慢性甲状旁腺功能减退症患者的心血管状况：168例患者的系统性横断面评估

Cardiovascular status in chronic hypoparathyroidism: a systematic cross-sectional assessment in 168 patients.

作者信息

Fuss Carmina Teresa, Gronemeyer Karen, Hermes Franca, Dörr Marcus, Schmid Benedikt, Morbach Caroline, Schmidbauer Lena, Schlegel Nicolas, Fassnacht Martin, Koschker Ann Cathrin, Nordbeck Peter, Hannemann Anke, Hahner Stefanie

机构信息

Department of Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, 97080 Würzburg, Germany.

German Centre for Cardiovascular Research (DZHK), partner site Greifswald, 17475 Greifswald, Germany.

出版信息

Eur J Endocrinol. 2025 Mar 27;192(4):373-384. doi: 10.1093/ejendo/lvaf023.

DOI:10.1093/ejendo/lvaf023

PMID:40172208

Abstract

OBJECTIVE

Long-term complications such as renal diseases are well known in patients with chronic hypoparathyroidism (hypoPT), but risk of cardiovascular comorbidity remains less clear. This study comprehensively assessed cardiovascular parameters in hypoPT compared to matched controls.

DESIGN

Cross-sectional cohort study involving 168 patients with chronic hypoPT.

METHODS

Patients underwent electrocardiograms, blood pressure measurements, and echocardiography. A 1:3 propensity score matching was performed with individuals from the German population-based Study of Health in Pomerania (SHIP-TREND) and the "Characteristics and Course of Heart Failure Stages A-B" (STAAB) cohort.

RESULTS

HypoPT showed significantly higher systolic (128 vs 125 mm Hg, P = .02) and diastolic blood pressures (83 vs 77 mm Hg, P < .01). Intake of antihypertensives was similar between groups. The QTc interval was markedly prolonged (438 vs 420 ms, P < .01) with QTc interval prolongation occurring significantly more frequently in hypoPT (24% vs 6%, P < .01). Interestingly, echocardiography revealed significantly lower left ventricular mass index (28 vs 43 g/m2.7, P < .01) and less frequent left ventricular hypertrophy (7%% vs 41%, P < .01) in hypoPT but comparable left ventricular ejection fraction (P = .48). HypoPT patients had higher prevalence of mitral (20 vs 0%, P < .01) and aortic valve stenoses (7 vs 2%, P < .01). Comparison with STAAB confirmed the increased prevalence of arterial hypertension and reduced myocardial mass indices.

CONCLUSIONS

Patients with hypoPT exhibit a higher prevalence of QTc interval prolongation despite established therapy and an increased incidence of hypertension. Conversely, echocardiography revealed lower left ventricular mass and less frequent left ventricular hypertrophy in hypoPT, but higher prevalence of valve stenosis. Regular monitoring of hypertension, QTc interval prolongation, and valve stenosis is recommended to reduce the risk of cardiovascular diseases.

CLINICAL TRIAL REGISTRATION NUMBER

NCT05585593.

摘要

目的

肾脏疾病等长期并发症在慢性甲状旁腺功能减退症（甲旁减）患者中广为人知，但心血管合并症的风险仍不太明确。本研究全面评估了甲旁减患者与匹配对照组的心血管参数。

设计

涉及168例慢性甲旁减患者的横断面队列研究。

方法

患者接受心电图、血压测量和超声心动图检查。采用1:3倾向评分匹配法，与来自德国基于人群的波美拉尼亚健康研究（SHIP-TREND）和“心力衰竭A - B期的特征与病程”（STAAB）队列的个体进行匹配。

结果

甲旁减患者的收缩压（128 vs 125 mmHg，P = .02）和舒张压（83 vs 77 mmHg，P < .01）显著更高。两组间抗高血压药物的使用情况相似。甲旁减患者的QTc间期明显延长（438 vs 420 ms，P < .01），且QTc间期延长在甲旁减患者中出现的频率显著更高（24% vs 6%，P < .01）。有趣的是，超声心动图显示甲旁减患者的左心室质量指数显著更低（28 vs 43 g/m2.7，P < .01），左心室肥厚的发生率更低（7% vs 41%，P < .01），但左心室射血分数相当（P = .48）。甲旁减患者二尖瓣狭窄（20% vs 0%，P < .01）和主动脉瓣狭窄（7% vs 2%，P < .01）的患病率更高。与STAAB队列的比较证实了动脉高血压患病率增加和心肌质量指数降低。