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Cardiac structural and functional abnormalities in primary hyperparathyroidism

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Abstract

Purpose

Studies on cardiac structural and functional abnormalities in primary hyperparathyroidism (PHPT) have yielded conflicting and inconsistent results. In this prospective case–control study, we sought to compare cardiac structure and function in symptomatic PHPT patients and controls.

Methods

One hundred consecutive symptomatic PHPT patients and 113 matched controls underwent echocardiographic evaluation by the same operator.

Results

Left ventricular mass index (LVMI) was significantly higher in patients as compared to controls, (median of 90.95 g/m2 vs 86.5 g/m2, p = 0.041). Patients had significantly lower early trans-mitral diastolic flow (E velocity) as compared to controls (57.13 ± 14.88 vs 64.76 ± 15.45 cm/s, p < 0.001). Patients also had significantly lower early to late mitral annular velocity (E/A) as compared to controls (0.98 ± 0.37 vs 1.10 ± 0.34, p 0.013). Patients had higher frequency of aortic valve calcification (29% vs 2.65%, p < 0.001), mitral annular calcification (23% vs. 4.42%, p < 0.001), myocardial and septal calcifications (25% vs none, p < 0.001) as compared to controls. Serum PTH, calcium and uric acid significantly correlated with calcifications. Serum calcium showed a negative correlation with E/A ratio.

Conclusions

Symptomatic patients with PHPT have substantial cardiac structural and functional abnormalities. These abnormalities include elevated LVMI, diastolic dysfunction, and aortic valve, mitral annular, septal and myocardial calcifications. We strongly suggest and conclude that the evaluation of PHPT patients should not only include traditional end organs like bones and kidneys but also the cardiovascular system in the form of echocardiography to detect subclinical cardiac dysfunction so that the cardiovascular health of such patients can be optimized.

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Funding

No funding was received for the study.

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Authors and Affiliations

  1. Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India

    S. Purra, M. H. Bhat, R. A. Misgar, A. I. Wani, M. I. Bashir & S. R. Masoodi

  2. Department of Cardiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India

    A. A. Lone

  3. Department of Medicine, Government Medical College Srinagar, Srinagar, Jammu and Kashmir, India

    W. Purra

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  1. S. Purra
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  2. A. A. Lone
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Contributions

RAM, MIB, AIW and SRM conceptualized the study and oversaw the data. SP, MHB, and WP collected the data. AIW, ALL and RAM analyzed the data. RAM and MHB prepared the manuscript. All the authors reviewed and edited the manuscript and contributed the discussion. All the authors have read and approved the manuscript.

Corresponding author

Correspondence to R. A. Misgar.

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The authors declare they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study that was approved by the Hospital Ethics Committee.

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Purra, S., Lone, A.A., Bhat, M.H. et al. Cardiac structural and functional abnormalities in primary hyperparathyroidism. J Endocrinol Invest 45, 327–335 (2022). https://doi.org/10.1007/s40618-021-01645-x

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