title: Cardiovascular dysfunction in symptomatic primary hyperparathyroidism and its reversal after curative parathyroidectomy: results of a prospective case control study.
abstract: BACKGROUND
  Cardiovascular mortality in primary hyperparathyroidism (PHPT) is attributed to myocardial and endothelial dysfunction. In this prospective, case-control study we assessed cardiovascular dysfunction in patients with symptomatic PHPT and its reversal after successful parathyroidectomy.
  
  
  METHODS
  Fifty-six patients with symptomatic PHPT underwent two-dimensional echocardiography, tissue Doppler (diastolic function assessment), serum N-terminal pro-brain natriuretic peptide (s-NTproBNP, a myocardial damage marker), and endothelial- and smooth muscle-dependent vasodilatory response (vascular dysfunction) studies before, 3, and 6 months after parathyroidectomy; 25 age-matched controls were studied similarly.
  
  
  RESULTS
  Patients had greater left ventricular mass (192 ± 70 vs. 149 ± 44 g; P = .006), interventricular septal thickness (10.8 ± 2.5 vs. 9.0 ± 1.6 mm; P = .001), posterior wall thickness (9.9 ± 2.0 vs. 8.6 ± 2.2 mm; P = .004), and diastolic dysfunction (lower E/A trans-mitral flow velocity ratio [1.0 ± 0.4 vs. 1.3 ± 0.4; P = .01). Patients had greater s-NTproBNP (4,625 ± 1,130 vs. 58 ± 49 pg/mL; P = .002) and lower endothelial-mediated vasodilation (9.3 ± 8.6 vs. 11.7 ± 6.3%; P = .03) and smooth muscle-mediated vasodilation (20.1 ± 17.9 vs. 23.8 ± 11.2%; P = .01). Improvements in left ventricular mass, systolic and diastolic function, and smooth muscle-mediated vasodilation were noted from 3 to 6 months after parathyroidectomy. Endothelial-mediated vasodilation did not improve significantly. S-NTproBNP levels mirrored echocardiographic changes with a substantial, sustained decrease. Results were similar in hypertensive and normotensive patients.
  
  
  CONCLUSIONS
  Symptomatic PHPT patients have substantial cardiac and vascular dysfunction, which improve by 6 months after parathyroidectomy. Objective cardiovascular evaluation may improve outcomes in symptomatic PHPT patients.
authors.affiliation: Department of Endocrine & Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. Electronic address: gaurav@sgpgi.ac.in.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Agarwal
authors.forename: Gitika
authors.initials: G
authors.lastname: Nanda
authors.forename: Aditya
authors.initials: A
authors.lastname: Kapoor
authors.forename: Kul Ranjan
authors.initials: KR
authors.lastname: Singh
authors.forename: Gyan
authors.initials: G
authors.lastname: Chand
authors.forename: Anjali
authors.initials: A
authors.lastname: Mishra
authors.forename: Amit
authors.initials: A
authors.lastname: Agarwal
authors.forename: Ashok K
authors.initials: AK
authors.lastname: Verma
authors.forename: Saroj K
authors.initials: SK
authors.lastname: Mishra
authors.forename: Sanjeev K
authors.initials: SK
authors.lastname: Syal
mesh_terms: D000328:Adult; D002319:Cardiovascular System / Q000473:pathology / Q000503:physiopathology*; D016022:Case-Control Studies; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D006973:Hypertension / Q000150:complications; D017379:Hypertrophy, Left Ventricular / Q000209:etiology; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010281:Parathyroid Hormone / Q000502:physiology; D016105:Parathyroidectomy; D010446:Peptide Fragments / Q000097:blood; D011446:Prospective Studies; D018487:Ventricular Dysfunction, Left / Q000209:etiology
chemical_list: C470125:PTH protein, human; D010281:Parathyroid Hormone; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain