Impact of curative parathyroidectomy on left ventricular functions assessed with 2D ECHO and MUGA study
Kishore Abuji1, Divya Dahiya1, Ashwani Sood3, Madan Parmar3, Sanjay Kumar Bhadada2, Rajesh Vijayvergiya4, Arunanshu Behera1
1Department of General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
2Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
3Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
4Department of Cardiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
Abstract
Objective: Primary hyperparathyroidism (PHPT) is associated with increased cardiovascular morbidity and mortality with inconsistent results on the reversibility of cardiovascular changes after parathyroidectomy (PTx). The present study was undertaken to evaluate both structural and functional cardiac changes and their reversal after PTx in patients with PHPT.
Material and Methods: Thirty patients of symptomatic PHPT without cardiovascular risk factors were evaluated prospectively by means of 2D echocar- diography (ECHO) and Multigated Acquisition (MUGA) study before surgery and six months after curative parahyroidectomy.
Results: Nine of 30 patients had hypertension which improved in two after PTx (p 0.20). Two patients had left ventricle hypertrophy on 2D ECHO pre- operatively which improved after PTx (p< 0.001). Left ventricular ejection fraction (LVEF) did not show significant change before and after PTx on 2D ECHO. Nine out of 30 patients had hypertension which improved in two after PTx (p 0.20). Two patients with left ventricle hypertrophy on 2D ECHO preoperatively improved after PTx (p< 0.001). Left ventricular ejection fraction (EF) did not depict significant change before and after PTx on 2D ECHO. Whereas, four out of six patients with preoperative EF <50% representing systolic dysfunction on MUGA study showed improvement after PTx. On 2D ECHO, eight patients depicted diastolic dysfunction which improved in six patients after curative surgery (p= 0.07). However, on MUGA study, 13 pa- tients presented with tTPF >180 ms indicating diastolic dysfunction, of which ten showed improvement after PTx (p= 0.007).
Conclusion: The present study analyzed preoperative and postoperative cardiac function using both 2D ECHO and MUGA study. MUGA study provided a more objective assessment of the cardiac function by determining left ventricular ejection fraction and diastolic dysfunction.
Keywords: Muga study, primary hyperparathyroidism, left ventricular dysfunction, 2D ECHO, parathyroidectomy, cardiac manifestations
This study approval was obtained from Postgraduate Institute of Medical Education and Research (PGIMER) (Decision No: NK/4667/MS/731, Date: 27.03.2019).
Externally peer-reviewed.
Concept - D.D.; Design - D.D.; Supervision - D.D.; Data Collection and/or Processing - K.A.; Materials - S.K.B., A.B.; Analysis and/ or Interpretation - A.S.; Writing Manuscript - D.D.; Critical Reviews - D.D., A.B.
The authors have no conflicts of interest to declare.
The authors declared that this study has received no financial support.