Endocrine Abstracts

Aim: The primary objective of this study was to evaluate the structural and functional cardiac parameters with MRI in patients with primary hyperparathyroidism (pHPT) before and after successful surgery.

Method: In this prospective study 16 patients with pHPT were included. Detailed cardiac magnetic resonance imaging (MRI) examinations were performed preoperatively and at six months post-surgery. Following parameters were measured: Left ventricle ejection fraction (LVEF), left ventricle end-diastolic volume (LVED), left ventricle stroke volume and left ventricle stroke index; left ventricle cardiac output and cardiac index; left ventricle end-diastolic wall mass, left ventricle peak filling rate and peak filling time; E and A, mitral deceleration time, left atrium volume index (LAVI). In addition, pre-contrast T1-T2 relaxation times and ECV values were analyzed.

Results: The mean ±SD age of the 16 patients was 54 ± 12 years. The majority of the patients were female (F/M: 11/5). Only two patients had symptomatic pHPT, rest were asymptomatic. Evaluation of the asymptomatic patients revealed nephrolithiasis in four (26%) and osteoporosis in six (46%). All of the patients had sporadic disease. The mean ±SD levels of PTH and calcium were 170 ± 84 pg/ml and 11.2 ± 0.5 mg/dl, respectively before surgery. The culprit lesion was adenoma in 15 (93%) and hyperplasia and adenoma could not be differentiated in one. After successful surgery PTH and calcium were decreased: 64 ± 28 pg/ml and 9.7 ± 0.2 mg/dl, respectively. Comparative cardiac MR images demonstrated lower apical global ECV values postoperatively. Apical global ECV values decreased from 27.9 ± 3.6% to 26.4 ± 2.6%, (P =0.015). The both atrial (late ventricular filling velocities from 43.80 ± 12.97 cm/s to 37.10± 11.89 cm/s, P=0.047) and ventricular (left ventriculary ejection fraction from 62.81 ± 3.74% to 60.31 ± 4.65%, P=0.021; early ventricular filling velocities from 43.78 ± 9.25 cm/s to 36.10 ± 9.57 cm/s, P=0.017) systolic forces of the heart were reduced after the control of PTH secretion. There were no differences in other MRI parameters.

Conclusion: In this first study that evaluates structural and functional cardiac MRI parameters in a cohort of patients with pHPT (especially in asymptomatic patients) we showed that apical ECV values, which is an indicator of myocardial fibrosis, were improved after successful surgery. Moreover, we determined that myocardium contracts stronger in primary hyperparathyroidism.