ECHOCARDIOGRAPHIC FINDINGS IN PATIENTS WITH NORMOCALCEMIC PRIMARY HYPERPARATHYROIDISM COMPARED TO HYPERCALCEMIC PRIMARY HYPERPARATHYROID PATIENTS AND CONTROL SUBJECTS

2020 ◽  
Author(s):  
Jessica Pepe ◽  
Luciano Colangelo ◽  
Chiara Sonato ◽  
Marco Occhiuto ◽  
Carla Ferrara ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Ejection Fraction ◽  
Primary Hyperparathyroidism ◽  
Cardiovascular Risk Factors ◽  
Urinary Calcium ◽  
Left Ventricular ◽  
Ionized Calcium ◽  
Echocardiographic Parameters ◽  
Echocardiographic Findings

Objective: There are no data regarding echocardiographic parameters in patients with normocalcemic primary hyperparathyroidism (NCPHPT). Our aim was to compare the echocardiographic findings in postmenopausal women with NCPHPT with those found in patients with hypercalcemic primary hyperparathyroidism (PHPT) and with controls. Methods: Seventeen consecutive Caucasian postmenopausal women with NCPHPT were compared to 20 hypercalcemic PHPT and 20 controls. Obesity, diabetes, kidney failure and previous cardiovascular diseases were considered exclusion criteria. Each patient underwent biochemical evaluation, bone mineral density scan and echocardiographic measurements. Patients with parathyroid disorder underwent kidney ultrasound evaluation. Results: PHPT patients had significantly mean higher total, ionized calcium, 24-hour urinary calcium, PTH and lower phosphorus compared to controls (all p <0.05). The only differences between NCPHPT and PHPT patients were significantly mean lower total, ionized calcium, 24-hour urinary calcium and higher phosphorus in NCPHPT (all p <0.05). The only biochemical difference between NCPHPT and controls was mean higher levels of PTH in patients with NCPHPT. There were no differences in cardiovascular risk factors between NCPHPT, PHPT and controls. Hypertension was the most frequent cardiovascular risk factor, diagnosed in 65% of PHPT patients. This high prevalence was not statistically different compared to that observed in NCPHT (59%) and in controls (30%). Echocardiography parameters were not different between NCPHPT, PHPT and controls subdivided according to the presence of hypertension (ANOVA followed by Bonferroni correction). Conclusions: In a population not at high cardiovascular risk, we found no differences in cardiovascular risk factors and echocardiographic parameters between NCPHPT, PHPT and controls. Abbreviations: NCPHPT = normocalcemic primary hyperparathyroidism, PHPT = hypercalcemic primary hyperparathyroidism, PTH = parathyroid hormone, PTX = parathyroidectomy, CA = total serum calcium, CA++= ionized calcium, P = phosphorus, CR = creatinine, [25(OH)D]= 25-OH-vitamin D, 24-UCa= 24- hour urinary calcium, GFR= glomerular filtration rate, HDL= lower high-density lipoprotein, LVM= left ventricular mass, LVEF= left ventricular ejection fraction LVEDD = left ventricular end-diastolic diameter, IVS= interventricular septum thickness, PWT= posterior wall thickness, LA= transverse diameter of left atrium, EF %= ejection fraction, E/A ratio= early transmitral diastolic flow (E) and flow velocity during atrial contraction (A) ratio, LVMI= left ventricular mass indexed, IVRT= isovolumetric relaxation time, DXA= dual X-ray absorptometry, BMI= body mass index, ANOVA= analysis of variance.

scholarly journals SLEEP APNEA AS A RISK FACTOR FOR DIASTOLIC DYSFUNCTION: A SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Author(s):  
Mohammed Al-Sadawi ◽  
Kleanthis Theodoropoulos ◽  
farzane saeidifard ◽  
Adekunle Kiladejo ◽  
Patricia Erwin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Sleep Apnea ◽  
Diastolic Dysfunction ◽  
Cardiovascular Risk Factors ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Control Group ◽  
Obstructive Sleep ◽  
Echocardiographic Parameters

Abstract: Background: This meta-analysis assessed the relationship between Obstructive Sleep Apnea (OSA) and echocardiographic parameters of diastolic dysfunction (DD), which are used in the assessment of Heart Failure with Preserved Ejection Fraction (HFpEF). Methods: We searched the databases including Ovid MEDLINE, Ovid Embase Scopus, Web of Science, Google Scholar, and EBSCO CINAHL from inception up to December 26th, 2020. The search was not restricted to time, publication status or language. Comparisons were made between patients with OSA, diagnosed in-laboratory polysomnography (PSG) or home sleep apnea testing (HSAT), and patients without OSA in relation to established markers of diastolic dysfunction. Results: Primary search identified 2512 studies. A total of 18 studies including 2509 participants were included. The two groups were free of conventional cardiovascular risk factors. Significant structural changes were observed between the two groups. Patients with OSA exhibited greater LAVI (3.94 CI [0.8, 7.07]; p=0.000) and left ventricular mass index (11.10 CI [2.56,19.65]; p=0.000) as compared to control group. The presence of OSA was also associated with more prolonged DT (10.44 ms CI [0.71,20.16]; p=0.04), IVRT (7.85 ms CI[4.48, 11.22]; p=0.000), and lower E/A ratio (-0.62 CI [-1,-0.24]; p=0.001) suggestive of early DD. The E/e’ ratio (0.94 CI[0.44, 1.45]; p=0.000) was increased. Conclusion: An association between OSA and echocardiographic parameters of DD was detected that was independent of conventional cardiovascular risk factors. OSA may be independently associated with DD perhaps due to higher LV mass. Investigating the role of CPAP therapy in reversing or ameliorating diastolic dysfunction is recommended.

Disease activity is associated with reduced left ventricular systolic myocardial function in patients with rheumatoid arthritis

2016 ◽  
Vol 76 (2) ◽  
pp. 371-376 ◽  
Author(s):  
Helga Midtbø ◽  
Anne Grete Semb ◽  
Knut Matre ◽  
Tore K Kvien ◽  
Eva Gerdts
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Ejection Fraction ◽  
Disease Activity ◽  
Cardiovascular Risk Factors ◽  
Myocardial Function ◽  
Systolic Function ◽  
Left Ventricular ◽  
Lv Ejection Fraction ◽  
Lv Systolic Function

ObjectivesDisease activity has emerged as a new, independent risk factor for cardiovascular disease in patients with rheumatoid arthritis (RA). We tested if disease activity in RA was associated with lower left ventricular (LV) systolic function independent of traditional cardiovascular risk factors.MethodsEchocardiographic assessment was performed in 78 patients with RA having low, moderate or high disease activity (Simplified Disease Activity Index (SDAI) >3.3), 41 patients in remission (SDAI ≤3.3) and 46 controls, all without known cardiac disease. LV systolic function was assessed by biplane Simpson ejection fraction, stress-corrected midwall shortening (scMWS) and global longitudinal strain (GLS).ResultsPatients with active RA had higher prevalence of hypertension and diabetes compared with patients in remission and controls (both p<0.05). LV ejection fraction (endocardial function) was normal in all three groups, while mean scMWS and GLS (myocardial function) were reduced in patients with RA with active disease compared with patients with RA in remission (95±18% vs 105±17% and −18.9±3.1% vs −20.6±3.5%, respectively, both p<0.01). Patients with RA in remission had similar scMWS and GLS as the controls. In multivariable analyses, having active RA was associated with lower GLS (β=0.21) and scMWS (β=−0.22, both p<0.05), both reflecting lower LV systolic myocardial function, independent of cardiovascular risk factors and LV ejection fraction. Classification of RA disease activity by other disease activity composite scores yielded similar results.ConclusionsActive RA is associated with lower LV systolic myocardial function despite normal ejection fraction and independent of traditional cardiovascular risk factors.

scholarly journals Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

2017 ◽  
Vol 177 (6) ◽  
pp. R297-R308 ◽  
Author(s):  
Jessica Pepe ◽  
Cristiana Cipriani ◽  
Chiara Sonato ◽  
Orlando Raimo ◽  
Federica Biamonte ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Primary Hyperparathyroidism ◽  
Cardiovascular Risk Factors ◽  
Pancreatic Beta Cells ◽  
Left Ventricular ◽  
Narrative Review ◽  
Cardiac Conduction ◽  
Cardiovascular Involvement ◽  
The Impact

Data on cardiovascular disease in primary hyperparathyroidism (PHPT) are controversial; indeed, at present, cardiovascular involvement is not included among the criteria needed for parathyroidectomy. Aim of this narrative review is to analyze the available literature in an effort to better characterize cardiovascular involvement in PHPT. Due to physiological effects of both parathyroid hormone (PTH) and calcium on cardiomyocyte, cardiac conduction system, smooth vascular, endothelial and pancreatic beta cells, a number of data have been published regarding associations between symptomatic and mild PHPT with hypertension, arrhythmias, endothelial dysfunction (an early marker of atherosclerosis), glucose metabolism impairment and metabolic syndrome. However, the results, mainly derived from observational studies, are inconsistent. Furthermore, parathyroidectomy resulted in conflicting outcomes, which may be linked to several potential biases. In particular, differences in the methods utilized for excluding confounding co-existing cardiovascular risk factors together with differences in patient characteristics, with varying degrees of hypercalcemia, may have contributed to these discrepancies. The only meta-analysis carried out in PHPT patients, revealed a positive effect of parathyroidectomy on left ventricular mass index (a predictor of cardiovascular mortality) and more importantly, that the highest pre-operative PTH levels were associated with the greatest improvements. In normocalcemic PHPT, it has been demonstrated that cardiovascular risk factors are almost similar compared to hypercalcemic PHPT, thus strengthening the role of PTH in the cardiovascular involvement. Long-term longitudinal randomized trials are needed to determine the impact of parathyroidectomy on cardiovascular diseases and mortality in PHPT.

SURVEY OF CARDIOVASCULAR RISK FACTORS AND ELECTROCARDIGRAPHIC, ECHOCARDIOGRAPHIC ABNORMALITIES IN PATIENTS ON WAITING LIST FOR RENAL TRANSPLANTATION

2014 ◽  
pp. 26-30
Author(s):  
Huu Thinh Nguyen ◽  
Thi Thuy Hang Nguyen ◽  
Bui Bao Hoang
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Renal Transplantation ◽  
Left Ventricular Hypertrophy ◽  
Cardiovascular Risk Factors ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Valve Insufficiency ◽  
Transplant Candidates ◽  
End Stage

Background: Cardiovascular disease is the major cause of death in dialysis patients, as well as in kidney transplant patients. Assessment of cardiovascular risks of renal transplant candidates to prevent or slow the progression of cardiovascular abệnh nhânormalities. Aim: 1) Evaluating cardiovascular risk factors, electrocardiographic and echocardiographic abnormalities in renal transplant candidates. 2) Identifying the correlation between cardiac morphological parameters with a number of factors involved. Subjects and Methods: We assessed 57 patients (73.7% male, mean age 32.4±8.8) with end-stage renal disease waiting for renal transplantation at Cho Ray Hospital between Jan 2012 and Jan 2013. All patients received a physical examination, blood pressure measurement, Hb, blood glucose test, lipid profile, ECG, echocardiography. Results: The percentage of hypertension was 98.2%, smoking (69.2%), dyslipidemia 40.4% and diabetes 12.3%. All patients had sinus rhythm, left ventricular hypertrophy 61.4% in ECG. Pericardial effusion 5.3%, mitral valve insufficiency 56.1%, aortic valve insufficiency 12.3%, left ventricular hypertrophy 94.7% in echocardiography. IVSd, LVPWd, LVMI positively correlated with kidney failure time (p <0.01, p<0.001), with DBP and SBP (p <0.05) and the degree of anemia (p <0.05). Percentage the degree of hypertension associated with proportion of left ventricular hypertrophy (p <0.05). Conclusions: Identification of cardiovascular risk factors for the prevention or intervention to reduce mortality in renal transplantation. Keywords: Cardiovascular risk factors, end-stage chronic renal failure, renal transplantation.

Investigation of the prevalence of cardiovascular risk factors in obese patients diagnosed with metabolic syndrome in childhood and examination of left ventricular function by echocardiography

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Güzin Özden ◽  
Ayşe Esin Kibar Gül ◽  
Eda Mengen ◽  
Ahmet Ucaktürk ◽  
Hazım Alper Gürsu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Insulin Resistance ◽  
Blood Pressure ◽  
Metabolic Syndrome ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Left Ventricular ◽  
Atherogenic Index ◽  
Volume Index ◽  
Common Component

Abstract Objectives The objective of this study is to investigate the cardiovascular risk factors associated with metabolic syndrome (MetS), which is increasingly becoming prevalent in childhood obesity. Methods A total of 113 patients, 76 of whom were between the ages of 10 and 17 (mean age: 14.5 ± 1.8 years) and diagnosed with obesity (30 non-MetS and 46 MetS using IDF) and 37 of whom constituted the control group, participated in the study. Echocardiographic examination and atherogenicity parameters (Atherogenic index of plasma [AIP: logTG/HDL], total cholesterol/HDL, and TG/HDL ratio and non-HDL) were evaluated. Results The most common component accompanying obese MetS was found to be hypertension and low HDL. While obesity duration, body mass index (BMI), blood pressure, fasting insulin, insulin resistance, atherogenicity parameters were determined to be significantly higher in the obese-MetS group. Echocardiography showed that while the thickness, volume, and diameter of LV end-diastolic wall, left ventricular mass (LVM), LVM index (LVMI g/m2) and relative wall thickness (RWT) were significantly high in the MetS group, however, mitral E/A ratio was significantly lower (p<0.05). Change in LV geometry consistent with concentric remodeling (increased RWT, normal LVMI) was visible in obese groups. LVM were positively significantly related to BMI, waist circumference, insulin resistance, blood pressure, LDL level, and negative to mitral E/A ratio. In the obese-MetS group, LVMI was positively correlated to office systolic BP, left atrium end-diastolic volume/index. Conclusions LVMI and atherogenicity parameters that were found to be significantly higher in obese MetS exhibit increased cardiovascular risk in childhood.

scholarly journals The effect of surgery on fat mass, lipid and glucose metabolism in mild primary hyperparathyroidism

2018 ◽  
Vol 7 (8) ◽  
pp. 941-948 ◽  
Author(s):  
Kristin Godang ◽  
Karolina Lundstam ◽  
Charlotte Mollerup ◽  
Stine Lyngvi Fougner ◽  
Ylva Pernow ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Glucose Metabolism ◽  
Primary Hyperparathyroidism ◽  
Cardiovascular Risk Factors ◽  
Outcome Measures ◽  
Fat Mass ◽  
Lipid Lowering ◽  
Mild Primary Hyperparathyroidism ◽  
Over Time

Context Mild primary hyperparathyroidism has been associated with increased body fat mass and unfavorable cardiovascular risk factors. Objective To assess the effect of parathyroidectomy on fat mass, glucose and lipid metabolism. Design, patients, interventions, main outcome measures 119 patients previously randomized to observation (OBS; n = 58) or parathyroidectomy (PTX; n = 61) within the Scandinavian Investigation of Primary Hyperparathyroidism (SIPH) trial, an open randomized multicenter study, were included. Main outcome measures for this study were the differences in fat mass, markers for lipid and glucose metabolism between OBS and PTX 5 years after randomization. Results In the OBS group, total cholesterol (Total-C) decreased from mean 5.9 (±1.1) to 5.6 (±1.0) mmol/L (P = 0.037) and LDL cholesterol (LDL-C) decreased from 3.7 (±1.0) to 3.3 (±0.9) mmol/L (P = 0.010). In the PTX group, the Total-C and LDL-C remained unchanged resulting in a significant between-group difference over time (P = 0.013 and P = 0.026, respectively). This difference was driven by patients who started with lipid-lowering medication during the study period (OBS: 5; PTX: 1). There was an increase in trunk fat mass in the OBS group, but no between-group differences over time. Mean 25(OH) vitamin D increased in the PTX group (P < 0.001), but did not change in the OBS group. No difference in parameters of glucose metabolism was detected. Conclusion In mild PHPT, the measured metabolic and cardiovascular risk factors were not modified by PTX. Observation seems safe and cardiovascular risk reduction should not be regarded as a separate indication for parathyroidectomy based on the results from this study.

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