Assessment of cardiac function by echocardiography in Paget's disease of bone

Objective To identify the mechanisms which influence the development of car diac insufficiency in Paget's disease of bone (PD). Methods In this hospital-based case-control study 23 consecutive, recently diagnosed and untreated PD patients were compared against 23 controls frequ ency-matched by sex, age and body index. All subjects underwent non-invasiv e assessment of cardiac function by two-dimensional Doppler echocardiograph y. Calcium, phosphate, and creatinine were determined in the serum and urin e, along with alkaline phosphatase and hydroxyproline excretion, two bioche mical parameters of PD activity. Results Peripheral vascular resistance proved lower (1604.9 +/- 390.1 vs 18 01.2 +/- 421.0) and the stroke volume higher in PD patients (67.2 +/- 14.4 vs 56.0 +/- 8.6; p = 0.07) compared with controls. These differences were g reater (1504. +/- 289.9 and 71.0 +/- 6.2) and attained statistical signific ance (p = 0.008) when the subgroup with more extensive skeletal disease onl y was considered. A model-ate correlation was observed between hydroxyproli ne excretion and the E/A ratio (r = 0.45; p = 0.03), peripheral vascular re sistance (r = -0.42; p = 0.04), and diastolic arterial pressure (r = -0.42; p = 0.04). The final model obtained via multivariate analysis identified b oth urinary hydroxyproline and age as predictive variables linked to periph eral vascular resistance. Conclusion In the early phases of PD there is a trend towards a reduction i n peripheral vascular resistance. If this persists, it may lead progressive ly to increased cardiac output which is mainly influenced by the degree of turnover impairment and the age of the individual.