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Curative Parathyroidectomy in Primary Hyperparathyroidism Improves Both Systolic and Diastolic Cardiac Dysfunction: A
Ajaz Qadir1, Sameer Purra2, Raiz Ahmad Misgar1
1Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, J&K, India.
Insights
Parathyroidectomy (PTX) significantly improves cardiovascular function in patients with primary hyperparathyroidism (PHPT). This includes enhanced systolic function, as measured by global longitudinal strain (GLS), benefiting overall heart health.
Area of Science:
- Cardiology
- Endocrinology
- Echocardiography
Background:
- Primary hyperparathyroidism (PHPT) is linked to cardiovascular issues like hypertension and left ventricular hypertrophy, increasing mortality.
- While diastolic dysfunction in PHPT is known, data on systolic dysfunction and its recovery post-parathyroidectomy (PTX) is limited.
Purpose of the Study:
- To assess the impact of PTX on cardiovascular parameters in PHPT patients.
- Specifically evaluate the improvement in systolic dysfunction using conventional and speckle-tracking echocardiography (STE).
Main Methods:
- Prospective study of 59 PHPT patients undergoing successful PTX.
- Preoperative and 6-month postoperative evaluations included biochemical tests and echocardiography.
- Global longitudinal strain (GLS) assessed via STE to evaluate systolic function.
Main Results:
- Curative PTX normalized serum calcium and phosphorus, reducing PTH and other markers.
- Significant improvements observed in diastolic parameters (E velocity, E/A ratio).
- Systolic function improved, with reduced LV mass, improved EF, and enhanced GLS post-PTX. GLS proved more sensitive than EF for detecting systolic improvement.
Conclusions:
- Parathyroidectomy significantly improves both diastolic and systolic cardiac functions in PHPT patients.
- The findings support PTX as beneficial for cardiovascular health in PHPT.
- STE, particularly GLS, is valuable for assessing systolic function changes after PTX.
Background:
Primary hyperparathyroidism (PHPT) is associated with hypertension, left ventricular hypertrophy, and myocardial and valvular calcifications, leading to increased mortality rates. While the association between PHPT and diastolic dysfunction has been well-documented, data on systolic dysfunction and its reversal after curative parathyroidectomy (PTX) remains limited.
Purpose:
To evaluate the effect of PTX on cardiovascular parameters, especially systolic dysfunction, in PHPT patients using conventional and speckle-tracking echocardiography (STE).
Methods:
This prospective study was conducted at a tertiary care hospital from August 2016 to September 2019; 59 patients underwent successful PTX based on standard criteria, with 58 completing the study. Preoperative and 6-month postoperative biochemical and cardiovascular evaluations, including echocardiography, were performed. Global longitudinal strain (GLS) was assessed using speckle-tracking echocardiography (STE).
Results:
The mean age of subjects was 45.2 ± 10.4 years with a male-to-female ratio of 1.5:1. Normalization of serum calcium and phosphorus with significant reductions in serum intact PTH, alkaline phosphate, total cholesterol, HDL, and uric acid levels (p ≤ 0.0001) were seen after curative PTX. Echocardiographic evaluations significantly improved diastolic parameters, including E velocity (cm/s) and E/A(atrial) ratio. Systolic dysfunction also showed significant improvement on conventional echocardiography and STE, as evidenced by reduced left ventricular (LV) mass, ejection fraction (EF), and postoperative GLS. Although a relative drop in EF was noted postprocedure, STE findings suggested a significant improvement in systolic dysfunction, signifying GLS as a more appropriate means of assessing systolic dysfunction. Serum PTH demonstrated a strong positive correlation (r = 0.638, p < 0.001) with changes in GLS, while serum calcium showed a weak correlation (r = 0.291, p = 0.027) with changes in GLS following surgery.
Conclusion:
This study demonstrates significant improvements in diastolic and systolic functions, as evidenced by conventional echocardiography and STE, and suggests that PTX benefits cardiovascular health in PHPT patients.
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