Coronary Microvascular Dysfunction Induced by Primary Hyperparathyroidism is Restored After Parathyroidectomy

Abstract

Background-Symptomatic primary hyperparathyroidism (PHPT) is associated with increased cardiovascular mortality.However, data on the association between asymptomatic PHPT and cardiovascular risk are lacking. We assessed coronary flow reserve (CFR) as a marker of coronary microvascular function in asymptomatic PHPT of recent onset. Methods and Results-We studied 100 PHPT patients (80 women; age, 58Ϯ12 years) without cardiovascular disease and 50 control subjects matched for age and sex. CFR in the left anterior descending coronary artery was detected by transthoracic Doppler echocardiography, at rest, and during adenosine infusion. CFR was the ratio of hyperemic to resting diastolic flow velocity. CFR was lower in PHPT patients than in control subjects (3.0Ϯ0. 2).In multivariable linear regression analysis, PTH, age, and heart rate were the only factors associated with CFR (Pϭ0.04, Pϭ0.01, and Pϭ0.006, respectively). In multiple logistic regression analysis, only PTH increased the probability of CFR Յ2.5 (Pϭ0.03). In all PHPT patients with CFR Յ2.5, parathyroidectomy normalized CFR (3.3Ϯ0.7 versus 2.1Ϯ0.5; PϽ0.0001). Conclusions-PHPT patients have coronary microvascular dysfunction that is completely restored after parathyroidectomy. PTH independently correlates with the coronary microvascular impairment, suggesting a crucial role of the hormone in explaining the increased cardiovascular risk in PHPT.

Cardiovascular risk and metabolic syndrome in primary hyperparathyroidism and their correlation to different clinical forms

“…Present results show that PHPT patients, independently of clinical presentation, bear an enhanced intermediate-high CRS in comparison to controls; these new data are in accord with previous studies reporting an increased coronary artery and cerebrovascular morbidity in PHPT [3,4,12].…”

“…Among cardiovascular alterations, increased arterial stiffness and carotid intima-media thickness, endothelial dysfunction, hypertension, left ventricular hypertrophy, and diastolic dysfunction have been reported [4,5]. Among metabolic disorders, impaired insulin sensitivity, high prevalence of type 2 diabetes mellitus (Type 2 DM), dyslipidemia, hyperuricemia, increased body weight, and metabolic syndrome (MS) have been shown [6][7][8][9][10][11][12].…”

“…Among metabolic disorders, impaired insulin sensitivity, high prevalence of type 2 diabetes mellitus (Type 2 DM), dyslipidemia, hyperuricemia, increased body weight, and metabolic syndrome (MS) have been shown [6][7][8][9][10][11][12]. So far, it remains to be fully elucidated the pathogenetic link between PHPT and cardiometabolic morbidity and mortality which might be ascribed potentially to the contributory role of hypercalcemia, high serum PTH levels and vitamin D deficiency [4,6,13,14] .…”

Coronary microvascular dysfunction due to essential thrombocythemia and policythemia vera: The missing piece in the puzzle of their increased cardiovascular risk?

“…Patients with abnormal CFR who consented underwent MSCT coronary angiography to exclude epicardial significant CAD, as previously described [14].…”

“…Coronary flow reserve (CFR) by transthoracic Doppler echocardiography (TDE) may provide functional assessment of the microvascular function [13]. As reported in other diseases [14,15], CFR may become of clinical relevance in the management, treatment, and risk assessment of MPN in its asymptomatic initial phase. Accordingly, the aim of the present study was to evaluate the coronary microvascular function, assessed by CFR by TDE, in healthy subjects and in patients with ET and PV without evidence of CAD.…”