Cardiac structural and functional abnormalities in primary hyperparathyroidism

J Endocrinol Invest. 2022 Feb;45(2):327-335. doi: 10.1007/s40618-021-01645-x. Epub 2021 Jul 29.


Purpose: Studies on cardiac structural and functional abnormalities in primary hyperparathyroidism (PHPT) have yielded conflicting and inconsistent results. In this prospective case-control study, we sought to compare cardiac structure and function in symptomatic PHPT patients and controls.

Methods: One hundred consecutive symptomatic PHPT patients and 113 matched controls underwent echocardiographic evaluation by the same operator.

Results: Left ventricular mass index (LVMI) was significantly higher in patients as compared to controls, (median of 90.95 g/m2 vs 86.5 g/m2, p = 0.041). Patients had significantly lower early trans-mitral diastolic flow (E velocity) as compared to controls (57.13 ± 14.88 vs 64.76 ± 15.45 cm/s, p < 0.001). Patients also had significantly lower early to late mitral annular velocity (E/A) as compared to controls (0.98 ± 0.37 vs 1.10 ± 0.34, p 0.013). Patients had higher frequency of aortic valve calcification (29% vs 2.65%, p < 0.001), mitral annular calcification (23% vs. 4.42%, p < 0.001), myocardial and septal calcifications (25% vs none, p < 0.001) as compared to controls. Serum PTH, calcium and uric acid significantly correlated with calcifications. Serum calcium showed a negative correlation with E/A ratio.

Conclusions: Symptomatic patients with PHPT have substantial cardiac structural and functional abnormalities. These abnormalities include elevated LVMI, diastolic dysfunction, and aortic valve, mitral annular, septal and myocardial calcifications. We strongly suggest and conclude that the evaluation of PHPT patients should not only include traditional end organs like bones and kidneys but also the cardiovascular system in the form of echocardiography to detect subclinical cardiac dysfunction so that the cardiovascular health of such patients can be optimized.

Keywords: Diastolic dysfunction; Left ventricular mass index; Primary hyperparathyroidism; Valvular calcification.

MeSH terms

  • Calcinosis* / blood
  • Calcinosis* / diagnostic imaging
  • Calcinosis* / etiology
  • Calcium / blood
  • Cardiomyopathies* / diagnosis
  • Cardiomyopathies* / etiology
  • Cardiomyopathies* / physiopathology
  • Case-Control Studies
  • Early Diagnosis
  • Echocardiography / methods
  • Echocardiography / statistics & numerical data
  • Female
  • Heart Valve Diseases* / etiology
  • Heart Valve Diseases* / pathology
  • Heart Valve Diseases* / physiopathology
  • Heart Ventricles* / diagnostic imaging
  • Heart Ventricles* / pathology
  • Humans
  • Hyperparathyroidism, Primary* / complications
  • Hyperparathyroidism, Primary* / diagnosis
  • Male
  • Middle Aged
  • Organ Size
  • Parathyroid Hormone / blood


  • Parathyroid Hormone
  • Calcium