Changes in Echocardiographic Parameters of Cardiac Function Following Parathyroidectomy: A Meta-Analysis

Primary Hyperparathyroidism (PHPT) is associated with increased cardiovascular risk, partly driven by elevated calcium and parathyroid hormone levels that contribute to structural cardiac changes, including left ventricular hypertrophy. Parathyroidectomy is the definitive treatment for symptomatic PHPT, yet evidence on postoperative cardiac improvement remains inconsistent. This study aims to evaluate echocardiographic changes following parathyroidectomy to clarify its impact on cardiac structure and function.

We followed the PRISMA guidelines and searched through electronic databases including Medline, Embase and Cochrane. We identified a total of 24 studies encompassing data from 881 patients with PTHP undergoing parathyroidectomy with measurements of echocardiographic parameters. Echocardiographic parameters included strain, ejection fraction, relaxation time, chamber diameters and flow velocities.

Although the pooled standardized mean difference demonstrated that left ventricular ejection fraction did not undergo a statistically significant change (SMD: 0.15, 95% CI: -0.12 to 0.49, p = 0.40), global longitudinal strain exhibited a significant post‑parathyroidectomy improvement (SMD: 0.60, 95% CI: 0.37 to 0.83, p < 0.00001). Furthermore, we identified a reduction in the E/A ratio and an increase in left ventricular mass, collectively suggesting the presence of ongoing cardiac remodeling after parathyroidectomy.

Global longitudinal strain may represent a more sensitive marker of subtle improvements in left ventricular function following parathyroidectomy in patients with PHPT. Further studies are needed to determine whether this parameter confers additional prognostic value in individuals with cardiovascular disease.