Santori Rachele, Menafra Vito, Sgreccia Alessandro, Colangelo Luciano, Cipriani Cristiana, Occhiuto Marco, Desideri Giovambattista, Ettorre Evaristo, Minisola Salvatore, Pepe Jessica
Department of clinical, internal, anesthesiology and cardiovascular sciences, "Sapienza" University of Rome, Rome, Italy.
Endocrine. 2025 May 9. doi: 10.1007/s12020-025-04235-6.
Postsurgical hypoparathyroidism is associated with an increased cardiovascular risk, however an increased arrhythmic risk in this population is controversial.
Twenty-two postmenopausal women with postsurgical hypoparathyroidism and 22 healthy postmenopausal women of the same age were enrolled. Each subject underwent blood tests, standard 12-lead ECG, 24-hour Holter ECG and echocardiographic measurements. The exclusion criteria were: previous cardiovascular disease, arrhythmias, diabetes mellitus, kidney failure, use of drugs that may interfere with cardiac conduction.
Time since diagnosis of postsurgical hypoparathyroidism was 19.33 ± 8.82 years. As expected, serum calcium and PTH levels were significantly lower in hypoparathyroid patients compared to controls, while phosphorus was higher (all p < 0.05). ECG parameters were within normal values in both groups. A higher number of hypoparathyroid patients had significantly more supraventricular and ventricular premature beats compared to controls (p < 0.05). An index of heart variability, predominantly of parasympathetic activity, such as the root mean square of the difference between successive RR intervals was significantly lower in hypoparathyroid patients compared to controls (21.09 ± 9.84 vs 33.0 ± 17.89 msec, p = 0.009). All the echocardiographic parameters were within the normal limits. The only statistically significant difference between groups was a lower ejection fraction (EF) in the hypoparathyroid group compared to controls (57.5% ± 2.98 vs 64.85% ± 6.09, p < 0.0001). A longer time since diagnosis of hypoparathyroidism was only positively associated with heart rate: B = 0.45, QRS: B = 0.66 and negatively with EF:B = -0.64 (all p < 0.05).
24-hour ECG Holter demonstrated an increase in arrhythmia in postmenopausal women with long-term postsurgical hypoparathyroidism in the absence of long QT or cardiac structural abnormalities.
术后甲状旁腺功能减退与心血管风险增加相关，然而该人群心律失常风险增加存在争议。
纳入22名绝经后术后甲状旁腺功能减退女性和22名年龄相同的健康绝经后女性。每位受试者均接受血液检查、标准12导联心电图、24小时动态心电图及超声心动图测量。排除标准为：既往有心血管疾病、心律失常、糖尿病、肾衰竭、使用可能干扰心脏传导的药物。
术后甲状旁腺功能减退确诊时间为19.33±8.82年。正如预期，甲状旁腺功能减退患者的血清钙和甲状旁腺激素水平显著低于对照组，而磷水平更高（均p<0.05）。两组的心电图参数均在正常范围内。与对照组相比，甲状旁腺功能减退患者出现更多的室上性和室性早搏（p<0.05）。甲状旁腺功能减退患者的心率变异性指数（主要反映副交感神经活动），如连续RR间期差值的均方根，显著低于对照组（21.09±9.84对33.0±17.89毫秒，p=0.009）。所有超声心动图参数均在正常范围内。两组之间唯一具有统计学意义的差异是甲状旁腺功能减退组的射血分数（EF）低于对照组（57.5%±2.98对64.85%±6.09，p<0.0001）。甲状旁腺功能减退确诊时间较长仅与心率呈正相关：B=0.45，QRS：B=0.66，与EF呈负相关：B=-0.64（均p<0.05）。
24小时动态心电图显示，长期术后甲状旁腺功能减退的绝经后女性在无长QT或心脏结构异常的情况下心律失常增加。
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