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

Abstract

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.

High prevalence of abdominal aortic calcification in patients with primary hyperparathyroidism as evaluated by Kauppila score

“…The Kauppila score provides a simple method to assess AAC without additional cost. This finding together with previous studies on cardiovascular risk factors in PHPT patients, including data on valve and cardiac calcifications, cardiomyopathy, and arrhythmia (5,10,28,34,35), suggests the need of a cardiovascular assessment in PHPT patients. Stratification according to CV risk category, as a result of AAC scoring, may improve patient care, with a more aggressive prevention strategy targeting patients with higher risk profiles.…”

The effect of successful parathyroid surgery on left ventricle function in patients with primary hyperparathyroidism evaluated with strain echocardiography

“…In PHP, an increase in diastolic filling disorder is expected due to increased prevalence of hypertension associated with left ventricular hypertrophy, myocardial calcification, and disease in diastolic functions 17 . Some studies have shown an improvement in postoperative diastolic function, 18 while others have found no changes in deceleration time (DT) 19,20 . In the current study, there was no statistically significant difference in the DT, early diastolic filling and late diastolic filling parameters.…”

Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

“…Nilsson et al evaluating the effect of PTx on VPBs did not find significant changes in prevalence; it is worthy to underline that the investigators enrolled patients with coronary artery disease and diabetes (25). Our randomized study, carried out under strict exclusion criteria to avoid potential biases, showed a reduction of VPBs and a restored physiological QT dynamics, 6 months after PTx, as evaluated by exercise test (95). In this context, Birgander et al demonstrated a previously unknown impairment of catecholamine response to physical stress test in PHPT patients along with changes of heart rate variability, a predictor of arrhythmias, that was reversed 6 months following PTx (96).…”

“…However, the vast majority of the studies conducted so far are observational, crosssectional, single-center studies, not randomized. After 2008, only three randomized trials were carried out: two involving mild PHPT, suggesting neither improvement on both blood pressure and insulin sensitivity (41), nor a significant improvement in cardiac structure (82) after PTx; the third one involving symptomatic PHPT, which demonstrates reduction of arrhythmias following PTx (95). For this reason, further longitudinal randomized studies are needed to determine whether or not cardiovascular involvement should be included among the criteria for recommending PTx; the same could apply to the different nontraditional manifestations of PHPT reported in the literature (119).…”