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Vitamin D deficiency and functional response to CRT in heart failure patients

Vitamin-D-Mangel und funktionelle Antwort auf CRT bei Herzinsuffizienzpatienten

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Abstract

Background

Vitamin D deficiency has been associated with a poor outcome in patients with heart failure (HF). We examined the role of vitamin D in the response of HF patients to cardiac resynchronization therapy (CRT).

Methods

The study comprised 50 patients (30 men and 20 women) with HF undergoing CRT implantation who were prospectively enrolled. Response to CRT was defined as a combination of ≥15% reduction in left ventricular end-systolic volume (LVESV) and ≥10% improvement in the 6‑Minute Walk Test within 6 months. Patients were grouped based on their levels of vitamin D prior to CRT implantation. Clinical and echocardiographic examinations were performed prior to and 6 months after the procedure.

Results

Of the patients, 11 (22%) failed to respond to CRT; two patients died within 6 months and an additional nine patients showed no improvement in the 6‑Minute Walk Test and no reduction in their baseline LVESV. A comparison was made between 25 patients with sufficient levels of vitamin D and 25 patients with insufficient levels. Nine patients (36%) in the “insufficient” group and two patients (8%) in the “sufficient” group failed to respond to CRT implantation (p = 0.037).

Conclusion

Adequate serum concentrations of vitamin D play a significant role in improving the functional status of patients with systolic HF following CRT implantation.

Zusammenfassung

Hintergrund

Vitamin-D-Mangel wird mit einem ungünstigen Verlauf bei Patienten mit Herzinsuffizienz in Zusammenhang gebracht. In der vorliegenden Arbeit wurde die Bedeutung von Vitamin D für die Antwort von Herzinsuffizienzpatienten auf eine kardiale Resynchronisationstherapie (CRT) untersucht.

Methoden

Die vorliegende Studie umfasste 50 Patienten (30 m., 20 w.) mit Herzinsuffizienz und CRT-Implantation, die prospektiv in die Studie aufgenommen wurden. Als Therapieansprechen auf die CRT wurde die Kombination einer Verminderung des linksventrikulären endsystolischen Volumens (LVESV) von ≥15 % und einer Verbesserung im 6‑min-Gehtest von ≥10 % innerhalb von 6 Monaten definiert. Die Patienten wurden anhand ihrer Vitamin-D-Werte vor CRT in Gruppen eingeteilt. Eine klinische Untersuchung und eine Echokardiographie wurden vor und 6 Monate nach dem Eingriff durchgeführt.

Ergebnisse

Kein Therapieansprechen auf die CRT bestand bei 11 Patienten (22 %); 2 Patienten starben innerhalb von 6 Monaten und weitere 9 zeigten weder eine Verbesserung im 6‑min-Gehtest noch eine Verminderung ihres Ausgangs-LVESV. Es wurden 25 Patienten mit ausreichenden Vitamin-D-Werten und 25 Patienten mit nicht ausreichenden Werten verglichen. Kein Therapieansprechen auf die CRT gab es bei 9 Patienten (36 %) in der „nicht ausreichenden“ Gruppe und bei 2 Patienten (8 %) in der „ausreichenden“ Gruppe (p = 0,037).

Schlussfolgerung

Ausreichende Serumkonzentrationen von Vitamin D spielen eine bedeutende Rolle bei der Verbesserung der Leistungsfähigkeit von Patienten mit systolischer Herzinsuffizienz nach CRT-Implantation.

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Authors and Affiliations

  1. Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

    A. Separham MD,  L. Pourafkari MD, FACC,  B. Kazemi MD, Y. Haghizadeh MD,  F. Akbarzadeh MD,  M. Toufan MD &  H. Sate MD

  2. Dept. of Anesthesiology, University at Buffalo, 77 Goodell Suite #550, 14203, Buffalo, NY, USA

    L. Pourafkari MD, FACC &  N. D. Nader MD, PhD, FACC, FCCP

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  1. A. Separham MD
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  2. L. Pourafkari MD, FACC
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  4. Y. Haghizadeh MD
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  5. F. Akbarzadeh MD
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  8. N. D. Nader MD, PhD, FACC, FCCP
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Correspondence to N. D. Nader MD, PhD, FACC, FCCP.

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Conflict of interest

A. Separham , L. Pourafkari, B. Kazemi, Y. Haghizadeh, F. Akbarzadeh, M. Toufan, H. Sate, and N.D. Nader declare that they have no competing interests.

The study was approved by the local ethics committees of the university and all patients provided written informed consent according to the Declaration of Helsinki to participate in this study.

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Separham, A., Pourafkari, L., Kazemi, B. et al. Vitamin D deficiency and functional response to CRT in heart failure patients. Herz 44, 147–154 (2019). https://doi.org/10.1007/s00059-017-4630-x

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  • DOI: https://doi.org/10.1007/s00059-017-4630-x

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