Cardiac function in mild primary hyperparathyroidism and the outcome after parathyroidectomy

Abstract

ObjectivePrimary hyperparathyroidism (PHPT) is associated with cardiovascular morbidity. The extent of cardiovascular abnormalities in patients with mild-asymptomatic disease is unclear. Using sensitive echocardiographic methods, we compared cardiac structure and function in patients with mild PHPT and in healthy controls, and evaluated the changes after parathyroidectomy (PTX).MethodsIn a prospective case–control design, we studied 51 PHPT patients without any cardiovascular risk factors/diseases and 51 healthy matched controls. Cardiac structure, and systolic and diastolic function were evaluated by echocardiography and Doppler tissue imaging (DTI). Blood pressure (BP) and heart rate were measured.ResultsWe observed no differences in systolic or diastolic function or in cardiac morphology between the PHPT patients and the age-matched healthy controls. The regional peak systolic myocardial velocities (S′) measured with DTI decreased at all sites (P<0.05) after PTX (tricuspid annulus 14.23±1.85 to 13.48±1.79, septal 8.48±0.96 to 7.97±0.85, and lateral 9.61±2.05 to 8.87±1.63 cm/s, part of the mitral annulus). At baseline, systolic BP was higher in patients compared to controls (127.6±17.1 vs 119.6±12.6 mmHg, P<0.05). After PTX, both systolic (127.6±17.1 vs 124.6±16.6 mmHg, P<0.05) and diastolic (80.3±9.6 vs 78.4±8.6 mmHg, P<0.05) BP decreased.ConclusionsOur results indicate that patients with PHPT without cardiovascular risk factors have a normal global systolic and diastolic function and cardiac morphology. BP and the systolic velocities were marginally reduced after PTX, but reflected the values of the control group. Our findings warrant further investigation of the clinical and prognostic significance of these possibly disease-related inotropic effects.

Cardiovascular risk factors in patients with asymptomatic primary hyperparathyroidism

“…27 The surgical patients in our sample showed no improvement in cardiovascular risk factors at one year of follow-up. As regards HBP, some studies, 12,28 but not all, 29 have shown blood pressure decreases after surgery. It should be noted that in studies showing no changes, mean baseline blood pressure values were not excessively elevated, as occurred in our study.…”

Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

“…After 2008 several studies were published; in particular, in 2010, Farahnk et al reported no significant abnormalities in left ventricular ejection fraction, fractional shortening and left ventricular end-systolic volume (80). Two studies carried out in patients with mild PHPT showed no diastolic dysfunction (81,82).…”

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

“…At baseline, the level of 25-OHD was significantly lower in patients in comparison with controls (40.1 ± 16.5), but still very high from our patients. Another study from Israel 22 in severe PHPT patients did not find any beneficial effect of parathyroidectomy on cardiovascular risk. In our series, there was no significant increase in the LV systolic dimensions, volume, and LV EF, but there was a trend of higher values not reaching a significant level.…”

“…Also, we used an echo machine HP 5500, which has a better resolution. In a recent study by Farahnak et al, 21,22 they concluded that mild HPT patients did not differ from healthy controls for cardiovascular risk and observed no differences in systolic or diastolic functions or in cardiac morphology between the PHPT patients and the age-matched healthy controls. At baseline, the level of 25-OHD was significantly lower in patients in comparison with controls (40.1 ± 16.5), but still very high from our patients.…”