Relation of Parathyroid hormone to QT interval independent of serum calcium level in critically ill patients presenting with renal impairment. | ||||
| The Egyptian Journal of Intensive Care and Emergency Medicine | ||||
| Volume 5, Issue 1, January 2025, Page 84-94 PDF (251.57 K) | ||||
| Document Type: Original papers | ||||
| DOI: 10.21608/jicem.2025.411171 | ||||
 View on SCiNiTO | ||||
| Authors | ||||
Osama Amin Abd Elhamid  ; Remon Rafeek Michel; Kamel Abd El Aziz Mohamed; Ahmed Rostom Abd Elmonem
| ||||
| Critical Care Medicine, Faculty of Medicine Cairo University | ||||
| Abstract | ||||
| Purpose: To assess whether parathyroid hormone is associated with QT interval changes in critical ill patients presenting with renal impairment. Methods: This observational cohort study designed to examine ninety patients in the unit of intensive care who were admitted suffering from renal impairment whether as acute kidney injury or chronic kidney disease. Parathormone level, ECG and bedside echocardiography were done upon admission to the ICU. Results: Elevated PTH was associated with statistically significant longer corrected QT, (p-value = 0.002) with positive correlation (r = 0.326). The PTH level was statistically significant inversely correlated with EF (r = - 0.465), Na (r = - 0.226), ionized Ca2+ (r = - 0.222), and corrected Ca (r = - 0.222). The level of PTH was statistically significant positively correlated with creatinine (r = 0.216), K (r = 0.303), and PO4 (r = 0.214). The PTH level also showed a significant increase in patients with HTN compared to patients without HTN. There was an increased PTH level in patients with CKD when compared to non-CKD patients with a highly statistical significant difference. Moreover, a statistically significant increased PTH level was obtained in participants with ischemic heart disease as detected by the presence of RWMAs in echocardiography when compared to other non-ischemic participants without RWMAs. Conclusion: The abnormally high level of PTH is associated with more prolonged QTc intervals and is also associated with lower ejection fraction of the left ventricle. | ||||
| Keywords | ||||
| parathyroid hormone; QTc; calcium; cardiovascular risk; electrocardiogram | ||||
| References | ||||
|
[1] Agarwal G, Nanda G, Kapoor A, Singh KR, Chand G, Mishra A, Agarwal A, Verma AK, Mishra SK, Syal SK. Cardiovascular dysfunction in symptomatic primary hyperparathyroidism and its reversal after curative parathyroidectomy: results of a prospective case control study. Surgery. 2013;154(6):1394-404.
[2] Axelsson KF, Wallander M, Johansson H, Harvey NC, Vandenput L, McCloskey E, Liu E, Kanis JA, Litsne H, Lorentzon M. Analysis of comorbidities, clinical outcomes, and parathyroidectomy in adults with primary hyperparathyroidism. JAMA network open. 2022;5(6):e2215396-.
[3] Bozic M, Diaz-Tocados JM, Bermudez-Lopez M, Forné C, Martinez C, Fernandez E, Valdivielso JM. Independent effects of secondary hyperparathyroidism and hyperphosphataemia on chronic kidney disease progression and cardiovascular events: an analysis from the NEFRONA cohort. Nephrology Dialysis Transplantation. 2022;37(4):663-72..
[4] Brown SJ, Ruppe MD, Tabatabai LS. The parathyroid gland and heart disease. Methodist DeBakey cardiovascular journal. 2017;13(2):49.
[5] Curione M, Amato S, Di Bona S, Petramala L, Cotesta D, Letizia C. Parathyroidectomy erase increased myocardial electrical vulnerability in patients with primary hyperparathyroidism. International Journal of Cardiology. 2010;141(2):201-2.
[6] Floege J, Kim J, Ireland E, Chazot C, Drueke T, de Francisco A, Kronenberg F, Marcelli D, Passlick-Deetjen J, Schernthaner G, Fouqueray B. Serum iPTH, calcium and phosphate, and the risk of mortality in a European haemodialysis population. Nephrology Dialysis Transplantation. 2011;26(6):1948-55.
[7] Jorde R, Figenschau Y, Emaus N, Hutchinson M, Grimnes G. Serum 25-hydroxyvitamin D levels are strongly related to systolic blood pressure but do not predict future hypertension. Hypertension. 2010;55(3):792-8.
[8] Kim HW, Park CW, Shin YS, Kim YS, Shin SJ, Kim YS, Choi EJ, Chang YS, Bang BK. Calcitriol regresses cardiac hypertrophy and QT dispersion in secondary hyperparathyroidism on hemodialysis. Nephron Clinical Practice. 2006;102(1):c21-9.
[9] Kong SK, Tsai MC, Yeh CL, Tsai YC, Chien MN, Lee CC, Tsai WH. Association between primary hyperparathyroidism and cardiovascular outcomes: A systematic review and meta-analysis. Bone. 2024:117130.
[10] Luigi P, Chiara FM, Laura Z, Cristiano M, Giuseppina C, Luciano C, Giuseppe P, Sabrina C, Susanna S, Antonio C, Giuseppe C. Arterial hypertension, metabolic syndrome and subclinical cardiovascular organ damage in patients with asymptomatic primary hyperparathyroidism before and after parathyroidectomy: preliminary results. International journal of endocrinology. 2012;2012(1):408295.
[11] Monego G, Arena V, Pasquini S, Stigliano E, Fiaccavento R, Leone O, Arpesella G, Potena L, Ranelletti FO, Nardo PD, Capelli A. Ischemic injury activates PTHrP and PTH1R expression in human ventricular cardiomyocytes. Basic research in cardiology. 2009;104:427-34.
[12] Nilsson IL, Åberg J, Rastad J, Lind L. Left ventricular systolic and diastolic function and exercise testing in primary hyperparathyroidism—effects of parathyroidectomy. Surgery. 2000;128(6):895-902.
[13] Osto E, Fallo F, Pelizzo MR, Maddalozzo A, Sorgato N, Corbetti F, Montisci R, Famoso G, Bellu R, Lüscher TF, Iliceto S. Coronary microvascular dysfunction induced by primary hyperparathyroidism is restored after parathyroidectomy. Circulation. 2012;126(9):1031-9.
[14] 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. Annals of Noninvasive Electrocardiology. 2018;23(2):e12496.
[15] Pepe J, Curione M, Morelli S, Varrenti M, Cammarota C, Cilli M, Piemonte S, Cipriani C, Savoriti C, Raimo O, De Lucia F. Parathyroidectomy eliminates arrhythmic risk in primary hyperparathyroidism, as evaluated by exercise test. European Journal of Endocrinology. 2013;169(2):255-61.
[16] Purra S, Lone AA, Bhat MH, Misgar RA, Wani AI, Bashir MI, Masoodi SR, Purra W. Cardiac structural and functional abnormalities in primary hyperparathyroidism. Journal of Endocrinological Investigation. 2022:1-9.
[17] Rosenqvist M, Nordenström J, Andersson M, Edhag OK. Cardiac conduction in patients with hypercalcaemia due to primary hyperparathyroidism. Clinical endocrinology. 1992;37(1):29-33.
[18] Scicchitano P, Iacoviello M, Passantino A, Gesualdo M, Trotta F, Basile M, De Palo M, Guida P, Paolillo C, Riccioni G, Ciccone MM. Plasma levels of intact parathyroid hormone and congestion burden in heart failure: Clinical correlations and prognostic role. Journal of Cardiovascular Development and Disease. 2022;9(10):334.
[19] Simeoni M, Perna AF, Fuiano G. Secondary hyperparathyroidism and hypertension: an intriguing couple. Journal of Clinical Medicine. 2020;9(3):629.
[20] Tournis S, Makris K, Cavalier E, Trovas G. Cardiovascular risk in patients with primary hyperparathyroidism. Current Pharmaceutical Design. 2020;26(43):5628-36.
[21] Walker MD, Rundek T, Homma S, DiTullio M, Iwata S, Lee JA, Choi J, Liu R, Zhang C, McMahon DJ, Sacco RL. Effect of parathyroidectomy on subclinical cardiovascular disease in mild primary hyperparathyroidism. European journal of endocrinology. 2012;167(2):277-85.
| ||||
|
Statistics Article View: 122 PDF Download: 52 |
||||
