DOI: 10.1111/j.1540-8175.2011.01468.x C  2011, Wiley Periodicals, Inc. The Assessment of Left Ventricular Systolic Asynchrony in Patients with Primary Hyperparathyroidism Abdulkadir Kırıs ¸, M.D., ∗ Cihangir Erem, M.D.,† G¨ ulhanım Kırıs ¸, M.D., ∗ ˙ Irfan Nuho˘ glu, M.D.,† Kayıhan Karaman, M.D., ∗ Nadim Civan, M.D.,† Cihan ¨ Orem, M.D., ∗ ˙ Ismet Durmus ¸, M.D., ∗ and Merih Kutlu, M.D. ∗ ∗ Department of Cardiology, Faculty of Medicine and †Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey Objectives: Primary hyperparathyroidism (PHP) is associated with a variety of cardiovascular disturbances such as left ventricular (LV) hypertrophy, diastolic cardiac dysfunction, and hypertension. LV asynchrony is defined as the loss of the simultaneous peak contraction of corresponding cardiac segments. The objective of this study was to assess systolic asynchrony in patients with overt hyperparthyroidism. Methods: Asynchrony was evaluated in 22 patients with PHP and 24 controls. All the patients and controls were subjected to a tissue synchronization imaging (TSI). The time to regional peak systolic tissue velocity (Ts) in LV by the six-basal-six-midsegmental model was measured on ejection phase TSI images and four TSI parameters of systolic asynchrony were computed. Results: All TSI parameters of LV asynchrony increased in patients with PHP patients compared to the controls: the standard deviation (SD) of the 12 LV segments Ts (37.3 ± 20.6 vs. 21.5 ± 11.1, P = 0.01); the maximal difference in Ts between any 2 of the 12 LV segments (111.2 ± 59.8 vs. 70.2 ± 32.1, P = 0.01); the SD of the 6 basal LV segments (42.9 ± 36.4 vs. 18.5 ± 13, P = 0.003); and the maximal difference in Ts between any 2 of the 6 basal LV segments (89.6 ± 50.5 vs. 48 ± 31.1, P = 0.003). Conclusion: Patients with PHP show an evidence of LV asynchrony by TSI. Asynchrony may contribute to the harmful cardiovascular effects of PHP. (Echocardiography 2011;28:955-960) Key words: hyperparathyroidism, left ventricular asynchrony, tissue synchronization imaging Introduction: Primary hyperparathyroidism (PHP) is an en- docrine disorder that leads to different cardio- vascular disturbances such as left ventricular (LV) hypertrophy, 1–3 diastolic cardiac dysfunction, 4 hypertension, 5 and vascular dysfunction. 6,7 Also, there are increased cardiovascular mortality and morbidity because of myocardial infarction, heart failure and stroke. 8 LV asynchrony may result from delayed acti- vation of certain ventricular segments leading to uncoordinated contraction. It has been suggested that pacemaker-induced asynchrony may be re- lated to the development of LV dysfunction in pa- tients with normal ejection fraction 9 and the pres- ence of LV asynchrony is an independent factor of deterioration of heart failure. 10 Initially, the asyn- chrony was studied in patients with heart failure and reduced LV ejection fraction. 11 Later, it was shown that LV synchronicity might be impaired in disorders such as diabetes mellitus, 12 acute myocardial infarction, 13 diastolic heart failure, 14 Conflicts of interest: None. Address for correspondence and reprint requests: Abdulkadir Kırıs ¸, M.D., Department of Cardiology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey. Fax: +90- 462-3775305; E-mail: akiris79@yahoo.com hypertension, 15 hypo-, and hyperthyroidism, 16,17 However, LV asynchrony has never been studied in patients with PHP. The purpose of this study was to evaluate the relationship between LV asyn- chrony and PHP. Methods: Patients: The study population consisted of 22 primary hy- perparathyroid patients (6 males and 16 females) who had narrow QRS complexes on ECG and normal LV ejection fractions (LVEFs) on echocar- diography. In addition, 24 healthy control sub- jects (8 males and 16 females) coming for rou- tine checkup were included. PHP was defined as the presence of hypercalcaemia, hypophospho- temia, and inappropriately high normal or ele- vated plasma intact parathyroid hormone (iPTH) levels. Serum calcium concentration was cor- rected for serum albumin. Full demographic data, biochemical blood tests and ECG were obtained from the entire study population. Clinical exam- ination included height and body weight mea- surement. Body mass index (BMI) was calculated as weight (kilograms) divided by the square of height (meters squared). Systolic and diastolic blood pressures were measured three times in 955