title: Coronary microvascular dysfunction induced by primary hyperparathyroidism is restored after parathyroidectomy.
abstract: BACKGROUND
  Symptomatic primary hyperparathyroidism (PHPT) is associated with increased cardiovascular mortality. However, data on the association between asymptomatic PHPT and cardiovascular risk are lacking. We assessed coronary flow reserve (CFR) as a marker of coronary microvascular function in asymptomatic PHPT of recent onset.
  
  
  RESULTS
  We studied 100 PHPT patients (80 women; age, 58±12 years) without cardiovascular disease and 50 control subjects matched for age and sex. CFR in the left anterior descending coronary artery was detected by transthoracic Doppler echocardiography, at rest, and during adenosine infusion. CFR was the ratio of hyperemic to resting diastolic flow velocity. CFR was lower in PHPT patients than in control subjects (3.0±0.8 versus 3.8±0.7; P<0.0001) and was abnormal (≤2.5) in 27 patients (27%) compared with control subjects (4%; P=0.0008). CFR was inversely related to parathyroid hormone (PTH) levels (r=-0.3, P<0.004). In patients with CFR ≤2.5, PTH was higher (26.4 pmol/L [quartiles 1 and 3, 16 and 37 pmol/L] versus 18 [13-25] pmol/L; P<0.007), whereas calcium levels were similar (2.9±0.1 versus 2.8±0.3 mmol/L; P=0.2). In multivariable linear regression analysis, PTH, age, and heart rate were the only factors associated with CFR (P=0.04, P=0.01, and P=0.006, respectively). In multiple logistic regression analysis, only PTH increased the probability of CFR ≤2.5 (P=0.03). In all PHPT patients with CFR ≤2.5, parathyroidectomy normalized CFR (3.3±0.7 versus 2.1±0.5; P<0.0001).
  
  
  CONCLUSIONS
  PHPT patients have coronary microvascular dysfunction that is completely restored after parathyroidectomy. PTH independently correlates with the coronary microvascular impairment, suggesting a crucial role of the hormone in explaining the increased cardiovascular risk in PHPT.
authors: Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padua, Italy.
authors: Elena
authors: E
authors: Osto
authors: Francesco
authors: F
authors: Fallo
authors: Maria Rosa
authors: MR
authors: Pelizzo
authors: Anna
authors: A
authors: Maddalozzo
authors: Nadia
authors: N
authors: Sorgato
authors: Francesco
authors: F
authors: Corbetti
authors: Roberta
authors: R
authors: Montisci
authors: Giulia
authors: G
authors: Famoso
authors: Roberto
authors: R
authors: Bellu
authors: Thomas F
authors: TF
authors: Lüscher
authors: Sabino
authors: S
authors: Iliceto
authors: Francesco
authors: F
authors: Tona
mesh_terms: D000236:Adenoma / Q000150:complications / Q000378:metabolism / Q000601:surgery; D000368:Aged; D015897:Comorbidity; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology*; D003327:Coronary Disease / Q000209:etiology* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D050171:Dyslipidemias / Q000453:epidemiology; D004452:Echocardiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D008955:Models, Cardiovascular; D010281:Parathyroid Hormone / Q000097:blood / Q000378:metabolism; D010282:Parathyroid Neoplasms / Q000150:complications / Q000378:metabolism / Q000601:surgery; D016105:Parathyroidectomy; D020127:Recovery of Function
chemical_list: D010281:Parathyroid Hormone