IMPACT OF PARATHYROIDECTOMY ON VASCULAR STIFFNESS: EXPLORING PULSE WAVE VELOCITY AND RENAL RESISTIVE INDEX

Objective: Primary hyperparathyroidism (PHPT) promotes calcification, particularly in arterial walls, which may contribute to arterial stiffness. Carotid-femoral pulse wave velocity (PWV) is a validated marker for quantifying arterial stiffness. The renal resistive index (RRI) is a non-invasive ultrasound parameter reflecting renal microvascularization, which can be influenced by systemic vascular conditions, including arterial stiffness. The impact of elevated PTH concentrations on pulse wave velocity and renal resistive index values remains unclear. This study aims to investigate the association between arterial stiffness, assessed by PWV and RRI, and PTH concentrations before and after parathyroidectomy. Design and method: Primary hyperparathyroidism (PHPT) promotes calcification, particularly in arterial walls, which may contribute to arterial stiffness. Carotid-femoral pulse wave velocity (PWV) is a validated marker for quantifying arterial stiffness. The renal resistive index (RRI) is a non-invasive ultrasound parameter reflecting renal microvascularization, which can be influenced by systemic vascular conditions, including arterial stiffness. The impact of elevated PTH concentrations on pulse wave velocity and renal resistive index values remains unclear. This study aims to investigate the association between arterial stiffness, assessed by PWV and RRI, and PTH concentrations before and after parathyroidectomy. Results: The cohort included 107 patients with PHPT (86% female, median age of 64 years, normal BMI). Six months after parathyroidectomy, PTH levels and PWV significantly decreased, while RRI did not vary significantly. Multivariate regression revealed a positive association between PTH levels and PWV (β = 0.1, 95% CI 0.02 to 0.18). Other covariables, such as age, diastolic blood pressure, BMI, diabetes and total calcium were also associated with PWV (p<0.05). A correlation between RRI and PTH was observed at baseline (R = 0.27, p = 0.006), but disappeared at 6 months. In the multivariate regression model, there was no association between PTH levels and RRI. Conclusions: In a prospective study including patients treated surgically for PHPT, we demonstrated an association between PTH levels and arterial stiffness, as measured by PWV. This confirms an effect of PTH on vascular resistance.