Left Ventricular Dysfunction in Subjects with Mild Secondary Hyperparathyroidism Detected with Pulsed Wave Tissue Doppler Echocardiography

Abstract

Aims: To assess left ventricular function by conventional and pulsed wave tissue Doppler (PWTD) echocardiography in subjects with mild secondary hyperparathyroidism, and to evaluate whether PWTD would be more sensitive than conventional echocardiography in detecting subtle changes in LV systolic and diastolic function. Methods: In the fifth Tromsø study (2001) serum PTH and calcium were measured in 7,954 subjects. One hundred subjects with secondary hyperparathyroidism (SHPT; serum PTH >6.40 pmol/l and serum calcium <2.40 mmol/l) and 106 control subjects with normal PTH and calcium levels and with no history of cardiovascular disease were examined at the follow-up 6–12 months later. Results: Conventional transthoracic echocardiography and PWTD of mitral annulus were successfully performed in 83 cases and 88 controls. At follow-up mean serum PTH values were 6.0 ± 2.2 versus 3.2 ± 1.3 pmol/l (p < 0.05) and mean calcium 2.28 ± 0.10 versus 2.33 ± 0.08 mmol/l (p < 0.05) in cases and controls, respectively. Unpaired t test and multiple linear regression analyses were used. No significant differences in conventional echocardiographic parameters were found. However, PWTD showed reduced systolic velocity in septal, lateral and anterior mitral annulus (p < 0.05) and also reduced early diastolic velocity in septal and anterior mitral annulus (p < 0.05). Conclusion: Subjects with mild SHPT have impaired left ventricular long axis function as evaluated by PWTD compared to conventional echocardiography. PWTD seems to be a more sensitive tool in detecting minor changes in left ventricular function and the new modality should routinely be included in studies evaluating left ventricular function, especially the long axis function.

Cardiac Geometry in Children Receiving Chronic Peritoneal Dialysis

“…The most distinctive PTH cutoff level, independently predicting a 73% increase of LVH risk, was 200 ng/ml, suggesting that the cardiotrophic actions of PTH are operative even at moderate degrees of hyperparathyroidism. This interpretation is supported by recent findings from a population-based study in Norway, which found sharp increases in the prevalence of LVH and diastolic dysfunction when PTH levels exceeded the normal range (37,38).…”

Cardiac, Inflammatory and Metabolic Parameters: Hemodialysis versus Peritoneal Dialysis

“…Furthermore, Amann et al [24] showed that PTH seems to have a permissive role in fibroblast activation in nephrectomized and parathyroidectomized rats inducing intramyocardial fibrosis. Furthermore, SHPT may contribute to vascular dysfunction, with increased arterial stiffness, which may lead to persistent increases in BP [25]. …”

“…This condition was also shown on adult ventricular cardiomyocytes [23]. Furthermore, vascular calcification that accompanies secondary hyperparathyroidism (SHPT) in end-stage renal disease (ESRD) leads to an increased arterial resistance and induces the formation of LVH [24,25,26]. Other factors, such as oxidative stress, inappropriate activation of the renin-angiotensin-aldosterone system and inflammation, may also play a role in LV growth in ESRD [27].…”

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“…Therefore, CKD severity alone caused LV filling pressure elevation and diastolic dysfunction in patients with predialysis moderate/severe CKD which is consistent with a recent report 20 . Secondary hyperparathyroidism in CKD can affect LV diastolic function 21,22 . Parathyroid hormone has been demonstrated to stimulate the proliferation of cardiac fibroblasts, therefore, playing an important role in the genesis of myocardial fibrosis, which is a prerequisite of diastolic dysfunction 23 .…”