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Assessment of cardiac function by echocardiography in Paget's disease of bone
A A Morales-Piga1, J L Moya, F J Bachiller
1Department of Rheumatology, Ramón y Cajal Hospital, Madrid, Spain. antonio.morales@hrc.es
Insights
Paget's disease of bone (PD) may lead to cardiac issues due to reduced peripheral vascular resistance in early stages. Increased cardiac output is influenced by bone turnover and patient age.
Area of Science:
- Cardiology
- Endocrinology
- Metabolic Bone Disease
Background:
- Paget's disease of bone (PD) is a chronic disorder characterized by abnormal bone remodeling.
- Cardiac complications, including heart failure, can occur in patients with PD.
Purpose of the Study:
- To investigate the mechanisms influencing cardiac insufficiency in Paget's disease of bone.
- To identify early indicators of cardiac involvement in PD patients.
Main Methods:
- A case-control study compared 23 untreated PD patients with 23 matched controls.
- Cardiac function was assessed using two-dimensional Doppler echocardiography.
- Biochemical markers of bone turnover (alkaline phosphatase, hydroxyproline) and serum/urine chemistries were analyzed.
Main Results:
- PD patients exhibited lower peripheral vascular resistance and higher stroke volume compared to controls.
- These differences were more pronounced in patients with extensive skeletal involvement.
- Urinary hydroxyproline excretion and age were identified as predictors of peripheral vascular resistance.
Conclusions:
- Early-stage PD shows a trend towards reduced peripheral vascular resistance.
- Sustained reduction may increase cardiac output, influenced by bone turnover and age.
- These findings highlight potential mechanisms for cardiac insufficiency in Paget's disease.
Objective:
To identify the mechanisms which influence the development of cardiac insufficiency in Paget's disease of bone (PD).
Methods:
In this hospital-based case-control study 23 consecutive, recently diagnosed and untreated PD patients were compared against 23 controls frequency-matched by sex, age and body index. All subjects underwent non-invasive assessment of cardiac function by two-dimensional Doppler echocardiography. Calcium, phosphate, and creatinine were determined in the serum and urine, along with alkaline phosphatase and hydroxyproline excretion, two biochemical parameters of PD activity.
Results:
Peripheral vascular resistance proved lower (1604.9 +/- 390.1 vs 1801.2 +/- 421.0) and the stroke volume higher in PD patients (67.2 +/- 14.4 vs 56.0 +/- 8.6; p = 0.07) compared with controls. These differences were greater (1504.7 +/- 289.9 and 71.0 +/- 6.2) and attained statistical significance (p = 0.008) when the subgroup with more extensive skeletal disease only was considered. A moderate correlation was observed between hydroxyproline excretion and the E/A ratio (r = 0.45; p = 0.03), peripheral vascular resistance (r = -0.42; p = 0.04), and diastolic arterial pressure (r = -0.42; p = 0.04). The final model obtained via multivariate analysis identified both urinary hydroxyproline and age as predictive variables linked to peripheral vascular resistance.
Conclusion:
In the early phases of PD there is a trend towards a reduction in peripheral vascular resistance. If this persists, it may lead progressively to increased cardiac output, which is mainly influenced by the degree of turnover impairment and the age of the individual.