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Primary hyperparathyroidism and the heart: cardiac abnormalities correlated to clinical and biochemical data
F Längle1, C Abela, J Koller-Strametz
1Department of Surgery, University of Vienna Medical School, Austria.
Insights
Primary hyperparathyroidism (PHP) patients show cardiac abnormalities, but clinical and biochemical data don't predict calcifications. Skeletal issues and valvular calcification correlate with left ventricular hypertrophy in PHP.
Area of Science:
- Endocrinology
- Cardiology
- Nephrology
Background:
- Primary hyperparathyroidism (PHP) is linked to increased cardiovascular disease and cardiac abnormalities.
- Cardiac manifestations include valvular/myocardial calcification and hypertrophy.
- Correlation between cardiac findings and clinical/biochemical data in PHP is not well-established.
Purpose of the Study:
- To correlate cardiac findings (calcification, hypertrophy) with clinical and biochemical data in PHP patients.
- To identify predictors of cardiac abnormalities in primary hyperparathyroidism.
Main Methods:
- Study included 132 patients with surgically verified PHP.
- Evaluated cardiac findings via echocardiography and radiography.
- Correlated findings with clinical data (symptoms, history) and biochemical data (serum calcium, phosphate, iPTH, creatinine).
Main Results:
- No statistical correlation found between clinical symptoms, biochemical data, and cardiac calcific alterations.
- Skeletal manifestations and valvular calcifications significantly correlated with left ventricular hypertrophy (p=0.005).
- PHP-related skeletal abnormalities and valvular calcification predicted left ventricular hypertrophy.
Conclusions:
- Cardiac abnormalities in PHP, like calcific deposits, do not correlate with initial laboratory findings or clinical presentation.
- Left ventricular hypertrophy, a reversible cardiac manifestation, is predicted by PHP-related skeletal abnormalities and valvular calcification.
- Myocardial hypertrophy is more common in symptomatic PHP with osseous abnormalities.
Abstract:
Comparing patients with primary hyperparathyroidism (PHP) to a normocalcemic control population, those with PHP have a higher incidence of cardiovascular disease and cardiac abnormalities. This study aimed at correlating cardiac findings (valvular and myocardial calcification, myocardial hypertrophy) with clinical data (age, sex, clinical manifestation, nephrolithiasis, nephrocalcinosis, hypertension, skeletal abnormalities, hypercalcemic syndrome) and biochemical data (serum calcium, serum phosphate, serum iPTH level, serum creatinine). A group of 132 consecutive patients with surgically verified PHP (94 women, 38 men; ages 15-86, mean age 57 +/- 16 years) were included in this study. Blood chemistry, clinical presentation, radiography, and echocardiography were carried out in all patients for univariate and multivariate analyses of all parameters. There was no statistical correlation between clinical symptoms, biochemical data, and cardiac calcific alterations. Typical skeletal manifestations (osteolysis/subperiostal resorption) and valvular calcifications were significantly correlated to left ventricular hypertrophy (p = 0.005). Cardiac abnormalities such as calcific myocardial deposits or mitral and aortic valvular calcifications do not correlate with laboratory findings and clinical presentation at the time of diagnosis. There was no biochemical or clinical variable that could predict the frequency or severity of valvular sclerosis or calcific deposits in the myocardium. However, PHP-related skeletal abnormalities and valvular calcification were predicting factors for left ventricular hypertrophy, a reversible cardiac manifestation of PHP. Myocardial hypertrophy is more often found with classic symptomatic PHP with osseous abnormalities.