Hypocalcemic cardiomyopathy - A rare and reversible entity

Cardiovascular status in chronic hypoparathyroidism: a systematic cross-sectional assessment in 168 patients

OBJECTIVE

Long-term complications such as renal diseases are well known in patients with chronic hypoparathyroidism (hypoPT), but risk of cardiovascular comorbidity remains less clear. This study comprehensively assessed cardiovascular parameters in hypoPT compared to matched controls.

DESIGN

Cross-sectional cohort study involving 168 patients with chronic hypoPT.

METHODS

Patients underwent electrocardiograms, blood pressure measurements, and echocardiography. A 1:3 propensity score matching was performed with individuals from the German population-based Study of Health in Pomerania (SHIP-TREND) and the "Characteristics and Course of Heart Failure Stages A-B" (STAAB) cohort.

RESULTS

HypoPT showed significantly higher systolic (128 vs 125 mm Hg, P = .02) and diastolic blood pressures (83 vs 77 mm Hg, P < .01). Intake of antihypertensives was similar between groups. The QTc interval was markedly prolonged (438 vs 420 ms, P < .01) with QTc interval prolongation occurring significantly more frequently in hypoPT (24% vs 6%, P < .01). Interestingly, echocardiography revealed significantly lower left ventricular mass index (28 vs 43 g/m2.7, P < .01) and less frequent left ventricular hypertrophy (7%% vs 41%, P < .01) in hypoPT but comparable left ventricular ejection fraction (P = .48). HypoPT patients had higher prevalence of mitral (20 vs 0%, P < .01) and aortic valve stenoses (7 vs 2%, P < .01). Comparison with STAAB confirmed the increased prevalence of arterial hypertension and reduced myocardial mass indices.

CONCLUSIONS

Patients with hypoPT exhibit a higher prevalence of QTc interval prolongation despite established therapy and an increased incidence of hypertension. Conversely, echocardiography revealed lower left ventricular mass and less frequent left ventricular hypertrophy in hypoPT, but higher prevalence of valve stenosis. Regular monitoring of hypertension, QTc interval prolongation, and valve stenosis is recommended to reduce the risk of cardiovascular diseases.

CLINICAL TRIAL REGISTRATION NUMBER

NCT05585593.

Delayed onset of non-cardiogenic pulmonary oedema following amlodipine overdose

Amlodipine, a widely used antihypertensive medication, can cause serious complications in overdose, including hypotension, bradycardia, non-cardiogenic pulmonary oedema (NCPO) and death. This report describes a young adult woman who ingested 100 mg of amlodipine in a polypharmacy suicide attempt. Although she initially stabilised, she unexpectedly developed delayed NCPO 3 days post ingestion, requiring intubation and intensive care unit readmission. She recovered fully with supportive care and was discharged in good health. This case highlights the importance of prolonged monitoring and vigilance in managing long-acting calcium channel blocker overdoses, even when the initial clinical response appears satisfactory.

Hypocalcemic cardiomyopathy: A case report

Hypocalcemia and its related symptoms are common manifestations in postsurgical hypoparathyroidism, but patients with hypocalcemia manifested as heart failure is rare and few cases are reported in the literature. Here we reported a 58-year-old female with hypoparathyroidism and uncontrolled hypocalcemia after thyroidectomy, presented with acute heart failure, accompanied with enlargement and reduced ejection fraction of left ventricle. She was refractory to guideline-directed medical therapy for heart failure including digitalis and diuretics. However, her symptoms resolved and cardiac function improved dramatically after normalization of serum calcium level. This rare case highlights the pivotal role of calcium in maintaining cardiac function and the importance of treating underlying reversible causes of heart failure. For patients with hypoparathyroidism, it is essential to get standard treatment to avoid development of heart failure and hypocalcemia related syndromes.

Lower Risk of Cardiovascular Events in Adult Patients with Chronic Hypoparathyroidism Treated with rhPTH(1-84): A Retrospective Cohort Study

Introduction

Patients with chronic hypoparathyroidism are at increased risk of cardiovascular disease. This study evaluated the risk of developing cardiovascular conditions over a period of 5 years in adult patients with chronic hypoparathyroidism treated with recombinant human parathyroid hormone (1–84), rhPTH(1–84), compared with a historical control cohort of patients not treated with rhPTH(1–84).

Methods

This retrospective cohort study comprised patients with chronic hypoparathyroidism treated with rhPTH(1–84) in the REPLACE (NCT00732615), RELAY (NCT01268098), and RACE (NCT01297309) clinical trials, and controls selected from the IBM^® Explorys electronic medical record database (January 2007–August 2019) who did not receive parathyroid hormone but who had enrollment criteria similar to those for the clinical trials. Cardiovascular outcomes were the first diagnosis of cerebrovascular, coronary artery, peripheral vascular disease, or heart failure during the study period.

Results

We evaluated 113 adult patients with chronic hypoparathyroidism treated with rhPTH(1–84) and 618 control patients who did not receive rhPTH(1–84). Over the 5-year follow-up period, 3.5% of patients (n = 4) in the rhPTH(1–84) cohort had a cardiovascular event compared with 16.3% (n = 101) in the control cohort. Kaplan–Meier analysis demonstrated that patients in the rhPTH(1–84) cohort had lower risk of experiencing a cardiovascular event compared with patients in the control cohort (P = 0.005). Multivariable analyses adjusted for baseline variables showed that patients in the rhPTH(1–84) cohort had 75% lower risk for a cardiovascular event compared with patients in the control cohort (adjusted hazard ratio, 0.25 [95% CI 0.08–0.81]; P = 0.020).

Conclusion

Long-term treatment with rhPTH(1–84) was associated with a lower risk of incident cardiovascular conditions compared with conventional therapy in patients with chronic hypoparathyroidism. Previous studies demonstrated that mineral homeostasis was maintained with lower use of calcium and active vitamin D when rhPTH(1–84) was added to conventional therapy. Future studies are needed to understand whether improved regulation of mineral homeostasis conferred by rhPTH(1–84) may provide long-term cardiovascular benefits to patients with chronic hypoparathyroidism.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12325-022-02198-y.