Abstract
Background: The data about cardiovascular (CV) changes in patients with asymptomatic primary hyperparathyroidism (PHPT) are scarce. Aim: The aim of this study is to compare cardiac structure and functions in patients with asymptomatic PHPT and controls by using tissue Doppler echocardiography. Subjects and methods: Thirty-eight patients with asymptomatic PHPT and 31 sex- and age-matched controls with similar cardiac risk factors were evaluated. Results: There was no significant difference in ejection fraction (EF) between the patients and the controls [64±5.95 vs 62±3.25% (p=0.094)]. Left ventricular mass index (LVMI) was significantly higher in patients than controls [105.96 (66.45–167.24) vs 93.79 (64.25–139.25) g/m2, p=0.014]. There was a significant correlation between LVMI and serum calcium (Ca) (r=0.240, p<0.005). Myocardial performance index (MPI) was significantly higher in patients than controls [0.49 (0.35–0.60) vs 0.39 (0.33–0.62), p<0.001]. There was positive correlation between the MPI and serum Ca levels (r=0.505, p<0.001), parathyroid hormone (PTH) levels (r=0.464, p<0.001) and LVMI (r=0.270, p<0.005). When the normotensive patients and controls were evaluated, the difference between the groups remained statistically significant considering LVMI and MPI [109 (66.45–167.24) g/m2 vs 94.17 (64.25–75.10) g/m2, p=0.03; and 0.49 (0.35–0.60) vs 0.39 (0.33–0.62), p<0.01, respectively]. There were significant correlations between MPI and Ca (r=0.566, p<0.001), and PTH (r=0.472, p<0.001). Conclusions: Our study results showed that cardiac morphology and diastolic functions are altered in the patients with asymptomatic PHPT. High serum PTH and Ca levels may have an impact on these CV changes. Whether these subtle CV changes would affect cardiac systolic functions and mortality in patients with asymptomatic PHPT should be investigated in further prospective studies.
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Palmer M, Adami HO, Bergstrom R, Akerstrom G, Ljunghall S. Mortality after surgery for primary hyperparathyroidism: a follow-up of 441 patients operated on from 1956 to 1979. Surgery 1987, 102: 1–7.
Hedback G, Tisell LE, Bengtsson BA, Hedman I, Oden A. Premature death in patients operated on for primary hyperparathyroidism. World J Surg 1990, 14: 829–35.
Walgenbach S, Hommel G, Junginger T. Outcome after surgery for primary hyperparathyroidism: ten-year prospective follow-up study. World J Surg 2000, 24: 564–9.
Ogard CG, Engholm G, Almdal TP, Vestergaard H. Increased mortality in patients hospitalized with primary hyperparathyroidism during the period 1977–1993 in Denmark. World J Surg 2004, 28: 108–11.
Piovesan A, Molineri N, Casasso F, et al. Left ventricular hypertrophy in primary hyperparathyroidism — Effects of successful parathyroidectomy. Clin Endocrinol (Oxf) 1999, 50: 321–8.
Almqvist EG, Bondeson AG, Bondeson L, Nissborg A, Smedgard P, Svensson SE. Cardiac dysfunction in mild primary hyperparathyroidism assessed by radionuclide angiography and echocardiography before and after parathyroidectomy. Surgery 2002, 132: 1126–32.
Nilsson IL, Aberg J, Rastad J, Lind L. Left ventricular systolic and diastolic function and exercise testing in primary hyperparathyroidism — effects of parathyroidectomy. Surgery 2000, 128: 895–902.
Nappi S, Saha H, Virtanen V, et al. Left ventricular structure and function in primary hyperparathyroidism before and after parathyroidectomy. Cardiology 2000, 93: 229–33.
Barletta G, De Feo ML, Del Bene R, et al. Cardiovascular effects of parathyroid hormone: a study in healthy subjects and normotensive patients with mild primary hyperparathyroidism. J Clin Endocrinol Metab 2000, 85: 1815–21.
Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976, 16: 31–41.
Henry WL, DeMaria A, Gramiak R, et al. Report of the American Society of Echocardiography Committee on Nomenclature and Standards in Two-dimensional Echocardiography. Circulation 1980, 62: 212–7.
Devereux RB, Alonso DR, Lutas EM, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986, 57: 450–8.
Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005, 18: 1440–63.
Tei C, Ling LH, Hodge DO, et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function — a study in normals and dilated cardiomyopathy. J Cardiol 1995, 26: 357–66.
Stefenelli T, Abela C, Frank H, et al. Cardiac abnormalities in patients with primary hyperparathyroidism: implications for follow-up. J Clin Endocrinol Metab 1997, 82: 106–12.
Nuzzo V, Tauchmanova L, Fonderico F, et al. Increased intima-media thickness of the carotid artery wall, normal blood pressure profile and normal left ventricular mass in subjects with primary hyperparathyroidism. Eur J Endocrinol 2002, 147: 453–9.
Smogorzewski M, Zayed M, Zhang YB, et al. Parathyroid hormone increases cytosolic calcium concentration in adult rat cardiac myocytes. Am J Physiol 1993, 264: H1998–2006.
Schluter KD, Weber M, Piper HM. Parathyroid hormone induces protein kinase C but not adenylate cyclase in adult cardiomyocytes and regulates cyclic AMP levels via protein kinase C-dependent phosphodiesterase activity. Biochem J 1995, 310: 439–44.
Langle F, Abela C, Koller-Strametz J, et al. Primary hyperparathyroidism and the heart: cardiac abnormalities correlated to clinical and biochemical data. World J Surg 1994, 18: 619–24.
Bella JN, Palmieri V, Roman MJ, et al. Mitral ratio of peak early to late diastolic filling velocity as a predictor of mortality in middle-aged and elderly adults: the Strong Heart Study. Circulation 2002, 105: 1928–33.
Redfield MM, Jacobsen SJ, Burnett JC jr, Mahoney DW, Bailey KR, Rodeheffer RJ. Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA 2003, 289: 194–202.
Almqvist EG, Bondeson AG, Bondeson L, Svensson J. Increased markers of inflammation and endothelial dysfunction in patients with mild primary hyperparathyroidism. Scand J Clin Lab Invest 2011, 71: 139–44.
Shimizu Y, Uematsu M, Shimizu H, Nakamura K, Yamagishi M, Miyatake K. Peak negative myocardial velocity gradient in early diastole as a noninvasive indicator of left ventricular diastolic function: comparison with transmitral flow velocity indices. J Am Coll Cardiol 1998, 32: 1418–25.
Giannuzzi P, Imparato A, Temporelli PL, et al. Doppler-derived mitral deceleration time of early filling as a strong predictor of pulmonary capillary wedge pressure in postinfarction patients with left ventricular systolic dysfunction. J Am Coll Cardiol 1994, 23: 1630–7.
Morgan JP. Abnormal intracellular modulation of calcium asa major cause of cardiac contractile dysfunction. N Engl J Med 1991, 325: 625–32.
Bogin E, Massry SG, Harary I. Effect of parathyroid hormone on rat heart cells. J Clin Invest 1981, 67: 1215–27.
Galiuto L, Ignone G, DeMaria AN. Contraction and relaxation velocities of the normal left ventricle using pulsed-wave tissue Doppler echocardiography. Am J Cardiol 1998, 81: 609–14.
Sohn DW, Chai IH, Lee DJ, et al. Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol 1997, 30: 474–80.
Baykan M, Erem C, Erdogan T, et al. Assessment of left ventricular diastolic function and the Tei index by tissue Doppler imaging in patients with primary hyperparathyroidism. Clin Endocrinol (Oxf) 2007, 66: 483–8.
Farahnak P, Ring M, Caidahl K, Farnebo LO, Eriksson MJ, Nilsson IL. Cardiac function in mild primary hyperparathyroidism and the outcome after parathyroidectomy. Eur J Endocrinol 2010, 163: 461–7.
Walker MD, Fleischer JB, Di Tullio MR, et al. Cardiac structure and diastolic function in mild primary hyperparathyroidism. J Clin Endocrinol Metab 2010, 95: 2172–9.
Silverberg SJ, Lewiecki EM, Mosekilde L, Peacock M, Rubin MR. Presentation of asymptomatic primary hyperparathyroidism: proceedings of the Third International Workshop. J Clin Endocrinol Metab 2009, 94: 351–65.
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Yılmaz, B.A., Akyel, A., Kan, E. et al. Cardiac structure and functions in patients with asymptomatic primary hyperparathyroidism. J Endocrinol Invest 36, 848–852 (2013). https://doi.org/10.3275/8961
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DOI: https://doi.org/10.3275/8961