https://doi.org/10.1007/s00392-025-02625-4
1Medizinische Hochschule Hannover Kardiologie und Angiologie Hannover, Deutschland; 2Medizinische Hochschule Hannover Zentrum Innere Medizin - Klinik für Gastroenterologie, Hepatologie und Endokrinologie Hannover, Deutschland
In non-congenital heart disease, secondary hyperparathyroidism (sHPT) is associated with an elevated risk of new-onset heart failure (HF) and an increased incidence of HF-related hospitalizations. Yet, for adults with congenital heart disease (ACHD), the role of sHPT and the factors contributing to its development remain poorly understood.
Methods
This cross-sectional, single-center study assessed the prevalence of sHPT in 755 patients with ACHD. Independent predictors of sHPT were identified in both, within the entire cohort and specifically in ACHD with biventricular physiology.
Findings
We found a high prevalence of sHPT in ACHD at 14.8%, with the highest rates in patients with Eisenmenger syndrome/PAH-CHD (39.1%), Ebstein’s anomaly (29.2%), Fontan palliation (25%), and pulmonary atresia (25%). SHPT was more common in patients with univentricular physiology (29.6%) than biventricular physiology (13.2%) (p < 0.001). Independent predictors of sHPT were glomerular filtration rate (p < 0.001), serum 25-hydroxyvitamin D3 (p = 0.004), use of loop diuretics (p = 0.019), oxygen saturation (p = 0.019), and liver stiffness (p = 0.021). In patients with biventricular physiology, right ventricular free wall longitudinal strain (RV FWLS, p=0.027) and RV S’ (p=0.041), rather than left ventricular global longitudinal strain or systemic ventricular ejection fraction, were identified as independent predictors.
Conclusion
SHPT is a significant comorbidity across the entire spectrum of ACHD. Patients with complex and predominant right heart disease are at particularly high risk. Monitoring of vitamin D and PTH levels is essential to prevent complications associated with sHPT.