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Reduced coronary flow reserve in patients with primary hyperparathyroidism: a study by G-SPECT myocardial perfusion imaging

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The mechanisms underlying increased cardiovascular risk in primary hyperparathyroidism (pHPT) have not been fully defined. Recently, this issue has become the subject of renewed interest due to the increasing evidence that the endothelium and vascular wall are targets for parathyroid hormone (PTH). The aim of this study was to measure regional coronary flow reserve (CFR) to determine whether the vascular damage induced by pHPT extends to affect the coronary microvascular function.

Methods

A total of 22 pHPT patients without a history of coronary artery disease and 7 age-matched control subjects were recruited. Dipyridamole myocardial blood flow (MBF) was assessed using 99mTc-sestamibi by measuring first-transit counts in the pulmonary artery and myocardial count rate from G-SPECT images. Baseline MBF was estimated 2 h later according to the same procedure. Regional CFR was defined as the ratio between dipyridamole and baseline MBF using a 17-segment left ventricular model.

Results

Three pHPT patients showed reversible perfusion defects and were excluded from the analysis. In the remaining 19, CFR was significantly lower with respect to the control subjects (1.88 ± 0.64 vs. 3.36 ± 0.66, respectively; p < 0.01). Moreover, patients studied for more than 28 months from pHPT diagnosis showed lower CFR values than the others (1.42 ± 0.18 vs. 2.25 ± 0.64, respectively; p < 0.01). Consequently, the time from diagnosis to the nuclear study showed a reasonable correlation with the degree of CFR impairment (Spearman’s rho −0.667, p < 0.02).

Conclusion

pHPT is associated with a significant dysfunction of the coronary microcirculation. This disorder might contribute to the high cardiovascular risk of conditions characterized by chronic elevations in serum PTH levels.

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Acknowledgments

This study was supported in part by a Grant of Fondazione CARIGE for the year 2009 on “Diabetes and its vascular complications”, by the Grant “Limonte” of Regione Liguria and by the grant Ricerca Sanitaria of Regione Liguria for the year 2010.

Conflicts of interest

None.

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Authors and Affiliations

  1. CNR Institute of Bioimages and Molecular Physiology, Milan, Genoa Section, Genoa, Italy

    Cecilia Marini

  2. Endocrinology, Department of Endocrinological and Metabolic Sciences, University of Genoa, Genoa, Italy

    Massimo Giusti, Lara Vera & Francesco Minuto

  3. Nuclear Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy

    Riccardo Armonino, Silvia Morbelli, Elena Pomposelli, Michela Massollo, Patrizia Gandolfo & Gianmario Sambuceti

  4. Cardiology, Department of Internal MedicineUniversity of Genoa, Genoa, Italy

    Giorgio Ghigliotti & GianPaolo Bezante

  5. CNR Institute of Bioimages and Molecular Physiology,c/o Dipartimento di Neuroscienze, Oftalmologia e Genetica dell’Università di Genova, Via De Toni, 5, 16132, Genova, Italy

    Cecilia Marini

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  1. Cecilia Marini
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Correspondence to Cecilia Marini.

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Marini, C., Giusti, M., Armonino, R. et al. Reduced coronary flow reserve in patients with primary hyperparathyroidism: a study by G-SPECT myocardial perfusion imaging. Eur J Nucl Med Mol Imaging 37, 2256–2263 (2010). https://doi.org/10.1007/s00259-010-1599-6

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  • DOI: https://doi.org/10.1007/s00259-010-1599-6

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