Investigation of cardiac structure and functions in patients with asymptomatic primary hyperparathyroidism

Introduction: Especially after widespread usage of biochemical panels, it became possible to perform early diagnosis of PHPT patients. In prospective studies, it has been demonstrated that most asymptomatical PHPT (APHPT) patients have stable course over the years. While parathyroidectomy indications have been determined at APHPT patients, end-organ damage of hyperparathyroidism has been considered.Cardiovascular mortality is the leading cause of mortality for symptomatic PHPT patients. Information about mortality and the changes in the cardiovascular systems of APHPT patients are quite limited. In this study, the main aim is to examine the cardiac structure and functions in the APHPT patient group.Material and method: 31 patients with APHPT diagnosis and 32 control cases with similar cardiac risk factors are included in the study.Cardiac structure and functions are evaluated by means of two-dimensional doppler echocardiography (PWD) and tissue doppler echocardiography (PWDD).Results: Serum PTH and Ca levels are found to be statistically different for the patient and the control groups [181,38(79-736) vs 58,36(26,20-60,00) p<0,001; 10,95±0,62 vs 9,46±0,30 p<0,001]. Left ventricular mass index (LVMI) is determined to be statistically higher in patient group compared to the controlgroup (112,09±25,74 vs 93,42±26,52, p=0,006). It has also been determined that the significance is preserved even after the LVMI has been adjusted according to the cardiovascular risk factors. It has been determined that the LVMI is correlated with the Ca level (r=0,260, p=0,038). No significant difference (p=1,000) has been observed between the patients with and without left ventricular hypertrophy (LVH). Myocardial performance index (MPI) has been found to be significantly higher in the patient group compared to the control group (0,49±0,64 vs 0,39±0,48, p<0,001). MPI was determined to be correlated to Ca (r=0,493, p<0,001), PTH (r=0,494, p<0,001), and LVMI (r=0,334, p=0,007). It has been observed that the MPI is not correlated to hs-CRP (p>0.05). No difference was determined between the patient and control groups in terms of hs-CRP (2,38 (0,01-9,41) vs 3,07 (0,05-9,41) p=0,063).Conclusion: Cardiac structure and functions were affected in the asymptomatic PHPT patients. These changes occur independent of well-known cardiac risk factors. Well understanding of the cardiac changes in asymptomatic PHPT patients might lead to new parathyroidectomy indications.