Left ventricular systolic and diastolic function and exercise testing in primary hyperparathyroidism—effects of parathyroidectomy

Nilsson, Inga-Lena; Åberg, Jan; Rastad, Jonas; Lind, Lars

doi:10.1067/msy.2000.110240

Cited by 76 publications

(67 citation statements)

References 21 publications

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“…Also, mean blood pressure and heart rate during ET, before and after PTx, remained within the normal range and did not differ. This finding is in contrast to the only previous study that investigated ET in PHPT patients, which had many confounding factors (14).…”

Section: Discussioncontrasting

confidence: 55%

“…In our study, PTx did not modify echocardiographic parameters as some previous studies have shown; however, in our sample, these parameters were within the normal range and did not differ from controls, whereas in other studies, patients with left ventricular hypertrophy were enrolled (13,14). Also, mean blood pressure and heart rate during ET, before and after PTx, remained within the normal range and did not differ.…”

Section: Discussionmentioning

confidence: 36%

“…Several studies reported a substantial improvement after PTx in the metabolic and the cardiovascular risk factors, also measured by echocardiogram, while other studies do not support this finding (11,12,13,14,15,16,17,18,19,20,21). Interestingly, there are no studies regarding the effects of PTx on arrhythmic risk, in PHPT patients, evaluated during bicycle ergometry ET.…”

Section: Introductionmentioning

confidence: 68%

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Parathyroidectomy eliminates arrhythmic risk in primary hyperparathyroidism, as evaluated by exercise test

Pepe

Curione

Morelli

et al. 2013

European Journal of Endocrinology

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Objective: To investigate whether parathyroidectomy (PTx) reverses risk factors for arrhythmias related to the QT dynamic changes evaluated during bicycle ergometry exercise test (ET). Methods: Twenty-four postmenopausal women with primary hyperparathyroidism (PHPT) (mean age 60.0G8.4 years) and 30 sex-and age-matched controls underwent ET, echocardiography, and biochemical evaluation. The following stages were considered during ET: rest, peak exercise, and recovery. The patients were randomized to two groups: 12 underwent PTx (group A) and 12 were followed-up conservatively (group B). After 6 months, the patients were studied again. Results: Groups A and B showed no differences in mean baseline biochemical values, echocardiographic parameters, and QTc interval. PHPT patients showed an increased occurrence of ventricular premature beats (VPBs) during ET compared with controls (37.0 vs 6.6%, PZ0.03). Serum calcium level was a predictor of VPBs (PZ0.05). Mean value of QTc was in the normal range at baseline (group A: 401G16.9; group B: 402.25G13.5 ms) but significantly lower than controls (417.8G25.1 ms, P!0.01). A negative correlation was found between QTc and calcium values (PZ0.03). Physiological reduction of QTc interval from rest to peak exercise was not observed in PHPT patients before surgery. After PTx, group A had a significant reduction in VPBs compared with baseline (at baseline, 5 of 12 vs none of 12 patients after PTx, PZ0.03) and a restored normal QT adaptation during ET. Group B showed no significant changes after a 6-month period. Conclusions: PTx reduces the occurrence of VPBs and restored the QTc adaptation during ET.

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Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 36%

Section: Introductionmentioning

confidence: 68%

See 1 more Smart Citation

Parathyroidectomy eliminates arrhythmic risk in primary hyperparathyroidism, as evaluated by exercise test

Pepe

Curione

Morelli

et al. 2013

European Journal of Endocrinology

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“…Conflicting results are present in the current literature in relation to the finding of left ventricular (LV) hypertrophy and LV systolic and diastolic dysfunction in PHPT patients; these discrepancies might be related, among other things, to the heterogeneity in the clinical features of patients, the echocardiography criteria and the devices used [13,14]. The latest study on this issue, by Ozdemir et al, shows that patients with PHPT, but without cardiac symptoms or documented cardiovascular disease, have subclinical systolic and diastolic myocardial dysfunction [15].…”

mentioning

confidence: 68%

Emerging data on cardiovascular risk in primary hyperparathyroidism

et al. 2014

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The cardiovascular risk profile of patients affected by primary hyperparathyroidism (PHPT) has been an issue of debate over the last years. Studies regarding the potential damages caused by increased serum levels of parathyroid hormone (PTH) and/or calcium, have yielded controversial results, suggesting either the presence or the absence of damage [1,2].It is interesting to note that the answer to this question is further complicated by the changing clinical presentation of PHPT over the last decade. Indeed, once considered a symptomatic disorder characterized by significant hypercalcemia with kidney stones and/or bone involvement [3][4][5], today PHPT is most commonly seen in asymptomatic individuals with milder hypercalcemia, due to the large availability of routine serum calcium measurements and developments in assay systems. A new presentation is now emerging, characterized by normocalcemia and elevated serum parathyroid hormone levels (the so-called ''normocalcemic primary hyperparathyroidism'').Recently in this Journal, Procopio et al. reported an increased prevalence of intermediate-high cardiovascular risk score (CRS), both in symptomatic and asymptomatic PHPT patients, as compared to healthy controls [6]. Their data are in line with several previous studies that reported an increased coronary artery and cerebrovascular morbidity in PHPT [7,8]. By means of a multivariate analysis, they also showed that, PHPT status predicts the presence of intermediate-high CRS and metabolic syndrome [9], while elevated calcium levels predict altered glucose tolerance among the components of metabolic syndrome.Procopio et al. added new information on an emerging aspect of patients with this glandular disorder; however, there are also some limitations that should be kept in mind when interpreting the results obtained. For example, the classification of patients is somewhat arbitrary. Asymptomatic patients with complications should no longer be considered as such; indeed, future classifications should be based on the presence or absence of complications. Just to make an example, patients may be asymptomatic, but can be incidentally discovered to have a kidney stone by ultrasound; in such a case she/he is asymptomatic but already has a complication of the disease. In essence, the term asymptomatic does not mean without complications; in this context, also a vertebral fracture may be asymptomatic but represents a complication. Secondly, the paper does not include any follow-up after surgery; this could have added meaningful information about the possible reversible effects of a restored biochemical calcium metabolism on cardiovascular risk factors. The current data conflict on this last issue [10,11], possibly due to the different timing of surgery. For example in the case of hypertensive patients, it is entirely possible that parathyroidectomy would be effective only if performed in an early phase of the disease, when structural abnormalities are not present. A similar situation can be observed in other endocrine disorders ...

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“…В литературе имеются указания как на частое развитие ГЛЖ у пациентов, страдающих первичным гиперпаратиреозом [8,[13][14][30][31][32][33][34][35], так и на ее отсутствие [23,[67][68] (табл.2).…”

Section: гиперпаратиреоз и гипертро-фия левого желудочкаunclassified

Hyperparatirosis and Cardiovascular System Pathology

Voronenko¹,

Syrkin²,

ROZhINSKAYa³

et al. 2006

Osteopor Bone Dis

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ВВЕДЕНИЕМногие годы гиперпаратиреоз, в том числе и первичный, прежде всего ассоциировался с тяже-лой патологией костной системы и почек, считался редким заболеванием. Широкое внедрение в кли-ническую практику определения в крови кальция, а затем паратгормона, остеоденситометрии позволило значительно чаще и на более ранних стадиях распознавать это заболевание и более успешно его лечить. К настоящему вре-мени удельный вес мягких и бессимптомных форм гиперпара-тиреоза увеличился с 10-15% в 80-е годы ХХ века до 80%. Консервативное ведение этих форм гиперпаратиреоза требует более тщательных исследований по прогнозу выживаемости, длительности и качества жизни, риску развития ассоциирован-ных заболеваний у этих пациентов.За последние годы было обнаружено, что гиперпаратиреоз сопряжен с повышенным риском смерти от сердечно-сосудис-тых заболеваний (ССЗ), поскольку изменение уровней кальция (Са) и паратгормона (ПГ) нарушает работу сердечно-сосудис-той системы.Результаты ряда исследований свидетельствуют о высоком уровне смертности среди пациентов с клинически выражен-ным первичным гиперпаратиреозом до и после паратиреои-дэктомии [1-7] (табл.1). Наиболее частой причиной смерти являлись ССЗ, такие как инфаркт миокарда, инсульт, сердечная недостаточность [8]. Несколько меньшая смертность от сер-дечно-сосудистых заболеваний отмечается при бессимптомно текущем гиперпаратиреозе [4].В последнее время появляются данные о роли вторичного гиперпаратиреоза в увеличении смертности от патологии сер-дечно-сосудистой системы у пациентов с хронической почеч-ной недостаточностью (ХПН) [9][10][11][12].В связи с высоким риском смерти пациентов с гиперпа-ратиреозом актуален поиск возможных причин и механизмов развития патологии сердца и сосудов у больных с заболева-нием паращитовидных желез (см. рис.). В табл. 1 приведены данные клинических исследований по изучению смертности и риска ССЗ среди больных с первичным гиперпаратиреозом.Отмечено, что гиперпаратиреоз может способствовать разви-тию артериальной гипертензии [13][14][15][16][17][18], аритмий сердца [19][20][21][22], а также вызывать структурные и функциональные изменения в сосудистой стенке [23][24][25][26][27][28][29], также часто обнаруживают гипер-трофию левого желудочка [8,[13][14][30][31][32][33][34][35], кальцинаты в мио-карде, клапанах сердца, коронарных артериях [31][32][33].В настоящем обзоре пойдет речь о непосредственном действии паратгормона (ПГ) на сердечно-сосудистую систе-му, его эффектах, продемонстрированных в исследованиях in vitro и in vivo, рассмотрены основные структурные и функциональные изменения миокарда, сосудов, которые, по данным литературы, могут являться причиной высокого риска смерти от сердечно-сосудистых заболеваний среди пациентов с гиперпаратиреозом. ДЕЙСТВИЕ ПГ НА СЕРДЕЧНО-СОСУ-ДИСТУЮ СИСТЕМУВ течение длительного времени ПГ рассматривался как гормон, регулирующий кальциевый гомеостаз. Основными изученными мишенями его действия являлись кости и почки, а именно хондроциты, остеобласты и остеокласты костной ткани и клетки канальцев почек, эффект на кото...

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Left ventricular systolic and diastolic function and exercise testing in primary hyperparathyroidism—effects of parathyroidectomy

Cited by 76 publications

References 21 publications

Parathyroidectomy eliminates arrhythmic risk in primary hyperparathyroidism, as evaluated by exercise test

Parathyroidectomy eliminates arrhythmic risk in primary hyperparathyroidism, as evaluated by exercise test

Emerging data on cardiovascular risk in primary hyperparathyroidism

Hyperparatirosis and Cardiovascular System Pathology

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