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Cardiovascular dysfunction in symptomatic primary hyperparathyroidism and its reversal after curative
Gaurav Agarwal1, Gitika Nanda, Aditya Kapoor
1Department of Endocrine & Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Insights
Primary hyperparathyroidism (PHPT) causes significant cardiac and vascular issues. Parathyroidectomy improves these dysfunctions within six months, suggesting objective cardiovascular evaluation can enhance patient outcomes.
Area of Science:
- Cardiology
- Endocrinology
- Vascular Medicine
Background:
- Cardiovascular mortality in primary hyperparathyroidism (PHPT) is linked to myocardial and endothelial dysfunction.
- This study investigates cardiovascular dysfunction in symptomatic PHPT patients and its reversal post-parathyroidectomy.
Purpose of the Study:
- To assess cardiovascular dysfunction in symptomatic PHPT patients.
- To evaluate the reversal of this dysfunction after parathyroidectomy.
Main Methods:
- Prospective case-control study involving 56 PHPT patients and 25 controls.
- Utilized echocardiography, tissue Doppler, serum N-terminal pro-brain natriuretic peptide (s-NTproBNP), and vasodilatory response studies.
- Evaluations were conducted pre- and 3, 6 months post-parathyroidectomy.
Main Results:
- PHPT patients exhibited increased left ventricular mass, septal/posterior wall thickness, and diastolic dysfunction.
- Elevated s-NTproBNP and impaired endothelial- and smooth muscle-mediated vasodilation were observed in PHPT patients.
- Improvements in cardiac structure, function, and smooth muscle vasodilation occurred 3-6 months post-parathyroidectomy; endothelial function showed no significant improvement.
Conclusions:
- Symptomatic PHPT is associated with significant cardiac and vascular dysfunction.
- Parathyroidectomy leads to measurable improvements in cardiovascular function within six months.
- Objective cardiovascular assessment is recommended for managing symptomatic PHPT patients to potentially improve outcomes.
Background:
Cardiovascular mortality in primary hyperparathyroidism (PHPT) is attributed to myocardial and endothelial dysfunction. In this prospective, case-control study we assessed cardiovascular dysfunction in patients with symptomatic PHPT and its reversal after successful parathyroidectomy.
Methods:
Fifty-six patients with symptomatic PHPT underwent two-dimensional echocardiography, tissue Doppler (diastolic function assessment), serum N-terminal pro-brain natriuretic peptide (s-NTproBNP, a myocardial damage marker), and endothelial- and smooth muscle-dependent vasodilatory response (vascular dysfunction) studies before, 3, and 6 months after parathyroidectomy; 25 age-matched controls were studied similarly.
Results:
Patients had greater left ventricular mass (192 ± 70 vs. 149 ± 44 g; P = .006), interventricular septal thickness (10.8 ± 2.5 vs. 9.0 ± 1.6 mm; P = .001), posterior wall thickness (9.9 ± 2.0 vs. 8.6 ± 2.2 mm; P = .004), and diastolic dysfunction (lower E/A trans-mitral flow velocity ratio [1.0 ± 0.4 vs. 1.3 ± 0.4; P = .01). Patients had greater s-NTproBNP (4,625 ± 1,130 vs. 58 ± 49 pg/mL; P = .002) and lower endothelial-mediated vasodilation (9.3 ± 8.6 vs. 11.7 ± 6.3%; P = .03) and smooth muscle-mediated vasodilation (20.1 ± 17.9 vs. 23.8 ± 11.2%; P = .01). Improvements in left ventricular mass, systolic and diastolic function, and smooth muscle-mediated vasodilation were noted from 3 to 6 months after parathyroidectomy. Endothelial-mediated vasodilation did not improve significantly. S-NTproBNP levels mirrored echocardiographic changes with a substantial, sustained decrease. Results were similar in hypertensive and normotensive patients.
Conclusion:
Symptomatic PHPT patients have substantial cardiac and vascular dysfunction, which improve by 6 months after parathyroidectomy. Objective cardiovascular evaluation may improve outcomes in symptomatic PHPT patients.
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