Curative Parathyroidectomy in Primary Hyperparathyroidism Improves Both Systolic and Diastolic Cardiac Dysfunction: A Six-Month Follow-Up Study at a Tertiary Care Hospital.

Abstract

Background: Primary hyperparathyroidism (PHPT) is associated with hypertension, left ventricular hypertrophy, and myocardial and valvular calcifications, leading to increased mortality rates. While the association between PHPT and diastolic dysfunction has been well-documented, data on systolic dysfunction and its reversal after curative parathyroidectomy (PTX) remains limited.

Purpose: To evaluate the effect of PTX on cardiovascular parameters, especially systolic dysfunction, in PHPT patients using conventional and speckle-tracking echocardiography (STE).

Methods: This prospective study was conducted at a tertiary care hospital from August 2016 to September 2019; 59 patients underwent successful PTX based on standard criteria, with 58 completing the study. Preoperative and 6-month postoperative biochemical and cardiovascular evaluations, including echocardiography, were performed. Global longitudinal strain (GLS) was assessed using speckle-tracking echocardiography (STE).

Results: The mean age of subjects was 45.2 ± 10.4 years with a male-to-female ratio of 1.5:1. Normalization of serum calcium and phosphorus with significant reductions in serum intact PTH, alkaline phosphate, total cholesterol, HDL, and uric acid levels (p ≤ 0.0001) were seen after curative PTX. Echocardiographic evaluations significantly improved diastolic parameters, including E velocity (cm/s) and E/A(atrial) ratio. Systolic dysfunction also showed significant improvement on conventional echocardiography and STE, as evidenced by reduced left ventricular (LV) mass, ejection fraction (EF), and postoperative GLS. Although a relative drop in EF was noted postprocedure, STE findings suggested a significant improvement in systolic dysfunction, signifying GLS as a more appropriate means of assessing systolic dysfunction. Serum PTH demonstrated a strong positive correlation (r = 0.638, p < 0.001) with changes in GLS, while serum calcium showed a weak correlation (r = 0.291, p = 0.027) with changes in GLS following surgery.

Conclusion: This study demonstrates significant improvements in diastolic and systolic functions, as evidenced by conventional echocardiography and STE, and suggests that PTX benefits cardiovascular health in PHPT patients.