Title : Echocardiographic changes post parathyroidectomy in patient with primary hyperparathyroidism: A meta-analysis
Abstract:
Background: Patients with symptomatic Primary Hyperparathyroidism (PHPT) are known to have higher risk of cardiovascular disease and mortality. This is in part due to the biochemical changes in PHPT including elevations in calcium and parathyroid hormone (PTH) which are associated with cardiac structural abnormalities such as left ventricular hypertrophy and myocardial calcification. Parathyroidectomy is the only definitive treatment option available for patients with PHPT and is recommended for symptomatic disease or those with significant hypercalcemia. However, there is lack of consensus in the literature of whether cardiac function improves post parathyroidectomy. The purpose of this study is to identify echocardiographic changes post parathyroidectomy.
Methods: A systematic literature search was performed on Medline, Embase and Cochrane using the PRISMA guidelines. A meta-analysis of selected studies that assessed patients with PTHP undergoing parathyroidectomy with measurements of echocardiographic parameters was performed using Review Manager 5.4. Echocardiographic parameters included measurements of strain, ejection fraction, isovolumic relaxation time, posterior wall diameter, left ventricular (LV) mass, LV volume, LV diameter, intraventricular septum diameter and flow velocities.
Results: We identified a total of 21 studies encompassing data of 777 patients. The pooled odd ratio showed there was no significant change in left ventricular ejection fraction (OR: 0.20, 95% CI: -0.19-0.60, p = 0.31) and left ventricular diameter (OR: 0.17, 95% CI: 0.00-0.34, p = 0.05). However, global longitudinal strain (OR: 0.51, 95% CI: 0.22-0.80, p = 0.0005) and the ratio of the early to late ventricular filling velocities (OR: -0.21, 95% CI: -0.38- -0.04, p = 0.01) were found to improve significantly post parathyroidectomy
Conclusion: Global longitudinal strain may be an effective way to detect improvements in left ventricular function post parathyroidectomy in PHTP patients. More studies are required to assess whether this may add prognostic benefit to those with cardiovascular disease.
