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

Abstract

Background: Hyperparathyroidism (PHP) is the most common cause of hypercalcemia in outpatients. It is characterized by many cardiac complications including chronic cardiac arrhythmia, hypertrophy, and diastolic insufficiency. However, there are insufficient data about the cardiac systolic function in PHP. Data regarding the positive effects of surgical treatment on cardiac complications are limited and inadequate. The aim of this study was to evaluate the postoperative changes in the left ventricle functions of patients with PHP using strain echocardiography (STE) instead of traditional echocardiographic evaluation. Methods: This prospective study included 29 patients with PHP. Detailed echocardiographic evaluations were made including conventional and STE‚ ventricle function preoperatively and at 6 months after surgery. Then, preoperative and postoperative STE changes, global longitudinal (GLS) and circumferential strain (GCS), were compared. Patients with recurrent surgery, poor echogenicity, and comorbid conditions affecting STE were excluded.Results: No significant change was determined in ejection fraction in the period from preoperative to 6 months postoperative (P > .05). The GLS value increased from 18.53 ± 3.06 to 20.25 ± 3.89, to a statistically significant level (P = .004). The other echocardiographic parameters remained unchanged for the same patients. Conclusion:Despite normal 2D echocardiography data, it was determined that the GLS values deteriorated preoperatively and improved by the 6th postoperative month. The detection of early disorders in PHP that cannot be detected on 2D echocardiography, even in asymptomatic patients, may suggest a new treatment indication. For asymptomatic PHP patients, strain echocardiography may be more valuable than 2D echocardiographic evaluation to determine myocardial dysfunction. The recent literature is insufficient, and there is a need for further, more extensive studies with longer follow-up periods. K E Y W O R D Shyperparathyroidism, myocardial dysfunction, parathyroidectomy, strain echocardiography | 671 ATASEVER ET Al.

Assessment of left ventricular dysfunction by strain echo in primary hyperparathyroidism and its reversal after parathyroidectomy

“…17 In another study, changes in the left ventricle functions were evaluated using strain echo in addition to traditional echocardiography in 22 PHPT patients following parathyroidectomy. 16 There were no statistically significant changes in the LVEF and other echo parameters post operatively at 6 months follow up. Even though GCS was not changed significantly following surgery; however, significant increase in GLS from 18.53 � 3.06 preoperatively to 20.25 � 3.89 were observed postoperatively (p < 0.004).…”

“…There are few studies in the literature where Strain Echocardiography was used for the evaluation of LV function in PHPT patients. 6,16 Strain and strain rate echocardiography was concluded from color Doppler myocardial imaging and can estimate regional myocardial wall motion and its deformities. Strain describes the ratio of dimensional deformation in a tissue, and strain rate describes the degree of deformation.…”

Vitamin D Deficiency in Premenopause: Endothelial and Diastolic Functions With Hyperparathyroidism

“…Secondary hyperparathyroidism may be associated with disease severity in congestive heart failure, especially in older, due to bone loss and osteoporosis (21). When the literature is reviewed, there may be a relationship between PTH levels and arterial stiffness, coronary atherosclerosis, abnormal left ventricular function (global longitudinal strain), LV asynchrony, brachial flow-mediated dilatation (bFMD) (adversely), especially in primary hyperparathyroidism; a regression in pulse wave velocity and improvement in global longitudinal strain with parathyroidectomy (22)(23)(24)(25). Although this finding could not be reached with primary hyperparathyroidism in a different study, improvements in pulse wave velocity were also observed using cinacalcet; a calcimimetic agent that provides a decrease in PTH levels in chronic renal failure and secondary hyperparathyroidism, in literature (26,27).…”