Cardiovascular Risk in Patients with Primary Hyperparathyroidism

2020 ◽  
Vol 26 (43) ◽  
pp. 5628-5636
Author(s):  
Symeon Tournis ◽  
Konstantinos Makris ◽  
Etienne Cavalier ◽  
George Trovas
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Ventricular Hypertrophy ◽  
Experimental Studies ◽  
Left Ventricular ◽  
Current Evidence ◽  
Endocrine Disorders ◽  
Chronotropic Effects ◽  
Cv Disease ◽  
Lipid Abnormalities

Primary hyperparathyroidism (PHPT) is one of the most common endocrine disorders characterized by parathyroid hormone (PTH)-dependent hypercalcemia. Cardinal features include low trauma fractures, nephrolithiasis, and chronic kidney disease. Several experimental studies established that parathyroid hormone exerts actions on the cardiovascular (CV) system, including vasodilatation and positive inotropic and chronotropic effects. Observational studies, especially in severe cases, report a higher prevalence of hypertension, diabetes mellitus, lipid abnormalities, endothelial dysfunction, arrhythmias, and left ventricular hypertrophy in patients with PHPT, while the risk of CV events seems to be increased in severe cases. However, the effect of surgery is inconsistent on CV abnormalities and, more importantly, on CV disease (CVD) events, especially in mild cases. In the current review, we describe the available evidence linking PHPT and CVD, as well as the effect of surgical management and pharmacological treatment on CVD manifestations in patients with PHPT. Based on the current evidence, CVD is not considered an indication for surgery.

scholarly journals The cardiovascular system in patients with symptomatic and mild primary hyperparathyroidism

2009 ◽  
Vol 55 (3) ◽  
pp. 25-29 ◽  
Author(s):  
I V Voronenko ◽  
N G Mokrysheva ◽  
L Ya Rozhinskaya ◽  
A L Syrkin
Keyword(s):  
Parathyroid Hormone ◽  
Left Ventricular Hypertrophy ◽  
Primary Hyperparathyroidism ◽  
Cardiovascular System ◽  
Qt Interval ◽  
Ventricular Hypertrophy ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Ionized Calcium ◽  
Mild Primary Hyperparathyroidism

The cardiovascular system was analyzed in patients with symptomatic (n = 31) and mild primary hyperparathyroidism (n = 34) whose mean age was 54.6 years; 95% females). In the patients with symptomatic primary hyperparathyroidism, the PQ interval was longer and the QT interval was significantly shorter than those in patients with mild hyperparathyroidism. Left ventricular hypertrophy was noted in 45.2% of patients with symptomatic and in 15.2% of those with mild hyperparathyroidism (p = 0.013). Left ventricular diastolic dysfunction was also more common in the group of symptomatic hyperparathyroidism. There was a statistically significant correlation between the levels of parathyroid hormone, total and ionized calcium and the duration of QT interval and the determinants of diastolic function and left ventricular hypertrophy. The revealed cardiovascular disorders in patients with primary hyperparathyroidism are presumed to depend on the increase rate of parathyroid hormone and total and ionized calcium.

scholarly journals Uric acid and left ventricular hypertrophy: another relationship in hemodialysis patients

2019 ◽  
Author(s):  
Gjulsen Selim ◽  
Olivera Stojceva-Taneva ◽  
Liljana Tozija ◽  
Beti Zafirova-Ivanovska ◽  
Goce Spasovski ◽  
...  
Keyword(s):  
Uric Acid ◽  
General Population ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Reference Group ◽  
Left Ventricular ◽  
Reactive Protein ◽  
Cv Disease ◽  
The Impact

Abstract Background The impact of serum uric acid (UA) on morbidity and mortality in hemodialysis (HD) patients is quite controversial in relation to the general population. The aim of this study was to evaluate the association of serum UA with both mortality and left ventricular hypertrophy (LVH) in HD patients. Methods This longitudinal study enrolled 225 prevalent HD patients who were classified into three groups according to their follow-up-averaged UA (FA-UA) levels: low FA-UA (FA-UA <400 µmol/L), intermediate/reference FA-UA (FA-UA between 400 and 450 µmol/L) and high FA-UA (FA-UA >450 µmol/L). Echocardiography was performed on a nondialysis day and the presence of LVH was defined based on a left ventricular mass index (LVMI) >131 and >100 g/m2 for men and women, respectively. The patients were followed during a 60-month period. Results The mean FA-UA level was 425 ± 59 µmol/L (range 294–620). There was a consistent association of higher FA-UA with better nutritional status (higher body mass index, normalized protein catabolic rate, creatinine, albumin and phosphorus), higher hemoglobin, but lower C-reactive protein and LVMI. During the 5-year follow-up, 81 patients died (36%) and the main causes of death were cardiovascular (CV) related (70%). When compared with the reference group, the hazard ratio for all-cause mortality was 1.75 [95% confidence interval (CI) 1.02–2.98; P = 0.041] in the low FA-UA group, but there was no significant association with the high FA-UA group. In contrast, FA-UA did not show an association with CV mortality neither with the lower nor with the high FA-UA group. The unadjusted odds ratio (OR) of LVH risk in the low FA-UA compared with the reference FA-UA group was 3.11 (95% CI 1.38–7.05; P = 0.006), and after adjustment for age, gender, diabetes and CV disease, ORs for LVH persisted significantly only in the low FA-UA group [OR 2.82 (95% CI 1.16–6.88,); P = 0.002]. Conclusions Low serum UA is a mortality risk factor and is associated with LVH in HD patients. These results are in contrast with the association of UA in the general population and should be the subject of further research.

scholarly journals IMPACT OF SUBCLINICAL PRIMARY HYPERPARATHYROIDISM ON CARDIOVASCULAR MANIFESTATIONS OF ESSENTIAL ARTERIAL HYPERTENSION

2012 ◽  
Vol 67 (11) ◽  
pp. 53-58
Author(s):  
B. G. Iskenderov ◽  
O. N. Sisina
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Arterial Hypertension ◽  
Diastolic Function ◽  
Hormone Level ◽  
Left Ventricular ◽  
Parathyroid Hormone Level ◽  
Functional Remodeling ◽  
Essential Arterial Hypertension ◽  
Artery Remodeling

At 95 patients with essential arterial hypertension features of structural and functional remodeling of left ventricular and humeral artery depending on a level parathyroid hormone in blood are studied. It is shown that while increasing of plasma parathyroid hormone level frequency and expressiveness of left ventricular and humeral artery remodeling increases whereas diastolic function and endothelium-dependent vasodilatation considerably decrease. Subclinical primary hyperparathyroidism in patients with essential arterial hypertension is detected in 22,1% of cases. 

scholarly journals Serum Uric Acid Is Associated with Left Ventricular Hypertrophy Independent of Serum Parathyroid Hormone in Male Cardiac Patients

PLoS ONE ◽  
2013 ◽  
Vol 8 (12) ◽  
pp. e82735 ◽  
Author(s):  
Shu-ichi Fujita ◽  
Yusuke Okamoto ◽  
Kensaku Shibata ◽  
Hideaki Morita ◽  
Takahide Ito ◽  
...  
Keyword(s):  
Uric Acid ◽  
Parathyroid Hormone ◽  
Left Ventricular Hypertrophy ◽  
Serum Uric Acid ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Cardiac Patients ◽  
Serum Parathyroid Hormone

P1250LOW SERUM URIC ACID LEVEL AND LEFT VENTRICULAR HYPERTROPHY : THE NEW PARADOXICAL ASSOCIATION IN HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
GJULSEN SELIM ◽  
Angela Kabova ◽  
Blerim Bexheti ◽  
Zoran Janevski ◽  
Adrijana Spasovska Vasilova ◽  
...  
Keyword(s):  
Uric Acid ◽  
Left Ventricular Hypertrophy ◽  
Serum Uric Acid ◽  
Ventricular Hypertrophy ◽  
Prolonged Exposure ◽  
Reference Group ◽  
Serum Uric Acid Level ◽  
Left Ventricular ◽  
Cv Disease ◽  
Relationship Of

Abstract Background and Aims The association between serum uric acid (UA) and left ventricular hypertrophy (LVH) is controversial in chronic kidney disease, whereas in hemodialysis (HD) patients has not been studied until now. Thus, we evaluated the relationship of baseline and time-averaged UA with echocardiographic LVH over a 5-year period in HD patients. Method This longitudinal study was conducted on 225 prevalent HD patients over a 5-year period. Patients were stratified into 3 groups according to their baseline and time-averaged UA levels: lower group (UA<400µmmol/l), intermediate/reference group (UA between 400-450µmol/l) and higher group (UA>450µmol/l). Echocardiography was performed on a non-dialysis day and the presence of LVH was defined based on the left ventricular mass index (LVMI) >131 and >100 g/m2, for men and women, respectively. The patients were followed during a 60 month period. Results During the 5-year follow-up, 81 patients died (36%), and the main causes of death were cardiovascular (CV) related (70%). Survival analysis show that patients with time-averaged UA<400 µmmol/l had a significantly higher all cause (log rank, p=0.003) and CV mortality (log rank, p=0.004) rate, compared to those with time-averaged UA between 400-450 µmmol/l and time-averaged UA>450µmol/l, but this difference was not statistically significant in terms of baseline UA level. A negative correlation was observed between LVH and time-averaged UA (r=-0.26, p=0.001), but not with LVH and baseline UA. Patients in lower time-averaged UA group had significantly higher LVMI compared to patients in intermediate and higher group (153.10± 59.89, 131.62±40.99, 131.19±44.49 g/m2, p=0.029), but from the lowest to the highest baseline UA levels, LVH was not significantly different (146.99±59.20, 141.38±37.52, 126.85±42.48 g/m2, p=0.07). Unadjusted odd ratio of LVH risk in the lower time-averaged UA compared to the reference time-averaged UA group was 3.11 (95% CI=1.38-7.05; p=0.006); and after adjustment for age, gender, diabetes and CV disease, ORs for LVH persisted significant only in the lower time-averaged UA group (OR = 2.82, 95% CI = 1.16–6.88, P = 0.002). On the contrary, baseline UA did not affect unadjusted and adjusted LVH. Conclusion In HD patients the prolonged exposure to hypouricemia is associated with LVH. This paradoxical association can only be explained by the hypothesis that uremic milieu in HD patients changes the influence of uric acid. However, these results should be the subject of further research.

Ischemia induces aggravation of baseline repolarization abnormalities in left ventricular hypertrophy: a deleterious interaction

2006 ◽  
Vol 101 (1) ◽  
pp. 102-110 ◽  
Author(s):  
Aigars Rubulis ◽  
Jens Jensen ◽  
Gunilla Lundahl ◽  
Jari Tapanainen ◽  
Lennart Bergfeldt
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Coronary Occlusion ◽  
Experimental Studies ◽  
Three Dimensional ◽  
Epidemiological Studies ◽  
Left Ventricular ◽  
Artery Disease

Epidemiological studies show that left ventricular hypertrophy (LVH) and hypertension (HT) in coronary artery disease increases the risk for cardiovascular events including sudden cardiac death (SCD). According to experimental studies, myocardial hypertrophy is associated both with altered electrophysiological properties (including prolonged repolarization) and increased vulnerability to ischemia. However, human data to support a repolarization-related mechanism for the increased SCD risk has not been provided. We therefore studied 187 patients undergoing three-dimensional vectorcardiographic monitoring during coronary angioplasty. Eight parameters reflecting different aspects of ventricular repolarization were used: 1) the ST segment (ST-VM and STC-VM), 2) the T vector (QRS-T angle, Televation, and Tazimuth), and 3) the T vector loop (Tavplan, Teigenv, and Tarea). Data collection was performed at rest and at the time of maximum ischemia during coronary occlusion. The patients were divided into three groups: 33 patients with ECG signs of LVH (18 with HT), 54 with HT but without LVH signs, and 100 patients with neither. Coronary artery disease patients with LVH not only had the most abnormal baseline repolarization (as expected) but also a significantly more pronounced repolarization response during coronary occlusion, whereas HT patients had mean parameter values between LVH patients and those without neither HT nor LVH signs. Because there is a relation between increased SCD risk and repolarization disturbances in various clinical settings, the results of the present study are in agreement with animal data and epidemiological observations, although other factors than disturbed repolarization might be of importance.

Cardiovascular Disease in Peritoneal Dialysis

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 19-22 ◽  
Author(s):  
Sarah Prichard ◽  
Allan Sniderman ◽  
Katherine Cianflone ◽  
Derek Marpole
Keyword(s):  
Cardiac Output ◽  
Peritoneal Dialysis ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
High Cardiac Output ◽  
Risk Of Death ◽  
Cardiovascular Morbidity And Mortality ◽  
Erythropoietin Treatment ◽  
Lipid Abnormalities

Cardiovascular morbidity and mortality remain high in ESRD patients. Lipid abnormalities in CAPD may be more important than in hemodialysis. Vessel calcification may have a role in atherosclerotic heart disease, but this is only an inference from several clinical observations, and it remains to be defined more clearly as a risk factor. Left ventricular hypertrophy is frequent in this patient population, and is associated with specific clinical patterns and an in creased risk of death. Erythropoietin treatment of anemia and tight blood pressure controls have proved to help in reversing severe left ventricular hypertrophy. Finally, we describe a syndrome of the hypertrophic, high cardiac output hemodialysis heart, which is characterized by a high cardiac output in hemodialysis patients. It is associated with left ventricular hypertrophy and eventually right ventricular hypertrophy with tricuspid insufficiency. This may require fistula revision and even a switch to peritoneal dialysis.

scholarly journals Cardiovascular pathology in diff erent forms of primary hyperparathyroidism

2021 ◽  
Vol 12 (3) ◽  
pp. 36-43
Author(s):  
I. A. Baranova ◽  
T. A. Zykova ◽  
A. V. Baranov
Keyword(s):  
Primary Hyperparathyroidism ◽  
Ventricular Hypertrophy ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Total Blood ◽  
Blood Calcium ◽  
Cardiovascular Pathology ◽  
Mixed Form ◽  
Symptomatic Form

Objective: To study the frequency and features of the clinical course of cardiovascular pathology in patients with diff erent clinical forms of primary hyperparathyroidism (PHPT). Materials and Methods: A retrospective analysis of case histories of 48 patients who received inpatient treatment for PHPT in the endocrinological or surgical departments of two large hospitals in Arkhangelsk from 2005 to 2015 was performed.Results: Among the revealed cases of PHPT, the symptomatic form of PHPT was the most common (88%). Th e analysis showed a high frequency of arterial hypertension (AH) (69%) with a more severe course in patients with a mixed form of PHPT. Th e level of parathyroid hormone (PTH) was higher in patients with AH compared with patients without hypertension and PHPT (p = 0.008). Left ventricular hypertrophy was detected in 60% of patients with a mixed form of PHPT. In a mild form, this complication was not observed. Th e relationship between the level of total blood calcium and PTH and the interventricular septum thickness was revealed by the results of echocardiography (p = 0.036 and p = 0.012). Th e inverse relationship between the duration of the QT interval and the level of ionized blood calcium was shown (p = 0.022).Conclusions: Changes in phosphorus-calcium metabolism provoked by PHPT aff ect the state of the cardiovascular system, which determines the need for increased attention of various specialists to this type of complications in PHPT, timely indication of treatment, and improvement of the quality of patient’s life.

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