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Primary hyperparathyroidism and the heart: Cardiac abnormalities correlated to clinical and biochemical data

  • International Association of Endocrine Surgeons—Manuscripts Presented at the 35th World Congress of the International Society of Surgery, Hong Kong, August 1993
  • Published:
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Abstract

Comparing patients with primary hyperparathyroidism (PHP) to a normocalcemic control population, those with PHP have a higher incidence of cardiovascular disease and cardiac abnormalities. This study aimed at correlating cardiac findings (valvular and myocardial calcification, myocardial hypertrophy) with clinical data (age, sex, clinical manifestation, nephrolithiasis, nephrocalcinosis, hypertension, skeletal abnormalities, hypercalcemic syndrome) and biochemical data (serum calcium, serum phosphate, serum iPTH level, serum creatinine). A group of 132 consecutive patients with surgically verified PHP (94 women, 38 men; ages 15–86, mean age 57±16 years) were included in this study. Blood chemistry, clinical presentation, radiography, and echocardiography were carried out in all patients for univariate and multivariate analyses of all parameters. There was no statistical correlation between clinical symptoms, biochemical data, and cardiac calcific alterations. Typical skeletal manifestations (osteolysis/subperiostal resorption) and valvular calcifications were significantly correlated to left ventricular hypertrophy (p=0.005). Cardiac abnormalities such as calcific myocardial deposits or mitral and aortic valvular calcifications do not correlate with laboratory findings and clinical presentation at the time of diagnosis. There was no biochemical or clinical variable that could predict the frequency or severity of valvular sclerosis or calcific deposits in the myocardium. However, PHP-related skeletal abnormalities and valvular calcification were predicting factors for left ventricular hypertrophy, a reversible cardiac manifestation of PHP. Myocardial hypertrophy is more often found with classic symptomatic PHP with osseous abnormalities.

Résumé

Les patients ayant une hyperparathyroïdie primitive (HPP) ont plus de maladies cardiovasculaires que la population normocalcémique. Le but de cette étude a été de corréler les données cardiaques (calcifications myocardiques et valvulaires, hypertrophie myocardiques) avec des données cliniques (âge, sexe, manifestations cliniques, lithiase urinaire, néphrocalcinose, hypertension, anomalies squelettiques, hypercalcémie) et biochimiques (calcémie, phosphorémie, taux d'iPTH, créatinine). 132 patients consécutifs traités pour HPP 94 femmes et 38 hommes, âgés de 15 à 86 (moyenne = 57±16) ans ont eu ce bilan et tous ces facteurs ont été étudiés en analyse mono et multi-factorielle. Il n'a pas été retrouvé de corrélation entre les symptômes cliniques, biochimiques et les calcifications cardiaques. Les manifestations squelettiques typiques (ostéolyse/résorption souspériostée) et les calcifications valvulaires étaient significativement corrélées avec l'hypertrophie ventriculaire gauche (p=0.005). Les anomalies cardiaques telles que les calcifications myocardiques, valvulaires mitrales et/ou aortiques ne sont pas corrélées avec les données de laboratoire ou la présentation clinique au moment du diagnostic. Il n'y avait aucun variable clinique ou biochimique qui prédise la fréquence ou la sévérité de la sclérose valvulaire ou les calcifications myocardiques. Les anomalies squelettiques et calcifications valvulaires, cependant, étaient prédictives d'hypertrophie ventriculaire gauche, une complication réversible de l'HPP. L'hypertrophie myocardique est retrouvée plus souvent dans la forme classique d'HPP symptomatique avec des anomalies osseuses.

Resumen

Al comparar pacientes con hiperatiroidismo primario (HPP) con personas pertenecientes a una población normal control, aparece que en el HPP hay una mayor incidencia de enfermedad cardiovascular y de anormalidades cardíacas. El presente estudio está orientado a correlacionar los hallazgos cardíacos (calcificación valvular y miocárdica, hipertrofia miocárdica) con las características clínicas (edad, sexo, manifestación clínica, nefrolitiasis, nefrocalcinosis, hipertensión, anormalidades del esqueleto, síndrome hipercalcémico) y los datos bioquímicos (calcio sérico, fosfato sérico, nivel sérico de iHPT, creatinina sérica).

Ciento treinta y dos pacientes con HPP verificado quirúrgicamente 94 mujeres y 38 hombres con edades entre 15 y 86 (media 57±16) años fueron incorporados en el estudio, con la inclusión, para análisis uni y multivariable, de la química sanguínea, síntomas de presentación clínica, radiografía y ecocardiografía.

No apareció correlación estadística entre los síntomas clínicos, los datos bioquímicos y las alteraciones de calcificación cardíaca. Las manifestaciones esqueléticas (osteolisis/resorción subperióstica) y las calcificaciones valvulares aparecieron significativamente correlacionadas con la hipertrofia ventricular izquierda (p=0.005).

En conclusión, las anormalidades cardíacas tales como depósitos calcíficos en el miocardio, calcificaciones valvulares mitrales y/o aórticas no se correlacionan ni con los valores de laboratorio ni con los síntomas de presentación clínica en el momento del diagnóstico. No se encontró variable alguna, bioquímica o química, que pudiera predecir la frecuencia o la severidad de la esclerosis valvular o de los depósitos calcíficos en el miocardio. Sin embargo, tanto las anormalidades esqueléticas como la calcificación valvular aparecieron como factores de predicción de la hipertrofia ventricular izquierda, la cual es una manifestación reversible del HPP. La hipertrofia miocárdica se presenta con mayor frecuencia en un HPP clásico con anormalidades óseas.

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Authors and Affiliations

  1. Department of Surgery, Division of General Surgery, University of Vienna Medical School, Währinger Gürtel 18-20, A-1090, Vienna, Austria

    Friedrich Längle M.D., Claudette Abela M.D., Martina Mittelböck M.Sc. & Bruno Niederle M.D.

  2. Department of Internal Medicine II (Division of Cardiology), Medical School, Währinger Gürtel 18-20, A-1090, Vienna, Austria

    Janette Koller-Strametz M.D., Jutta Bergler-Klein M.D. & Thomas Stefenelli M.D.

  3. Luawig Boltzmann Institute for Clinical Endocrinology, University of Vienna, Medical School, Währinger Gürtel 18-20, A-1090, Vienna, Austria

    Wolfgang Woloszczuk Ph.D.

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  1. Friedrich Längle M.D.
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  2. Claudette Abela M.D.
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Längle, F., Abela, C., Koller-Strametz, J. et al. Primary hyperparathyroidism and the heart: Cardiac abnormalities correlated to clinical and biochemical data. World J. Surg. 18, 619–624 (1994). https://doi.org/10.1007/BF00353780

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