Primer Hiperparatiroidili Hastalarda Yapısal ve Fonksiyonel Kardiyak Belirteçlerin Manyetik Rezonans Görüntüleme ile Değerlendirilmesi ve Kardiyokinlerle İlişkilerinin İncelenmesi

Abstract

Primary hyperparathyroidism (PHPT) is characterized by hypercalcemia and elevated or inappropriately normal parathyroid hormone (PTH) levels. PHPT mainly affects the skeleton and the kidneys, but the heart is affected as well. Studies on cardiac structural and functional abnormalities in PHPT have yielded conflicting results. The primary aim of this study was to evaluate the effects of parathyroidectomy (PTX) on cardiovascular system in patients with PHPT. Patients admitted to Hacettepe University Department of Endocrinology and Metabolic Diseases between August 2021-May 2023 were recruited to the study. Patients who had cardiac disease, chronic kidney disease, chronic liver disease, active malignancy, a contraindication to cardiac magnetic resonance imaging (CMR), and pregnant and postpartum patients were excluded from the study. CMR examinations were performed and blood samples were drawn from patients for serum FSTL1 and FGF-23 before PTX. Six months after PTX, CMR was repeated, blood samples were drawn again for serum FSTL1 and FGF-23. Structural and functional changes of the heart were evaluated with CMR. FSTL1 and FGF-23 changes were analyzed. Changes in these parameters were evaluated with other parameters. 31 patients who met consensus guideline criteria for PTX were included in the study. Compared to the measurements made before PTX, there was an increase in the FSTL1 (30.585±8146 pg/mL and 33.316±9268 pg /mL respectively, p=0.001), while no change was found in the FGF-23 (7.15±5.71 pg /mL and 7.79±6.82 mL respectively, p=0.15). FSTL1 was found to be correlated with age (r=0.443, p=0.013) , height (r= -0.521, p=0.003), body mass index (r=0.387, p=0.032), fasting plasma glucose (r=0.559, p=0.002), HbA1c (r=0.538, p=0.002), left ventricular peak filling rate (r=-0.457, p=0.011), left ventricular peak filling time (r=0.423, p= 0.020), A (late ventricular filling velocity) (r=0.504, p=0.004) and E/A ratio (early ventricular filling velocity/late ventricular filling velocity) (r=-0.489, p=0.005) in measurements made before PTX. Multiple linear regression analysis was performed to evaluate the association between these parameters and FSTL1. No parameter was significantly associated with FSTL1. Compared to the pre-PTX measurements, a decrease in left ventricular ejection fraction (LVEF) (%62.25±3.22 and % 60.09±4.68 respectively, p=0.01), a decrease in left ventricular stroke volume (80.12±18.53 mL and 77.25±17.71 mL respectively, p=0.028), an increase in left ventricular end systolic volume (48.19±12.20 mL and 52.19±16.14 mL respectively, p=0.010), a decrease in E (42.94±10.89 cm/s and 37.55±10.73 cm/s respectively, p=0.021), and a decrease in A (44.28±11.67 cm/s and 39.33±10.90 cm/s respectively, p=0.031) were detected. LVEF was correlated with systolic blood pressure (r=0.371, p=0.040), diastolic blood pressure (r=0.379, p=0.035), FGF-23 (r=0.395, p=0.028), left ventricular end systolic volume (r=-0.363, p=0.045), E (r=0.382, p=0.034), basal pre-T1 (r=-0.405, p=0.024), midventricular T2 (r=0.378, p=0.036) and basal anterior extracellular volume (r=0.395, p=0.034) in measurements made before PTX. Multiple linear regression analysis was performed to evaluate the association between these parameters and LVEF. E (β=0.414, p=0.009) and basal pre-T1 (β=-0.445, p=0.007) were found to be significantly associated with LVEF. In PHPT the heart works in a hyperdynamic state. This may be a cause of the increased cardiovascular morbidity and mortality seen in mild PHPT. The improvement in the hyperdynamic state of the heart with PTX shows that cardiovascular evaluation should also be done when considering PTX decision.