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Muacevic A, Adler JR. Parathyroid Hormone Secretion and Related Syndromes. Cureus 2022; 14:e30251. [PMID: 36381723 PMCID: PMC9650928 DOI: 10.7759/cureus.30251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/13/2022] [Indexed: 01/24/2023] Open
Abstract
In this article, we will get to know about the parathyroid hormone and the parathyroid gland. Its anatomy, physiology, and pathology will be delved into. There will be a brief discussion about its secretion and also about various clinical syndromes related to it. Parathormone, the parathyroid glands, regulate normal calcium and phosphorus levels in the body. An increase in the secretion of parathormone results in increased calcium uptake from the kidney, intestine, and bones, hence elevating the blood calcium level. A few mechanisms of action of this hormone are increased by the presence of vitamin D. The increase in the secretion of this hormone as compared to the normal levels is termed hyperparathyroidism. Incidence is maximum after 60 years of age. The ratio of females to males is 2:1. There are three types of hyperparathyroidism which will be described in this article. Clinical manifestations of hyperparathyroidism include skeletal disease, renal involvement, GI manifestations, psychiatric diseases, decreased neuro-muscular irritability, decreased deep tendon reflexes, muscular weakness, and atrophy. Assessment for hyperparathyroidism can be done by various diagnostic tests which are described further in this article. Medical/surgical management to cure this is also well-established nowadays. The decrease in the secretion of this hormone as compared to normal levels is termed hypoparathyroidism. Serum calcium levels are very low, serum phosphate levels are very high, and tetany can develop. The incidence is that females are more prone than males. Assessment for acute hypoparathyroidism will show positive Chvostek sign and trousseau sign, hyperactive deep tendon reflexes, and paresthesia. Assessment of chronic hypoparathyroidism will show lethargy, weakness, fatigue, cataracts, brittle nails, dry scaly skin, personality changes, and can even cause permanent brain damage. The normal secretion process of this hormone and diseases when its secretion becomes abnormal and why that happens are briefed in this article.
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Endocrinopathies mimicking gene negative long QT syndrome. Cardiol Young 2022; 32:1016-1018. [PMID: 34814967 DOI: 10.1017/s1047951121004388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Ventricular repolarisation can be influenced by hormonal milieu which may mimic long QT syndrome. We describe a series of patients referred for genetic testing for diagnosed long QT syndrome where a detailed clinical workup demonstrated endocrinopathies as the cause of presumed "gene negative" long QT syndrome and QT prolongation.
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Stewart LA, Steinl GK, Huang BL, McManus C, Lee JA, Kuo JH, Walker MD. Primary Hyperparathyroidism Is Associated With Shorter QTc Intervals, but Not Arrhythmia. J Clin Endocrinol Metab 2022; 107:e1689-e1698. [PMID: 34752632 PMCID: PMC8947224 DOI: 10.1210/clinem/dgab820] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Primary hyperparathyroidism (PHPT) is associated with subclinical cardiovascular disease, but data regarding cardiac conduction abnormalities are limited. OBJECTIVE AND DESIGN Retrospective cross-sectional comparison of cardiac conduction in patients with PHPT or thyroid disease (TD). PARTICIPANTS AND SETTING Patients ≥40 years old who underwent parathyroidectomy or thyroidectomy at a single tertiary institution from 2013 to 2018. METHODS AND OUTCOMES Demographics and preoperative electrocardiogram (EKG) parameters were compared using the Mann-Whitney U, chi-square test, and linear regression. RESULTS A total of 1242 patients were included: 49.8% PHPT (n = 619) and 50.2% TD (n = 623). Median age was 60.5 years [interquartile range (IQR) 53.6-67.9]. Compared to controls, PHPT patients had higher median serum calcium [10.7 mg/dL (IQR 10.4-11.1) vs 9.5 mg/dL (IQR 9.3-9.8), P < 0.001] as expected, as well as, a higher prevalence of hyperlipidemia (49% vs 36%, P < 0.001) and hypertension (50.1% vs 42.2%, P < 0.01). Based on EKG, there was no difference in PR interval or the prevalence of arrhythmia, atrioventricular block, ST segment/T wave changes, premature ventricular complexes, right bundle branch block, or left bundle branch block after adjusting for covariates. The PHPT group had a lower mean corrected QT interval (414 ± 24) ms vs 422 ± 24 ms, P < 0.01), adjusted for covariates. Serum calcium predicted QTc independently of age, sex, and other covariates. CONCLUSIONS In the largest study to date, PHPT patients had shorter QTc intervals compared to TD controls but no increased prevalence of arrhythmia based on preoperative EKG.
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Affiliation(s)
- Latoya A Stewart
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Gabrielle K Steinl
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Bernice L Huang
- Section of Endocrine Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Catherine McManus
- Section of Endocrine Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - James A Lee
- Section of Endocrine Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Jennifer H Kuo
- Section of Endocrine Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Marcella D Walker
- Department of Medicine, Division of Endocrinology, Columbia University Irving Medical Center, New York, NY, USA
- Correspondence: Marcella Walker, MD, Division of Endocrinology, 180 Fort Washington Ave, 9th Floor #904, Columbia University Irving Medical Center, New York, NY 10032, USA.
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Muzurović E, Medenica S, Kalezić M, Pavlović S. Primary hyperparathyroidism associated with acquired long QT interval and ventricular tachycardia. Endocrinol Diabetes Metab Case Rep 2021; 2021:EDM210016. [PMID: 34341183 PMCID: PMC8346179 DOI: 10.1530/edm-21-0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/13/2021] [Indexed: 12/19/2022] Open
Abstract
SUMMARY We present a 54-year-old patient admitted to the emergency department due to loss of consciousness. The initial ECG registered monomorphic ventricular extrasystoles and prolonged QT interval (QT corrected (QTc) >500 ms). Sustained ventricular tachycardia (VT) was registered on 24-h Holter ECG monitoring, which clinically was presented as a crisis of consciousness. Coronary angiography and other visualization methods were normal. Implantable cardioverter-defibrillator (ICD) implantation was planned for the purpose of secondary prevention of sudden cardiac death (SCD). Laboratory and hormonal analyzes revealed primary hyperparathyroidism (PHPT), chronic kidney disease, and hypokalemia. Neck ultrasound showed a 25 mm, sharply outlined homogenous tumor mass which was separated from thyroid gland (TG) and exerted a mild impression on lower parts of the left lobe. Dual wash technetium-99m sestamibi parathyroid scintigraphy with single-photon emission CT (SPECT)/CT also showed the uptake of tracer behind the lower half of the left lobe of the TG. Surgical treatment, lower left parathyroidectomy, was performed, and pathohistological analysis verified parathyroid adenoma. The patient was rhythmically and hemodynamically stable for 7 days after surgery, without additional complaints, and was discharged from the hospital. Timely diagnosis of PHPT, correct assessment and surgical treatment, did not lead our patient to unnecessary ICD implantation. Our case suggests an additional intertwining of electrolyte disorders and ventricular arrhythmias in PHPT and more importantly emphasizes the need for caution when indicating ICD, even in patients with the most serious life-threatening arrhythmias. LEARNING POINTS Electrolyte abnormalities in PHPT can have highly malignant consequences, and the occurrence of hypokalemia in the presence of hypercalcemia is underestimated in PHPT, and the consequences can be life-threatening. Although hypercalcemia causes shortened QT interval, concomitant severe hypokalemia may overcome hypercalcemia and prolong QT interval, even in the absence of structural heart disease or LQTS. Timely diagnosis of PHPT, correct assessment and surgical treatment, do not lead to unnecessary ICD implantation.
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Affiliation(s)
- Emir Muzurović
- Department of Internal Medicine, Endocrinology Section, Clinical Center of Montenegro, Podgorica, Montenegro
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Sanja Medenica
- Department of Internal Medicine, Endocrinology Section, Clinical Center of Montenegro, Podgorica, Montenegro
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Milovan Kalezić
- Department of Cardiology, Clinical Center of Montenegro, Podgorica, Montenegro
| | - Siniša Pavlović
- Pacemaker Center, Clinical Center of Serbia, Faculty of Medicine University of Belgrade, Belgrade, Serbia
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Burchiel SW, Lauer FT, Factor-Litvak P, Liu X, Islam T, Eunus M, Abu Horayara M, Islam MT, Rahman M, Ahmed A, Cremers S, Nandakumar R, Ahsan H, Olopade C, Graziano J, Parvez F. Arsenic exposure associated T cell proliferation, smoking, and vitamin D in Bangladeshi men and women. PLoS One 2020; 15:e0234965. [PMID: 32574193 PMCID: PMC7310686 DOI: 10.1371/journal.pone.0234965] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/06/2020] [Indexed: 01/02/2023] Open
Abstract
There are limited data examining the consequences of environmental exposure to arsenic on the immune system in adults, particularly among smokers. Smoking has been shown to exacerbate or contribute to impaired immune function in men chronically exposed to arsenic. In contrast, vitamin D (VitD) is known to have a positive influence on innate and adaptive immune responses. The effect of circulating VitD on arsenic-associated immune dysfunction is not known. Here we examine the relationship of arsenic exposure and T cell proliferation (TCP), a measure of immune responsiveness, and circulating VitD among adult men and women in Bangladesh. Arsenic exposure was assessed using total urinary arsenic as well as urinary arsenic metabolites all adjusted for urinary creatinine. TCP was measured ex vivo in cryopreserved peripheral blood mononuclear cells from 614 adult participants enrolled in the Bangladesh Health Effects of Arsenic Longitudinal Study; serum VitD was also evaluated. The influence of cigarette smoking on arsenic-induced TCP modulation was assessed only in males as there was an inadequate number of female smokers. These studies show that arsenic suppressed TCP in males. The association was significantly strong in male smokers and to a lesser extent in male non-smokers. Interestingly, we found a strong protective effect of high/sufficient serum VitD levels on TCP among non-smoking males. Furthermore, among male smokers with low serum VitD (⊔20 ng/ml), we found a strong suppression of TCP by arsenic. On the other hand, high VitD (>20 ng/ml) was found to attenuate effects of arsenic on TCP among male-smokers. Overall, we found a strong protective effect of VitD, when serum levels were >20 ng/ml, on arsenic-induced inhibition of TCP in men, irrespective of smoking status. To our knowledge this is the first large study of immune function in healthy adult males and females with a history of chronic arsenic exposure.
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Affiliation(s)
- Scott W. Burchiel
- Department of Pharmaceutical Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM, United States of America
- * E-mail:
| | - Fredine T. Lauer
- Department of Pharmaceutical Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM, United States of America
| | - Pam Factor-Litvak
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Xinhua Liu
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Tariqul Islam
- University of Chicago and Columbia University Field Research Office, Dhaka, Bangladesh
| | - Mahbubul Eunus
- University of Chicago and Columbia University Field Research Office, Dhaka, Bangladesh
| | - M. Abu Horayara
- University of Chicago and Columbia University Field Research Office, Dhaka, Bangladesh
| | - Md. Tariqul Islam
- University of Chicago and Columbia University Field Research Office, Dhaka, Bangladesh
| | - Mizanour Rahman
- University of Chicago and Columbia University Field Research Office, Dhaka, Bangladesh
| | - Alauddin Ahmed
- University of Chicago and Columbia University Field Research Office, Dhaka, Bangladesh
| | - Serge Cremers
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, United States of America
| | - Renu Nandakumar
- Irving Institute for Clinical and Translational Research, Columbia University Medical Center, New York, NY, United States of America
| | - Habibul Ahsan
- Department of Health Studies, University of Chicago, Chicago, IL, United States of America
| | - Christopher Olopade
- University of Chicago Medical Center, University of Chicago, Chicago, IL, United States of America
| | - Joseph Graziano
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Faruque Parvez
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States of America
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Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in chronic kidney disease (CKD) patients. QT interval prolongation is a congenital or acquired condition that is associated with an increased risk of torsade de pointes (TdP), sudden cardiac death (SCD), and all-cause mortality in the general population. The prevalence of acquired long QT syndrome (aLQTS) is high, and various acquired conditions contribute to the prolonged QT interval in patients with CKD. More notably, the prolonged QT interval in CKD is an independent risk factor for SCD and all-cause mortality. In this review, we focus on the epidemiological characteristics, risk factors, underlying mechanisms and treatments of aLQTS in CKD, promoting the management of aLQTS in CKD patients.
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Affiliation(s)
- Peng Liu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R. China
| | - Lu Wang
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R. China.,Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R. China
| | - Dan Han
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R. China
| | - Chaofeng Sun
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R. China
| | - Xiaolin Xue
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R. China
| | - Guoliang Li
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R. China
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Malandish A, Tartibian B, Sheikhlou Z, Afsargharehbagh R, Rahmati M. The effects of short-term moderate intensity aerobic exercise and long-term detraining on electrocardiogram indices and cardiac biomarkers in postmenopausal women. J Electrocardiol 2020; 60:15-22. [PMID: 32208176 DOI: 10.1016/j.jelectrocard.2020.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 02/23/2020] [Accepted: 03/07/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the effects of 12-week of moderate-intensity aerobic exercise and 5-month detraining on electrocardiogram (ECG) indices and serum levels of 25-hydroxivitamin D (Vit D), parathyroid hormone (PTH), calcium (Ca2+), and phosphorus (P) in postmenopausal women (PMWs). MATERIALS AND METHODS Thirty-one PMWs (aged 50-70 yrs) were randomized to exercise (EX, n = 16) and control (C, n = 15) groups. EX group performed of 12-week of warm up- walking/jogging moderate intensity aerobic exercise training program- recovery (60 min/day, 3 days/week at 70% of maximal heart rate reserve), and then 5-month detraining remained. C group maintain their normal lifestyle during 8 months. The ECG indices and cardiac serum levels were measured at baseline, after 12-week exercise, and after 5-month detraining. RESULTS After 12-week exercise intervention, P-R interval, serum PTH and serum Vit D were significantly increased in the EX group compared to the C group (P = 0.020, P = 0.001 and P = 0.001, respectively). After 5-month detraining, P-R segment and S-T interval were significantly decreased (P = 0.042 and P = 0.001, respectively) while serum Vit D was significantly increased (P = 0.014) in the EX group compared to the C group. CONCLUSIONS The results suggested that 12-week of moderate intensity aerobic exercise increased the P-R interval, PTH and Vit D, as severe Vit D deficiency status (below 10 ng/ml) improved to Vit D deficiency status (between 10 and 20 ng/ml) in PMWs. Also, long-term positive adaptations to aerobic exercise such as increased Vit D were observed even after 5-month detraining. In addition, P-R segment and S-T interval decreased after 5-month detraining in sedentary PMWs, which may be a sign of atrial positive adaptations to aerobic exercise.
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Affiliation(s)
- Abbas Malandish
- Exercise Physiology, Department of Exercise Physiology, Faculty of Sport Sciences, Urmia University, Urmia, Iran.
| | - Bakhtyar Tartibian
- Exercise Physiology, Department of Sport Injuries & Corrective Exercises, Faculty of Physical Education & Sport Sciences, Allameh Tabataba'i University, Tehran, Iran
| | - Zeinab Sheikhlou
- Exercise Physiology, Department of Exercise Physiology, Faculty of Sport Sciences, Urmia University, Urmia, Iran
| | - Roghaiyeh Afsargharehbagh
- Fellowship of Balloon Angioplasty, Department of Interventional Cardiology, Shohada Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Mohammad Rahmati
- Clinical Biochemistry, Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Abstract
Calcium has long been known to be essential to cardiac electrical activity. Parathyroid hormone (PTH) is the main regulator of serum calcium and is central to calcium homeostasis. Although there are significant data linking parathyroid disease states with changes in cardiac electrophysiology, most data have focused on how PTH modulates serum calcium to produce these effects. Close scrutiny of early literature demonstrates that the relationship between PTH and electrocardiographic changes is not straightforward, and numerous studies have linked PTH to arrhythmia. Basic science research has demonstrated that there is a basis for a direct role of PTH on cardiac electrophysiology outside of its effect on serum calcium. Later studies in secondary hyperparathyroidism indicate that PTH disturbances could have important implications for broad categories of patients with cardiovascular disease. The current review summarizes the existing literature on PTH and electrophysiology based on clinical and basic science studies of various parathyroid states, providing directions for future study.
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Liu P, Han D, Sun X, Tan H, Wang Z, Liu C, Zhang Y, Li B, Sun C, Shi R, Li G. Prevalence and risk factors of acquired long QT syndrome in hospitalized patients with chronic kidney disease. J Investig Med 2018; 67:289-294. [PMID: 30367011 DOI: 10.1136/jim-2018-000798] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2018] [Indexed: 12/13/2022]
Abstract
Patients with chronic kidney disease (CKD) have a high risk of fatal arrhythmias. The extended severe corrected QT (QTc) interval is a hallmark of ventricular arrhythmias and sudden cardiac death. The objective of this study was to evaluate the prevalence of acquired long QT syndrome (aLQTS) in hospitalized patients with CKD and search for potential risk factors to improve clinical risk stratification in patients with CKD. Information about patients with CKD was retrospectively collected in our hospital between January 2013 and June 2017. The prevalence of aLQTS in different stages of CKD was evaluated. The common risk factors for QTc prolongation in patients with CKD were compiled, and multivariable logistic regression analysis was used to evaluate how each factor was related to aLQTS in CKD. A total of 804 patients with CKD (299 females, 37.2%) participated in our study. The prevalence of aLQTS among all 804 patients was 56.97%, and the prevalence of QTc prolongation (>500 ms) was 10.07%. Among the elderly, impaired kidney function, hemodialysis, low serum potassium and low left ventricular ejection fraction (LVEF) were associated with QTc prolongation in patients with CKD. The prevalence of aLQTS is much higher and increases with the decline of kidney function in hospitalized patients with CKD, which is related to older age, impaired kidney function, hemodialysis, serum potassium and low LVEF.
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Affiliation(s)
- Peng Liu
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Dan Han
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xuanzi Sun
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hui Tan
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhigang Wang
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chao Liu
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yali Zhang
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Bailin Li
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chaofeng Sun
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Rui Shi
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Guoliang Li
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Palmeri NO, Davidson KW, Whang W, Kronish IM, Edmondson D, Walker MD. Parathyroid hormone is related to QT interval independent of serum calcium in patients with coronary artery disease. Ann Noninvasive Electrocardiol 2017; 23:e12496. [PMID: 28949082 DOI: 10.1111/anec.12496] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 07/13/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Elevated serum parathyroid hormone (PTH) is associated with increased risk of cardiovascular death, including sudden cardiac death, in patients with and without parathyroid disease. In small studies, PTH levels have been associated with changes in cardiac conduction and repolarization. Changes in the corrected QT interval (QTc) in particular are thought to be mediated by the effect of PTH on serum calcium. There is limited evidence to suggest PTH may affect cardiac physiology independent of its effects on serum calcium, but there is even less data linking PTH to changes in electrical conduction and repolarization independent of serum calcium. METHODS ECG data were examined from the PULSE database-an observational cohort study designed to examine depression after acute coronary syndromes (ACS) at a single, urban American medical center. In all, 407 patients had PTH and ECG data for analysis. RESULTS The QTc was longer in patients with elevated PTH levels compared with those without elevated PTH levels (451 ± 38.6 ms vs. 435 ± 29.8 ms; p < .001). The difference remained statistically significant after controlling for calcium, vitamin D, and estimated glomerular filtration rate (p = .007). Inclusion of left ventricular ejection fraction in the model attenuated the association (p = .054), suggesting that this finding may be partly driven by changes in cardiac structure. CONCLUSIONS In one of the largest series to examine PTH, calcium, and QT changes, we found that elevated PTH is associated with longer corrected QT interval independent of serum calcium concentration in ACS survivors.
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Affiliation(s)
| | | | | | - Ian M Kronish
- Columbia University Medical Center, New York, NY, USA
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