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Updated: Dec 22, 2025
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
The effect of successful parathyroid surgery on left ventricle function in patients with primary hyperparathyroidism
Ahmet Atasever1, Emre Özdemir2, Turan Acar1
1General Surgery Clinic, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey.
Insights
Primary hyperparathyroidism (PHP) can impair cardiac systolic function, even in asymptomatic patients. Surgical treatment improved global longitudinal strain (GLS) detected by strain echocardiography, suggesting its value in managing PHP cardiac complications.
Area of Science:
- Cardiology
- Endocrinology
- Medical Imaging
Background:
- Primary hyperparathyroidism (PHP) is a common cause of hypercalcemia with known cardiac complications like arrhythmia and hypertrophy.
- Existing data on cardiac systolic function and surgical treatment effects in PHP are limited.
- This study investigates the impact of surgery on left ventricular systolic function in PHP patients using strain echocardiography.
Purpose of the Study:
- To evaluate postoperative changes in left ventricular systolic function in patients with primary hyperparathyroidism (PHP).
- To compare strain echocardiography (STE) parameters, specifically global longitudinal strain (GLS) and global circumferential strain (GCS), before and after surgical intervention.
- To determine if STE can detect subclinical myocardial dysfunction in PHP patients that may not be apparent with conventional echocardiography.
Main Methods:
- Prospective study of 29 patients with primary hyperparathyroidism (PHP).
- Echocardiographic assessments, including conventional and strain echocardiography (STE), were performed preoperatively and 6 months post-surgery.
- Preoperative and postoperative STE parameters (GLS, GCS) were compared; patients with specific exclusions were not included.
Main Results:
- No significant change was observed in ejection fraction post-surgery.
- Global longitudinal strain (GLS) significantly improved from 18.53 ± 3.06 preoperatively to 20.25 ± 3.89 at 6 months post-surgery (P = .004).
- Other echocardiographic parameters showed no significant changes.
Conclusions:
- Global longitudinal strain (GLS) values deteriorated preoperatively and improved post-surgery, indicating subclinical systolic dysfunction in PHP.
- Strain echocardiography (STE) may detect early myocardial dysfunction in asymptomatic PHP patients, potentially offering a new treatment indication.
- Further extensive studies with longer follow-up are needed due to limited current literature.
Background:
Hyperparathyroidism (PHP) is the most common cause of hypercalcemia in outpatients. It is characterized by many cardiac complications including chronic cardiac arrhythmia, hypertrophy, and diastolic insufficiency. However, there are insufficient data about the cardiac systolic function in PHP. Data regarding the positive effects of surgical treatment on cardiac complications are limited and inadequate. The aim of this study was to evaluate the postoperative changes in the left ventricle functions of patients with PHP using strain echocardiography (STE) instead of traditional echocardiographic evaluation.
Methods:
This prospective study included 29 patients with PHP. Detailed echocardiographic evaluations were made including conventional and STE' ventricle function preoperatively and at 6 months after surgery. Then, preoperative and postoperative STE changes, global longitudinal (GLS) and circumferential strain (GCS), were compared. Patients with recurrent surgery, poor echogenicity, and comorbid conditions affecting STE were excluded.
Results:
No significant change was determined in ejection fraction in the period from preoperative to 6 months postoperative (P > .05). The GLS value increased from 18.53 ± 3.06 to 20.25 ± 3.89, to a statistically significant level (P = .004). The other echocardiographic parameters remained unchanged for the same patients.
Conclusion:
Despite normal 2D echocardiography data, it was determined that the GLS values deteriorated preoperatively and improved by the 6th postoperative month. The detection of early disorders in PHP that cannot be detected on 2D echocardiography, even in asymptomatic patients, may suggest a new treatment indication. For asymptomatic PHP patients, strain echocardiography may be more valuable than 2D echocardiographic evaluation to determine myocardial dysfunction. The recent literature is insufficient, and there is a need for further, more extensive studies with longer follow-up periods.
