Cardiac structure and diastolic function in mild primary hyperparathyroidism.
BACKGROUND
Data on the presence, extent, and reversibility of cardiovascular disease in primary hyperparathyroidism (PHPT) are conflicting.


OBJECTIVE
To evaluate the heart in PHPT, we assessed cardiac structure and diastolic function in patients with mild PHPT compared with age- and sex-matched controls.


METHODS
This was a case-control study.


METHODS
The study was conducted in a university hospital Metabolic Bone Diseases Unit.


METHODS
Fifty-four men and women with PHPT and 76 controls without PHPT participated in the study.


METHODS
We measured left ventricular mass index (LVMI), the presence of mitral annular calcification, the ratio of early to late diastolic mitral inflow velocities (E/A), and early diastolic velocity of the lateral mitral annulus using Doppler tissue imaging (tissue Doppler e').


RESULTS
Patients had mild disease with mean (+/-sd) serum calcium 10.5 +/- 0.5 mg/dl and PTH 96 +/- 45 pg/ml. LVMI and diastolic function were normal in PHPT. There was no difference in LVMI (98 +/- 23 vs. 96 +/- 24 g/m(2), P = 0.69) or the frequency of mitral annular calcification between PHPT cases and controls. Diastolic function variables (E/A and tissue Doppler e') were higher (better) in cases compared with controls, although both were within the reference range. PHPT patients with low E/A had higher serum PTH (121 +/- 36 vs. 89 +/- 46 pg/ml, P = 0.03) and calcium (10.8 +/- 0.4 vs. 10.5 +/- 0.5 mg/dl, P = 0.05) than those with normal values. Finally, we found LVMI to be inversely associated with serum 25-hydroxyvitamin D in PHPT (r = -0.29, P < 0.05). All findings persisted after adjustment for group differences in cardiovascular risk factors.


CONCLUSIONS
Patients with biochemically mild PHPT do not have evidence of increased left ventricular mass, diastolic dysfunction, or increased valvular calcifications. However, the data support an association between low vitamin D levels and the development of left ventricular hypertrophy in this disorder. Finally, the increased serum calcium and PTH levels in those with diastolic dysfunction suggest that disease severity may determine the presence of cardiac manifestations in PHPT.
Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
M D
MD
Walker
J B
JB
Fleischer
M R
MR
Di Tullio
S
S
Homma
T
T
Rundek
E M
EM
Stein
C
C
Zhang
T
T
Taggart
D J
DJ
McMahon
S J
SJ
Silverberg
D000368:Aged; D001783:Blood Flow Velocity; D015992:Body Mass Index; D002114:Calcinosis / Q000473:pathology; D003327:Coronary Disease / Q000150:complications / Q000503:physiopathology; D048909:Diabetes Complications / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000503:physiopathology; D003971:Diastole / Q000502:physiology*; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000033:anatomy & histology / Q000503:physiopathology*; D006352:Heart Ventricles / Q000033:anatomy & histology; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006973:Hypertension / Q000150:complications / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology; D012307:Risk Factors; D018608:Ultrasonography, Doppler; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology