Assessment of Cardiovascular System Abnormalities in Patients with Advanced Primary Hyperparathyroidism by Detailed Echocardiographic Analysis: A Prospective Study

Abstract

Aim: Recognizing the paucity of data regarding the incidence of cardiovascular abnormalities in severe primary hyperparathyroidism (PHPT), a prospective study was done for left ventricular (LV) systolic and diastolic function by echocardiography in patients with hyperparathyroidism (HPT) before surgery. Materials and methods:A total of 18 consecutive patients with HPT and an equal number of age-and sex-matched controls were studied by two-dimensional and Doppler echocardiography.Results: Patients with HPT had higher systolic and diastolic blood pressures (BPs). Despite severe bone disease, nephropathy, and vitamin D deficiency, none had metastatic calcification in myocardium. There was no significant increase in LV systolic dimensions and volume, but decreased ejection fraction (EF) and significant diastolic dysfunction were observed. Conclusion:Despite an asymptomatic cardiac status, there were decreased EF and significant diastolic dysfunction. The HPT patients despite having severe disease, did not have metastatic calcification.

Management of Primary Hyperparathyroidism

“…This area continues to need additional studies, aided perhaps by utilizing a disease‐specific quality‐of‐life tool for PHPT. ( 48,49 ) Cardiovascular/metabolic : Previous small studies reported an increased risk of hypertension, ( 50 ) left ventricular hypertrophy, and impaired diastolic filling in patients with PHPT, ( 51 ) although the pathophysiologic mechanisms underlying these associations have not been identified. Patients with both normocalcemic and classic PHPT have been shown to exhibit similar rates of cardiovascular risk factors and comparable indices of arterial stiffness.…”

Improvement of hypertension control and left-ventricular function after cure of primary hyperparathyroidism

“…reported better LV contractility by speckle tracking examination but no change in LVM or diastolic function, while in patients randomized to surgery (n=12) or observation (n=12) by Pepe et al. neither systolic nor diastolic cardiac function altered ( 31 – 33 ). Two meta-analyses (from 2015 and 2017) contain discordant findings: a decrease in LVM was reported by McMahon et al.…”

“…Similarly to data concerning BP, improvement in echocardiographic parameters after PTX recorded in our study (LVH reduction, better systolic and diastolic function) can only be partially tracked to previous studies. In particular, at the same six-month follow-up: Agarwal et al found LVEF and diastolic function (E/A ratio) improved, Kepez et al reported better LV contractility by speckle tracking examination but no change in LVM or diastolic function, while in patients randomized to surgery (n=12) or observation (n=12) by Pepe et al neither systolic nor diastolic cardiac function altered (31)(32)(33). Two meta-analyses (from 2015 and 2017) contain discordant findings: a decrease in LVM was reported by McMahon et al in short-term follow-up (up to 6 months) based on 15 prospective studies (11 observational, 4 randomized, n=457), while Best and colleagues found no differences in LVEF or IVS, RWT, and two diastolic function parameters upon analyzing 14 studies (3 randomized, n=424) (34,35).…”

Evaluation and Management of Primary Hyperparathyroidism: Summary Statement and Guidelines from the Fifth International Workshop

“…Although small studies have reported hypertension, left ventricular hypertrophy, arterial stiffness, and impaired diastolic filling in patients with PHPT, ( 146,147 ) these observations do not have a clear pathophysiologic basis nor are they clearly changed after successful PTX. ( 146–148 ) Similarly, metabolic indices such as the Homeostatic Model of Assessment‐Insulin Resistance (HOMA‐IR) are not consistently associated or improved following PTX. ( 149–151 )…”