open access

Vol 72, No 5 (2021)
Original paper
Submitted: 2021-01-16
Accepted: 2021-04-01
Published online: 2021-05-05
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Atrial electromechanical delay is impaired in patients with primary hyperparathyroidism

Şaban Keleşoğlu1, Yücel Yilmaz2, Ferhat Gökay2, Yasin Simsek2, Bekir Calapkorur2, Deniz Elcik1
·
Pubmed: 34010441
·
Endokrynol Pol 2021;72(5):550-557.
Affiliations
  1. Faculty of Medicine, Erciyes University, Kayseri, Türkiye
  2. Kayseri Şehir Hastanesi, Kocasinan/Kayseri, Turkey

open access

Vol 72, No 5 (2021)
Original Paper
Submitted: 2021-01-16
Accepted: 2021-04-01
Published online: 2021-05-05

Abstract

Introduction: Primary hyperparathyroidism (PHPT) is an endocrine disease that poses a risk for cardiac arrhythmias. Atrial electromechanical delay (EMD) has been known as an early marker of atrial fibrillation (AF). This study aimed to evaluate the atrial EMD in PHPT.

Material and methods: Fifty PHPT patients (45 females, 5 males) aged 30–75 years and 38 controls (35 females, 3 males) aged 31–73 years were included in the study. Atrial EMD parameters were measured by using tissue Doppler imaging (TDI). Inter-atrial EMD was calculated as the difference between PA lateral and PA tricuspid; intra-atrial EMD was calculated as the difference between PA septum and PA tricuspid, and left-atrial EMD was calculated as the difference between PA lateral and PA septum.

Results: Atrial EMD parameters (PA lateral, PA septum, PA tricuspid) significantly increased in the PHPT group compared to the control group (p < 0.001, for all). Also, inter-atrial and intra-atrial EMD were higher in the PHPT group than in the control group (p < 0.001, for all). In correlation analysis, calcium was closely associated with PA lateral (r = 0.749, p < 0.001), PA septum (r = 0.735, p < 0.001), inter-atrial EMD (r = 0.807, p < 0.001), and intra-atrial EMD (r = 0.838, p < 0.001). The same correlation relationship was seen between PTH levels with PA lateral (r = 671, p < 0.001), PA septum (r = 0.660, p < 0,001), inter-atrial EMD (r = 0.674, p < 0.001), and intra-atrial EMD (r = 0.732, p < 0.001).

Conclusions: Atrial EMD parameters were prolonged in PHPT. The measurement of atrial EMD parameters might be used in determining the risk of AF development in PHPT.

Abstract

Introduction: Primary hyperparathyroidism (PHPT) is an endocrine disease that poses a risk for cardiac arrhythmias. Atrial electromechanical delay (EMD) has been known as an early marker of atrial fibrillation (AF). This study aimed to evaluate the atrial EMD in PHPT.

Material and methods: Fifty PHPT patients (45 females, 5 males) aged 30–75 years and 38 controls (35 females, 3 males) aged 31–73 years were included in the study. Atrial EMD parameters were measured by using tissue Doppler imaging (TDI). Inter-atrial EMD was calculated as the difference between PA lateral and PA tricuspid; intra-atrial EMD was calculated as the difference between PA septum and PA tricuspid, and left-atrial EMD was calculated as the difference between PA lateral and PA septum.

Results: Atrial EMD parameters (PA lateral, PA septum, PA tricuspid) significantly increased in the PHPT group compared to the control group (p < 0.001, for all). Also, inter-atrial and intra-atrial EMD were higher in the PHPT group than in the control group (p < 0.001, for all). In correlation analysis, calcium was closely associated with PA lateral (r = 0.749, p < 0.001), PA septum (r = 0.735, p < 0.001), inter-atrial EMD (r = 0.807, p < 0.001), and intra-atrial EMD (r = 0.838, p < 0.001). The same correlation relationship was seen between PTH levels with PA lateral (r = 671, p < 0.001), PA septum (r = 0.660, p < 0,001), inter-atrial EMD (r = 0.674, p < 0.001), and intra-atrial EMD (r = 0.732, p < 0.001).

Conclusions: Atrial EMD parameters were prolonged in PHPT. The measurement of atrial EMD parameters might be used in determining the risk of AF development in PHPT.

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Keywords

primary hyperparathyroidism; atrial fibrillation; electromechanical delay

About this article
Title

Atrial electromechanical delay is impaired in patients with primary hyperparathyroidism

Journal

Endokrynologia Polska

Issue

Vol 72, No 5 (2021)

Article type

Original paper

Pages

550-557

Published online

2021-05-05

Page views

6938

Article views/downloads

420

DOI

10.5603/EP.a2021.0044

Pubmed

34010441

Bibliographic record

Endokrynol Pol 2021;72(5):550-557.

Keywords

primary hyperparathyroidism
atrial fibrillation
electromechanical delay

Authors

Şaban Keleşoğlu
Yücel Yilmaz
Ferhat Gökay
Yasin Simsek
Bekir Calapkorur
Deniz Elcik

References (38)
  1. Pallan S, Rahman MO, Khan AA. Diagnosis and management of primary hyperparathyroidism. BMJ. 2012; 344: e1013.
  2. Walker MD, Silverberg SJ. Cardiovascular aspects of primary hyperparathyroidism. J Endocrinol Invest. 2008; 31(10): 925–931.
  3. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: A report of the american college of cardiology/american heart association task force on practice guidelines and the heart rhythm society. J Am Coll Cardiol. 2014; 64: e1–e76.
  4. Komatsu T, Kunugita F, Ozawa M, et al. Relationship between Impairment of the Vascular Endothelial Function and the CHADS-VASc Score in Patients with Sinus Rhythm and Non-valvular Atrial Fibrillation. Intern Med. 2018; 57(15): 2131–2139.
  5. Deniz A, Sahiner L, Aytemir K, et al. Tissue Doppler echocardiography can be a useful technique to evaluate atrial conduction time. Cardiol J. 2012; 19(5): 487–493.
  6. Daubert JC, Pavin D, Jauvert G, et al. Intra- and interatrial conduction delay: implications for cardiac pacing. Pacing Clin Electrophysiol. 2004; 27(4): 507–525.
  7. Piepoli M, Hoes A, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016; 37(29): 2315–2381.
  8. Cheitlin MD, Armstrong WF, Aurigemma GP, et al. ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). Circulation. 2003; 108(9): 1146–1162.
  9. Andersson P, Rydberg E, Willenheimer R. Primary hyperparathyroidism and heart disease--a review. Eur Heart J. 2004; 25(20): 1776–1787.
  10. Kosch M, Hausberg M, Vormbrock K, et al. Studies on flow-mediated vasodilation and intima-media thickness of the brachial artery in patients with primary hyperparathyroidism. Am J Hypertens. 2000; 13(7): 759–764.
  11. Gennari C, Nami R, Gonnelli S. Hypertension and primary hyperparathyroidism: the role of adrenergic and renin-angiotensin-aldosterone systems. Miner Electrolyte Metab. 1995; 21(1-3): 77–81.
  12. Nilsson IL, Rastad J, Johansson K, et al. Endothelial vasodilatory function and blood pressure response to local and systemic hypercalcemia. Surgery. 2001; 130(6): 986–990.
  13. Kepez A, Yasar M, Sunbul M, et al. Evaluation of left ventricular functions in patients with primary hyperparathyroidism: is there any effect of parathyroidectomy? Wien Klin Wochenschr. 2017; 129(9-10): 329–336.
  14. Ozdemir D, Kalkan GY, Bayram NA, et al. Evaluation of left ventricle functions by tissue Doppler, strain, and strain rate echocardiography in patients with primary hyperparathyroidism. Endocrine. 2014; 47(2): 609–617.
  15. Ekmekci A, Abaci N, Colak Ozbey N, et al. Endothelial function and endothelial nitric oxide synthase intron 4a/b polymorphism in primary hyperparathyroidism. J Endocrinol Invest. 2009; 32(7): 611–616.
  16. Lind L, Ljunghall S, Lind L, et al. Cytoplasmic calcium regulation and the electrocardiogram in patients with primary hyperparathyroidism. Clin Physiol. 1994; 14(1): 103–110.
  17. Surawicz B. Role of electrolytes in etiology and management of cardiac arrhythmias. Prog Cardiovasc Dis. 1966; 8(4): 364–386.
  18. Cui QQ, Zhang W, Wang Hu, et al. Assessment of atrial electromechanical coupling and influential factors in nonrheumatic paroxysmal atrial fibrillation. Clin Cardiol. 2008; 31(2): 74–78.
  19. Roshanali F, Mandegar MH, Yousefnia MA, et al. Prevention of atrial fibrillation after coronary artery bypass grafting via atrial electromechanical interval and use of amiodarone prophylaxis. Interact Cardiovasc Thorac Surg. 2009; 8(4): 421–425.
  20. Bakirci EM, Demirtas L, Degirmenci H, et al. Relationship of the total atrial conduction time to subclinical atherosclerosis, inflammation and echocardiographic parameters in patients with type 2 diabetes mellitus. Clinics (Sao Paulo). 2015; 70(2): 73–80.
  21. Ermiş N, Açıkgöz N, Yaşar E, et al. [Evaluation of atrial conduction time by P wave dispersion and tissue Doppler echocardiography in prehypertensive patients]. Turk Kardiyol Dern Ars. 2010; 38(8): 525–530.
  22. Ozer N, Yavuz B, Can I, et al. Doppler tissue evaluation of intra-atrial and interatrial electromechanical delay and comparison with P-wave dispersion in patients with mitral stenosis. J Am Soc Echocardiogr. 2005; 18(9): 945–948.
  23. Calapkorur B, Kelesoglu S, Sarli B, et al. Atrial electromechanical delay is impaired in patients with psoriasis. Med Princ Pract. 2015; 24(1): 30–35.
  24. Efe TH, Cimen T, Ertem AG, et al. Atrial Electromechanical Properties in Inflammatory Bowel Disease. Echocardiography. 2016; 33(9): 1309–1316.
  25. Deniz A, Yavuz B, Aytemir K, et al. Intra-left atrial mechanical delay detected by tissue Doppler echocardiography can be a useful marker for paroxysmal atrial fibrillation. Echocardiography. 2009; 26(7): 779–784.
  26. Hove-Madsen L, Llach A, Bayes-Genís A, et al. Atrial fibrillation is associated with increased spontaneous calcium release from the sarcoplasmic reticulum in human atrial myocytes. Circulation. 2004; 110(11): 1358–1363.
  27. Voigt N, Li Na, Wang Q, et al. Enhanced sarcoplasmic reticulum Ca2+ leak and increased Na+-Ca2+ exchanger function underlie delayed afterdepolarizations in patients with chronic atrial fibrillation. Circulation. 2012; 125(17): 2059–2070.
  28. Rosenqvist M, Nordenström J, Andersson M, et al. Cardiac conduction in patients with hypercalcaemia due to primary hyperparathyroidism. Clin Endocrinol (Oxf). 1992; 37(1): 29–33.
  29. Dalberg K, Brodin LA, Juhlin-Dannfelt A, et al. Cardiac function in primary hyperparathyroidism before and after operation. An echocardiographic study. Eur J Surg. 1996; 162(3): 171–176.
  30. Curione M, Letizia C, Amato S, et al. Increased risk of cardiac death in primary hyperparathyroidism: what is a role of electrical instability? Int J Cardiol. 2007; 121(2): 200–202.
  31. Ogino K, Burkhoff D, Bilezikian JP. The hemodynamic basis for the cardiac effects of parathyroid hormone (PTH) and PTH-related protein. Endocrinology. 1995; 136(7): 3024–3030.
  32. Cheng SP, Liu CL, Liu TP, et al. Association between parathyroid hormone levels and inflammatory markers among US adults. Mediators Inflamm. 2014; 2014: 709024.
  33. Shor R, Tilis Y, Halabe A, et al. Serum parathyroid hormone-related protein levels before and after paroxysmal atrial fibrillation. Am J Emerg Med. 2008; 26(3): 361–363.
  34. Wannamethee SG, Welsh P, Papacosta O, et al. Elevated parathyroid hormone, but not vitamin D deficiency, is associated with increased risk of heart failure in older men with and without cardiovascular disease. Circ Heart Fail. 2014; 7(5): 732–739.
  35. Rienstra M, Lubitz SA, Zhang ML, et al. Elevation of parathyroid hormone levels in atrial fibrillation. J Am Coll Cardiol. 2011; 57(25): 2542–2543.
  36. Lee KiH, Shin MHo, Park HW, et al. Association between Serum Parathyroid Hormone Levels and the Prevalence of Atrial Fibrillation: the Dong-gu Study. Korean Circ J. 2018; 48(2): 159–167.
  37. Pepe J, Cipriani C, Curione M, et al. Reduction of arrhythmias in primary hyperparathyroidism, by parathyroidectomy, evaluated with 24-h ECG monitoring. Eur J Endocrinol. 2018; 179(2): 117–124.
  38. Hindricks G, Potpara T, Dagres N, et al. ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2021; 42(5): 373–498.

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