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Secondary hyperparathyroidism in adult congenital heart disease: the CHD-HYPER-study

Friederike Löffler1, Justus Christian Garlichs1, Kirsten Linhorst1

  • 1Department of Cardiology and Angiology, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, Hannover 30625, Germany.

European Heart Journal Open
|November 12, 2025
PubMed

Insights

Secondary hyperparathyroidism (sHPT) affects 14.9% of adults with congenital heart disease (ACHD), particularly those with complex conditions. Factors like kidney function and vitamin D levels influence sHPT development in ACHD patients.

Area of Science:

  • Cardiology
  • Endocrinology
  • Internal Medicine

Background:

  • Secondary hyperparathyroidism (sHPT) is linked to adverse outcomes in non-congenital heart disease.
  • The prevalence and predictors of sHPT in adults with congenital heart disease (ACHD) are not well understood.

Purpose of the Study:

  • To determine the prevalence of sHPT in a large ACHD cohort.
  • To identify independent predictors of sHPT in ACHD patients, considering biventricular physiology.

Main Methods:

  • Cross-sectional, single-centre study of 754 ACHD patients.
  • Assessed sHPT prevalence and identified independent predictors using multivariate analysis.
  • Analyzed predictors in the entire cohort and specifically in those with biventricular physiology.

Main Results:

  • A high prevalence of sHPT (14.9%) was found in ACHD patients.
  • Higher sHPT rates were observed in patients with Eisenmenger syndrome/PAH-CHD, Ebstein's anomaly, Fontan palliation, and pulmonary atresia.
  • sHPT was more common in univentricular (29.6%) versus biventricular physiology (13.3%).
  • Independent predictors included glomerular filtration rate, 25-hydroxyvitamin D₃ levels, loop diuretic use, oxygen saturation, and liver stiffness.
  • Right ventricular free wall longitudinal strain, not left ventricular strain, was associated with sHPT in biventricular physiology.

Conclusions:

  • sHPT is prevalent across the ACHD spectrum.
  • sHPT is more common in patients with complex and severe ACHD, especially those with right heart involvement.
  • Predictors of sHPT in ACHD involve renal function, vitamin D status, medication use, oxygenation, and cardiac strain.
Abstract

Keywords:
Adult congenital heart diseaseHeart failureHyperparathyroidismParathyroid hormoneRight heart diseaseVitamin D deficiency

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