Coronary Microvascular Dysfunction Induced by Primary Hyperparathyroidism is Restored After Parathyroidectomy

Background— Symptomatic primary hyperparathyroidism (PHPT) is associated with increased cardiovascular mortality. However, data on the association between asymptomatic PHPT and cardiovascular risk are lacking. We assessed coronary flow reserve (CFR) as a marker of coronary microvascular function in asymptomatic PHPT of recent onset. Methods and Results— We studied 100 PHPT patients (80 women; age, 58±12 years) without cardiovascular disease and 50 control subjects matched for age and sex. CFR in the left anterior descending coronary artery was detected by transthoracic Doppler echocardiography, at rest, and during adenosine infusion. CFR was the ratio of hyperemic to resting diastolic flow velocity. CFR was lower in PHPT patients than in control subjects (3.0±0.8 versus 3.8±0.7; P <0.0001) and was abnormal (≤2.5) in 27 patients (27%) compared with control subjects (4%; P =0.0008). CFR was inversely related to parathyroid hormone (PTH) levels ( r =−0.3, P <0.004). In patients with CFR ≤2.5, PTH was higher (26.4 pmol/L [quartiles 1 and 3, 16 and 37 pmol/L] versus 18 [13–25] pmol/L; P <0.007), whereas calcium levels were similar (2.9±0.1 versus 2.8±0.3 mmol/L; P =0.2). In multivariable linear regression analysis, PTH, age, and heart rate were the only factors associated with CFR ( P =0.04, P =0.01, and P =0.006, respectively). In multiple logistic regression analysis, only PTH increased the probability of CFR ≤2.5 ( P =0.03). In all PHPT patients with CFR ≤2.5, parathyroidectomy normalized CFR (3.3±0.7 versus 2.1±0.5; P <0.0001). Conclusions— PHPT patients have coronary microvascular dysfunction that is completely restored after parathyroidectomy. PTH independently correlates with the coronary microvascular impairment, suggesting a crucial role of the hormone in explaining the increased cardiovascular risk in PHPT

Unusual antefemoral dissecting cyst.

Cystic collections in the popliteal space (Baker's cysts) are frequently observed in inflammatory joint diseases. The causal mechanism is generally regarded as entrapment of synovial fluid from the articular space in the gastrocnemio-semimembranosus bursa (Doppman, 1965; Freiberger & Kay, 1979; Wilson et al, 1938); back flow is prevented by a valve effect at the level of their connection. These cysts can remain localised in the popliteal space or can give rise to dissections and/or rupture. This usually occurs between the calf muscles but occasionally the cyst may extend into the thigh In comparison with these posterior dissecting cysts, the finding of an anterior dissecting cyst originating from the suprapatellar pouch is very rare

Myocardial Crypt in an Asymptomatic Young Athlete: How to Interpret?

Myocardial crypts are extensions of blood signal penetrating the compact myocardium and are considered in literature as either a distinctive cardiac magnetic resonance (CMR) imaging marker for hypertrophic cardiomyopathy or as benign congenital malformations. What if CMR reveals a myocardial crypt in the presence of an altered ECG in an asymptomatic, enlarged young athlete's heart? The illustrated case demonstrates that new insights in CMR can also require further diagnostic interventions, which might have deleterious consequences for the individual athlete due to the uncertain interpretation of some findings in the demanding new world of a rapidly developing diagnostic imaging technique