Effect of surgical treatment on left ventricular strain in patients with primary hyperparathyroidism: A meta-analysis of echocardiographic study

Aim: Current evidence on the effects of parathyroidectomy (PTX) on myocardial deformation in patients with primary hyperparathyroidism (PHPT) is scanty and based on a few studies. The aim of this meta-analysis was to provide a comprehensive and updated information on this issue. Data synthesis: Following the PRISMA guidelines, systematic searches were conducted across bibliographic databases (Pub-Med, OVID, EMBASE and Cochrane library) to identify eligible studies from inception up to September 30th, 2024. Searches were limited to clinical investigations published in English reporting data on LV mechanics (i.e. global longitudinal strain, GLS) in patients with PHPT before and after PTX. The statistical difference of the echocardiographic variables of interest collected at baseline and after PTX, such as left ventricular ejection fraction (LVEF) and GLS was calculated by standardized mean difference (SMD) with 95 % confidence interval (CI) by using random-effects models. Four studies including 126 patients with PHPT undergoing PTX, in whom LV mechanics had been assessed by speckle tracking echocardiography before and after six months from surgery, were considered. Baseline pooled average LVEF values were 59.5 ± 1.7 % and corresponding values after PTX 60.3 ± 1.2 %, (SMD: 0.16 ± 0.09, CI: -0.01/0.34, p = 0.07). Baseline and after surgical procedure values for GLS were -18.9 ± 0.28 % and -20.4 + 0.28 %, (SMD: 0.55 ± 0.10, CI: 0.37/0.74, p < 0.001). Meta-regression analysis showed a significant relationship between changes in serum PTH and GLS (p = 0.004). Conclusions: Our findings suggest that PTX impacts favourably on LV mechanics, and, more importantly, the assessment of LV changes in this setting should include GLS and no longer rely on conventional echocardiographic parameters such as LVEF.