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Cardiac function in primary hyperparathyroidism before and after operation. An echocardiographic study
K Dalberg1, L A Brodin, A Juhlin-Dannfelt
1Department of Surgery, Karolinska Hospital, Karolinska Institute, Stockholm, Sweden.
Insights
Primary hyperparathyroidism is linked to early left ventricular dysfunction, indicated by impaired diastolic filling. Echocardiography reveals these changes, which may explain increased cardiovascular risks in affected patients.
Area of Science:
- Cardiology
- Endocrinology
- Medical Research
Background:
- Primary hyperparathyroidism is associated with increased cardiovascular morbidity and mortality.
- The underlying mechanisms for these cardiovascular complications remain incompletely understood.
Purpose of the Study:
- To investigate potential causes of elevated cardiovascular risk in patients with primary hyperparathyroidism.
- To assess cardiac function using echocardiography in these patients.
Main Methods:
- A prospective, blind study was conducted at a university hospital.
- 44 patients with primary hyperparathyroidism and 23 controls underwent echocardiography before and one year after parathyroid surgery.
- Blood pressure and echocardiographic parameters, including mitral flow velocity (E:A ratio), were analyzed.
Main Results:
- Preoperatively, hyperparathyroid patients exhibited higher blood pressure and left atrial diameter compared to controls.
- A significantly lower E:A ratio was observed in hyperparathyroid patients, indicating impaired left ventricular diastolic filling.
- Cardiac calcifications were present in both groups, with no significant improvement in cardiac function one year post-surgery, except for reduced systolic blood pressure.
Conclusions:
- Echocardiographic findings suggest early left ventricular dysfunction in primary hyperparathyroidism.
- These diastolic dysfunction abnormalities may contribute to the clinical cardiovascular complications observed in these patients.
Objective:
To identify possible causes for the increased cardiovascular morbidity and mortality seen in patients with primary hyperparathyroidism.
Design:
Prospective, blind study.
Setting:
University hospital, Sweden.
Subjects:
44 Patients with primary hyperparathyroidism and 23 (sex and age matched) control patients with atoxic nodular goitres.
Interventions:
Exploration of the neck with removal of pathological parathyroid glands or thyroid resection. Echocardiography before, and one year after, the operation.
Main Outcome Measures:
Blood pressure and echocardiographic findings.
Results:
Hyperparathyroid patients had higher blood pressure and greater left atrial diameter than control patients preoperatively. They also had a significantly lower E:A ratio (mitral flow velocity pattern) than the controls (p = 0.02) indicating a disturbance in early diastolic filling of the left ventricle. The E:A ratio correlated negatively with the systolic blood pressure. 19 of the hyperparathyroid patients (43%) had cardiac calcifications as did 14 (61%) of the controls. Most of calcifications were located in the aortic and mitral valves; only a few patients had calcifications in the myocardium. No significant changes had occurred one year after parathyroidectomy, except for a reduction in systolic blood pressure, in the hyperparathyroid patients.
Conclusion:
Echocardiographic investigation of patients with primary hyperparathyroidism shows early signs of left ventricular dysfunction that may be of clinical importance.