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Normal left ventricular performance documented by Doppler echocardiography in patients with long-standing
1Metabolic Research Unit, Shriners Hospital for Crippled Children, St. Louis, Missouri 63131.
Insights
Long-standing hypocalcemia, despite causing electrocardiographic changes, does not impair left ventricular function in patients with hypoparathyroidism. Echocardiography confirmed normal cardiac performance in this study group.
Area of Science:
- Cardiology
- Endocrinology
- Calcium Metabolism
Background:
- Previous reports suggest impaired left ventricular function in chronic hypocalcemia.
- This study investigates cardiac performance in patients with hypoparathyroidism.
Purpose of the Study:
- To prospectively evaluate left ventricular function in patients with long-standing hypocalcemia.
- To determine the association between hypocalcemia and cardiac performance using echocardiography.
Main Methods:
- Prospective echocardiographic study of eight patients (aged 13-31) with hypocalcemia.
- Included Doppler, two-dimensional, and M-mode echocardiography.
- Clinical and biochemical assessments were performed concurrently.
Main Results:
- All patients had reduced total and ionized calcium levels.
- Electrocardiograms showed prolonged QTc intervals and other abnormalities in most subjects.
- Resting echocardiography revealed normal left ventricular function, ejection fraction, and cardiac output in all patients.
Conclusions:
- Long-standing hypocalcemia in patients with hypoparathyroidism is not associated with left ventricular dysfunction.
- Electrocardiographic abnormalities may be present without overt cardiac performance impairment.
Introduction:
Several reports suggest significantly reduced left ventricular performance in subjects with chronic hypocalcemia. We prospectively investigated eight patients, aged 13 to 31 years, with long-standing hypocalcemia due to idiopathic hypoparathyroidism or pseudohypoparathyroidism by echocardiography.
Patients And Methods:
Six subjects had symptomatic hypocalcemia manifested as recurrent tetany (four), seizures (four), mental retardation (three), behavior disorder (one), and skeletal abnormalities (four); three subjects were untreated when studied. None had cardiovascular symptoms. Each patient underwent clinical, biochemical, and cardiac studies, including Doppler, two-dimensional, and M-mode echocardiography, on the same day.
Results:
In serum, both total and ionized calcium concentrations were reduced and averaged 7.2 mg/dl (range: 5.3 to 8.5 mg/dl; normal: 9.0 to 10.3 mg/dl) and 3.6 mg/dl (range: 3.0 to 3.9 mg/dl; normal: 4.5 to 5.3 mg/dl), respectively. Electrocardiograms revealed prolonged QTc intervals in six patients. Also noted were prominent U waves (five), T-wave abnormalities (four), and right-axis deviation (one). Resting echocardiography, however, demonstrated normal left ventricular function in all subjects. All M-mode measurements were normal. Two-dimensional-derived left ventricular end-diastolic and end-systolic volumes were 87.1 +/- 20.1 ml and 30.2 +/- 9.7 ml (mean +/- SD), respectively. Left ventricular ejection fraction was 65 percent (61.2 to 74.7 percent). Doppler-derived cardiac output and cardiac index averaged 5.1 liters/minute (2.9 to 6.7 liters/minute) and 3.0 liters/minute/m2 (1.7 to 4.3 liters/minute/m2), respectively.
Conclusion:
Our prospective study of eight subjects with functional hypoparathyroidism demonstrated that, despite electrocardiographic abnormalities, long-standing hypocalcemia was not associated with left ventricular dysfunction.