Effect of surgery on cardiac structure and function in mild primary hyperparathyroidism.
BACKGROUND
The cardiovascular (CV) risk profile is worsened in primary hyperparathyroidism (PHPT), and CV mortality is related to serum calcium levels. It is unknown whether CV mortality is increased in the most common form of PHPT and whether the increased CV risk is reversible after surgery.


OBJECTIVE
To investigate reversibility of echocardiographic variables in patients with mild PHPT who were randomized to observation without surgery or operation, and followed for 2 years.


METHODS
Forty-nine patients (mean age 63 ± 7 years, 8 men) who had performed the 2-year visit in a randomized study on mild PHPT (serum calcium at baseline 2·65 ± 0·09 mm) (observation) vs 2·67 ± 0·06 mm (surgery) and where echocardiography had been performed, participated in the study.


RESULTS
Calcium and parathyroid hormone (PTH) levels were normalized following surgery and were stable in the observation group. PTH levels at baseline were highly correlated with ventricular mass. Detailed echocardiography revealed a minor and borderline significant treatment effect of surgery on left ventricular mass index (LVMI) compared to observation (P = 0·066) and a significant 11% reduction in diastolic dimension of the interventricular septum (IVSd-mean) in the surgery group (P<0·01), with no alterations in the observation group.


CONCLUSIONS
Based on detailed echocardiographic measures over a 2-year observation period, we found only minor differences between the two groups. However, the potential treatment effect on LVMI and the within-group differences in IVSd-mean suggest that longer follow-up may yield larger and clinically important differences.
Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Anita
A
Persson
Jens
J
Bollerslev
Thord
T
Rosen
Charlotte L
CL
Mollerup
Celina
C
Franco
Gunhild A
GA
Isaksen
Thor
T
Ueland
Svante
S
Jansson
Kenneth
K
Caidahl
D000368:Aged; D002118:Calcium / Q000097:blood; D004452:Echocardiography; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood
D010281:Parathyroid Hormone; D002118:Calcium