Interplay between parathyroid hormone concentration and valvular and aortic calcifications

Introduction Recently, a relationship between hyperparathyroidism and cardiovascular disorders has been highlighted. The current study aimed to find a possible relationship between parathyroid hormone (PTH) and valvular calcification performance. A secondary aim was to evaluate the potential association between PTH concentration and post-procedural outcomes after transcatheter aortic valve implantation (TAVI). Material and methods Patients with severe symptomatic aortic stenosis were evaluated for the study eligibility. Demographics, clinical data, and blood samples were collected. Pre-procedurally, echocardiography and computed tomography (CT) were performed. Quantitative evaluation of calcific tissue was conducted over the three regions of interest: ascending aorta, aortic, and mitral valves using semiautomated software. Results The final study group comprised 89 patients (50 females, median (Q1-3) age of 77 (72-82) years. Increased PTH concentration was associated with a higher peak aortic gradient (p=0.024), but not with mean aortic gradient nor mitral annular calcification occurrence. CT analysis revealed an association between increased PTH and mean calcific tissue attenuation in the mitral (p=0.004) and aortic valves (p<0.001) and ascending aorta (p<0.001), however lack of relationship with calcium volume in the regions of interest. Increased PTH did not differ between patients with and without paravalvular leak or new pacemaker implantation. Conclusions Increased PTH concentration is associated with calcific tissue attenuation but not calcium volume, suggesting that PTH may influence the degree of calcium accumulation in degenerated regions. PTH could potentially serve as a biomarker of calcific loading in valvular heart disease. However, PTH concentration does not appear to be linked to the rate of complications following TAVI.