动过速/纤颤（HR 64.3（15.9-259.7），p<0.001）风险增加相关。结论 De novo HF 发生在 5。4% 的 GD 患者与心血管住院和死亡的风险增加有关。危险因素包括房颤、较高的 TRAb、较高的 BMI 和明显的甲状腺功能亢进。可根据合理要求提供数据。