Cardiac function in mild primary hyperparathyroidism and the outcome after parathyroidectomy

P Farahnak, M Ring, K Caidahl, L-O Farnebo, M J Eriksson, I-L Nilsson, P Farahnak, M Ring, K Caidahl, L-O Farnebo, M J Eriksson, I-L Nilsson

Abstract

Objective: Primary hyperparathyroidism (PHPT) is associated with cardiovascular morbidity. The extent of cardiovascular abnormalities in patients with mild-asymptomatic disease is unclear. Using sensitive echocardiographic methods, we compared cardiac structure and function in patients with mild PHPT and in healthy controls, and evaluated the changes after parathyroidectomy (PTX).

Methods: In a prospective case-control design, we studied 51 PHPT patients without any cardiovascular risk factors/diseases and 51 healthy matched controls. Cardiac structure, and systolic and diastolic function were evaluated by echocardiography and Doppler tissue imaging (DTI). Blood pressure (BP) and heart rate were measured.

Results: We observed no differences in systolic or diastolic function or in cardiac morphology between the PHPT patients and the age-matched healthy controls. The regional peak systolic myocardial velocities (S') measured with DTI decreased at all sites (P<0.05) after PTX (tricuspid annulus 14.23+/-1.85 to 13.48+/-1.79, septal 8.48+/-0.96 to 7.97+/-0.85, and lateral 9.61+/-2.05 to 8.87+/-1.63 cm/s, part of the mitral annulus). At baseline, systolic BP was higher in patients compared to controls (127.6+/-17.1 vs 119.6+/-12.6 mmHg, P<0.05). After PTX, both systolic (127.6+/-17.1 vs 124.6+/-16.6 mmHg, P<0.05) and diastolic (80.3+/-9.6 vs 78.4+/-8.6 mmHg, P<0.05) BP decreased.

Conclusions: Our results indicate that patients with PHPT without cardiovascular risk factors have a normal global systolic and diastolic function and cardiac morphology. BP and the systolic velocities were marginally reduced after PTX, but reflected the values of the control group. Our findings warrant further investigation of the clinical and prognostic significance of these possibly disease-related inotropic effects.

Figures

Figure 1
Figure 1
Systolic blood pressure for the whole group of PHPT patients and the healthy control subjects was correlated to (a) the PTH level (r=0.26; P<0.01) and to (b) the ionized calcium level (r=0.25; P<0.05).

References

    1. Marx SJ. Hyperparathyroid and hypoparathyroid disorders. New England Journal of Medicine. 2000;343:1863–1875.
    1. Lundgren E, Hagstrom EG, Lundin J, Winnerback K, Roos J, Ljunghall S, Rastad J. Primary hyperparathyroidism revisited in menopausal women with serum calcium in the upper normal range at population-based screening 8 years ago. World Journal of Surgery. 2002;26:931–936.
    1. Bilezikian JP, Khan AA, Potts JT., Jr Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the third international workshop. Journal of Clinical Endocrinology and Metabolism. 2009;94:335–339.
    1. Barletta G, De Feo ML, Del Bene R, Lazzeri C, Vecchiarino S, La Villa G, Brandi ML, Franchi F. Cardiovascular effects of parathyroid hormone: a study in healthy subjects and normotensive patients with mild primary hyperparathyroidism. Journal of Clinical Endocrinology and Metabolism. 2000;85:1815–1821.
    1. Dalberg K, Brodin LA, Juhlin-Dannfelt A, Farnebo LO. Cardiac function in primary hyperparathyroidism before and after operation. An echocardiographic study. European Journal of Surgery. 1996;162:171–176.
    1. Hagstrom E, Lundgren E, Lithell H, Berglund L, Ljunghall S, Hellman P, Rastad J. Normalized dyslipidaemia after parathyroidectomy in mild primary hyperparathyroidism: population-based study over five years. Clinical Endocrinology. 2002;56:253–260.
    1. Nilsson IL, Aberg J, Rastad J, Lind L. Endothelial vasodilatory dysfunction in primary hyperparathyroidism is reversed after parathyroidectomy. Surgery. 1999;126:1049–1055.
    1. Piovesan A, Molineri N, Casasso F, Emmolo I, Ugliengo G, Cesario F, Borretta G. Left ventricular hypertrophy in primary hyperparathyroidism. Effects of successful parathyroidectomy. Clinical Endocrinology. 1999;50:321–328.
    1. Stefenelli T, Abela C, Frank H, Koller-Strametz J, Globits S, Bergler-Klein J, Niederle B. Cardiac abnormalities in patients with primary hyperparathyroidism: implications for follow-up. Journal of Clinical Endocrinology and Metabolism. 1997;82:106–112.
    1. Walker MD, Silverberg SJ. Cardiovascular aspects of primary hyperparathyroidism. Journal of Endocrinological Investigation. 2008;31:925–931.
    1. Yu N, Donnan PT, Flynn RWV, Murphy MJ, Smith D, Rudman A, Graham PL. Increased mortality and morbidity in mild primary hyperparathyroid patients. Clinical Endocrinology. 2010;(73):30–34.
    1. Bollerslev J, Rosen T, Mollerup CL, Nordenstrom J, Baranowski M, Franco C, Pernow Y, Isaksen GA, Godang K, Ueland T, Jansson S. Effect of surgery on cardiovascular risk factors in mild primary hyperparathyroidism. Journal of Clinical Endocrinology and Metabolism. 2009;94:2255–2261.
    1. Lundgren E, Lind L, Palmer M, Jakobsson S, Ljunghall S, Rastad J. Increased cardiovascular mortality and normalized serum calcium in patients with mild hypercalcemia followed up for 25 years. Surgery. 2001;130:978–985.
    1. Nilsson IL, Yin L, Lundgren E, Rastad J, Ekbom A. Clinical presentation of primary hyperparathyroidism in Europe – nationwide cohort analysis on mortality from nonmalignant causes. Journal of Bone and Mineral Research. 2002;17(Suppl 2):N68–N74.
    1. Soreide JA, van Heerden JA, Grant CS, Yau Lo C, Schleck C, Ilstrup DM. Survival after surgical treatment for primary hyperparathyroidism. Surgery. 1997;122:1117–1123.
    1. Wermers RA, Khosla S, Atkinson EJ, Grant CS, Hodgson SF, O'Fallon WM, Melton LJ., III Survival after the diagnosis of hyperparathyroidism: a population-based study. American Journal of Medicine. 1998;104:115–122.
    1. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ. 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. Journal of the American Society of Echocardiography. 2005;18:1440–1463.
    1. Sahn DJ, DeMaria A, Kisslo J, Weyman A. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation. 1978;58:1072–1083.
    1. Levy D, Savage DD, Garrison RJ, Anderson KM, Kannel WB, Castelli WP. Echocardiographic criteria for left ventricular hypertrophy: the Framingham Heart Study. American Journal of Cardiology. 1987;59:956–960.
    1. Govind S, Brodin LA, Nowak J, Quintana M, Raumina S, Ramesh SS, Keshava R, Saha S. Isolated type 2 diabetes mellitus causes myocardial dysfunction that becomes worse in the presence of cardiovascular diseases: results of the myocardial doppler in diabetes (MYDID) study 1. Cardiology. 2005;103:189–195.
    1. 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.
    1. Innelli P, Esposito R, Olibet M, Nistri S, Galderisi M. The impact of ageing on right ventricular longitudinal function in healthy subjects: a pulsed tissue Doppler study. European Journal of Echocardiography. 2009;10:491–498.
    1. Innelli P, Sanchez R, Marra F, Esposito R, Galderisi M. The impact of aging on left ventricular longitudinal function in healthy subjects: a pulsed tissue Doppler study. European Journal of Echocardiography. 2008;9:241–249.
    1. 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;132:1126–1132. discussion 1132.
    1. Cook NR, Cohen J, Hebert PR, Taylor JO, Hennekens CH. Implications of small reductions in diastolic blood pressure for primary prevention. Archives of Internal Medicine. 1995;155:701–709.
    1. Baykan M, Erem C, Erdogan T, Ersoz HO, Gedikli O, Korkmaz L, Kucukosmanoglu M, Haclhasanoglu A, Kaplan S, Celik S. Assessment of left ventricular diastolic function and the Tei index by tissue Doppler imaging in patients with primary hyperparathyroidism. Clinical Endocrinology. 2007;66:483–488.
    1. Kamycheva E, Sundsfjord J, Jorde R. Serum parathyroid hormone levels predict coronary heart disease: the Tromso Study. European Journal of Cardiovascular Prevention and Rehabilitation. 2004;11:69–74.
    1. Bergenfelz A, Lindblom P, Lindergard B, Valdemarsson S, Westerdahl J. Preoperative normal level of parathyroid hormone signifies an early and mild form of primary hyperparathyroidism. World Journal of Surgery. 2003;27:481–485.
    1. Walker MD, Fleischer J, Rundek T, McMahon DJ, Homma S, Sacco R, Silverberg SJ. Carotid vascular abnormalities in primary hyperparathyroidism. Journal of Clinical Endocrinology and Metabolism. 2009;94:3849–3856.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi