The effect of successful parathyroid surgery on left ventricle function in patients with primary hyperparathyroidism evaluated with strain echocardiography

Curative Parathyroidectomy in Primary Hyperparathyroidism Improves Both Systolic and Diastolic Cardiac Dysfunction: A Six-Month Follow-Up Study at a Tertiary Care Hospital

BACKGROUND

Primary hyperparathyroidism (PHPT) is associated with hypertension, left ventricular hypertrophy, and myocardial and valvular calcifications, leading to increased mortality rates. While the association between PHPT and diastolic dysfunction has been well-documented, data on systolic dysfunction and its reversal after curative parathyroidectomy (PTX) remains limited.

PURPOSE

To evaluate the effect of PTX on cardiovascular parameters, especially systolic dysfunction, in PHPT patients using conventional and speckle-tracking echocardiography (STE).

METHODS

This prospective study was conducted at a tertiary care hospital from August 2016 to September 2019; 59 patients underwent successful PTX based on standard criteria, with 58 completing the study. Preoperative and 6-month postoperative biochemical and cardiovascular evaluations, including echocardiography, were performed. Global longitudinal strain (GLS) was assessed using speckle-tracking echocardiography (STE).

RESULTS

The mean age of subjects was 45.2 ± 10.4 years with a male-to-female ratio of 1.5:1. Normalization of serum calcium and phosphorus with significant reductions in serum intact PTH, alkaline phosphate, total cholesterol, HDL, and uric acid levels (p ≤ 0.0001) were seen after curative PTX. Echocardiographic evaluations significantly improved diastolic parameters, including E velocity (cm/s) and E/A(atrial) ratio. Systolic dysfunction also showed significant improvement on conventional echocardiography and STE, as evidenced by reduced left ventricular (LV) mass, ejection fraction (EF), and postoperative GLS. Although a relative drop in EF was noted postprocedure, STE findings suggested a significant improvement in systolic dysfunction, signifying GLS as a more appropriate means of assessing systolic dysfunction. Serum PTH demonstrated a strong positive correlation (r = 0.638, p < 0.001) with changes in GLS, while serum calcium showed a weak correlation (r = 0.291, p = 0.027) with changes in GLS following surgery.

CONCLUSION

This study demonstrates significant improvements in diastolic and systolic functions, as evidenced by conventional echocardiography and STE, and suggests that PTX benefits cardiovascular health in PHPT patients.

Effect of surgical treatment on left ventricular strain in patients with primary hyperparathyroidism: A meta-analysis of echocardiographic study

AIM

Current evidence on the effects of parathyroidectomy (PTX) on myocardial deformation in patients with primary hyperparathyroidism (PHPT) is scanty and based on a few studies. The aim of this meta-analysis was to provide a comprehensive and updated information on this issue.

DATA SYNTHESIS

Following the PRISMA guidelines, systematic searches were conducted across bibliographic databases (Pub-Med, OVID, EMBASE and Cochrane library) to identify eligible studies from inception up to September 30th, 2024. Searches were limited to clinical investigations published in English reporting data on LV mechanics (i.e. global longitudinal strain, GLS) in patients with PHPT before and after PTX. The statistical difference of the echocardiographic variables of interest collected at baseline and after PTX, such as left ventricular ejection fraction (LVEF) and GLS was calculated by standardized mean difference (SMD) with 95 % confidence interval (CI) by using random-effects models. Four studies including 126 patients with PHPT undergoing PTX, in whom LV mechanics had been assessed by speckle tracking echocardiography before and after six months from surgery, were considered. Baseline pooled average LVEF values were 59.5 ± 1.7 % and corresponding values after PTX 60.3 ± 1.2 %, (SMD: 0.16 ± 0.09, CI: -0.01/0.34, p = 0.07). Baseline and after surgical procedure values for GLS were -18.9 ± 0.28 % and -20.4 + 0.28 %, (SMD: 0.55 ± 0.10, CI: 0.37/0.74, p < 0.001). Meta-regression analysis showed a significant relationship between changes in serum PTH and GLS (p = 0.004).

CONCLUSIONS

Our findings suggest that PTX impacts favourably on LV mechanics, and, more importantly, the assessment of LV changes in this setting should include GLS and no longer rely on conventional echocardiographic parameters such as LVEF.

Assessment of left ventricular dysfunction by strain echo in primary hyperparathyroidism and its reversal after parathyroidectomy

BACKGROUND

Strain echocardiography is a highly sensitive modality for detecting myocardial disease at an early stage. Therefore, we aim to evaluate subclinical left ventricular dysfunction in primary hyperparathyroidism (PHPT) patients with myocardial strain imaging in addition to conventional echocardiography and to look for its reversal after parathyroidectomy (PTx).

METHODS

Thirty patients who underwent curative parathyroidectomy for PHPT were included. All patients were evaluated with M mode echo, 2D echo and strain imaging before and 6 months after PTx. Left ventricular ejection fraction, left ventricular diastolic dysfunction, left ventricular hypertrophy (LVH), Global Longitudinal Strain (GLS) and global circumferential strain (GCS) were recorded.

RESULTS

On M mode echo, LVH was present in 15 patients and 8 of them improved completely after PTx (p < 0.038). Incidence of systolic and diastolic dysfunction on 2D echo was 10% and 13.3% respectively; while myocardial strain imaging showed impaired systolic function in 46.7% patients. Hence, compared to conventional 2D echo, strain imaging showed 36.7% high detection rate of subnormal cardiac function. There was improvement in left ventricle dysfunction (p = 0.083), GLS and GCS (p = 0.034) after PTx. Serum parathormone demonstrated a strong positive correlation with change in GLS and GCS (p = 0.013, p = 0.126) while serum calcium showed a weak correlation with change in GLS and GCS following surgery.

CONCLUSION

Myocardial strain imaging should be considered for all PHPT patients as early identification of subclinical ventricle dysfunction provides an opportunity for an early intervention and thereby preventing development of irreversible LV dysfunction.