Department of Endocrinological and Medical Sciences, University of Genova, Genova, Italy.
Nutr Metab Cardiovasc Dis. 2010 Nov;20(9):633-40. doi: 10.1016/j.numecd.2010.01.002. Epub 2010 Apr 15.
Vitamin D deficiency has been associated with chronic heart failure (CHF). We evaluated vitamin D levels in relationship with New York Heart Association (NYHA) classes, N-terminal pro-brain natriuretic peptide (NT-proBNP) values and left ventricular (LV) measures in ≥60 year old patients with stable CHF. Differently from previous investigations, LV function was assessed by transthoracic echocardiography, to provide easily reproducible results.
The study was performed at geographic latitude 44° N, from March to May and from September to November 2008. Acute HF and diseases or drugs altering vitamin D status were exclusion criteria. NYHA scores and 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D and NT-proBNP concentrations were assessed in 90 (45 F, 45 M) Caucasian patients with CHF secondary to hypertension and/or coronary artery disease. Vitamin D levels were also measured in 31 subjects without heart disease (controls). LV echocardiography was performed in 52 (26 F, 26 M) representative patients. Vitamin D concentrations were significantly lower in CHF cases than in controls. Among subject with CHF, 97.8% presented vitamin D deficiency (25(OH)D<75 nmol/L), being severe (<25 nmol/L) in 66.7%. LV end-diastolic and end-systolic diameters were significantly longer, LV end-diastolic and end-systolic volumes bigger and fractional shortening lower in CHF patients with 25(OH)D<25 nmol/L than with 25(OH)D≥25 nmol/L (p<0.05). Log-values of 25(OH)D were negatively correlated with LV end-systolic diameter and volume (r=-0.28; p<0.05). On subgroup analysis, these results persisted only in male patients.
In elderly CHF patients, vitamin D deficiency was highly prevalent and often severe. This first addressed echocardiography study showed a sex-specific association between vitamin D deficiency and LV dilation. Since further echocardiography data are easily obtainable, larger investigations are demanded.
维生素 D 缺乏与慢性心力衰竭（CHF）有关。我们评估了维生素 D 水平与纽约心脏协会（NYHA）分级、N 末端脑利钠肽前体（NT-proBNP）值和≥60 岁稳定 CHF 患者左心室（LV）指标的关系。与以往的研究不同，LV 功能通过经胸超声心动图评估，以提供易于重复的结果。
本研究于 2008 年 3 月至 5 月和 9 月至 11 月在北纬 44°进行。急性 HF 和改变维生素 D 状态的疾病或药物是排除标准。评估了 90 名（45 名女性，45 名男性）由高血压和/或冠状动脉疾病引起 CHF 的白人患者的 NYHA 评分和 25-羟维生素 D [25(OH)D]、1,25-二羟维生素 D 和 NT-proBNP 浓度。还在 31 名无心脏病（对照组）的受试者中测量了 LV 超声心动图。在 52 名具有代表性的患者（26 名女性，26 名男性）中进行了 LV 超声心动图检查。CHF 患者的维生素 D 浓度明显低于对照组。在 CHF 患者中，97.8%的患者存在维生素 D 缺乏症（25(OH)D<75nmol/L），66.7%的患者存在严重缺乏症（<25nmol/L）。25(OH)D<25nmol/L 的 CHF 患者的 LV 舒张末期和收缩末期直径、LV 舒张末期和收缩末期容积较大，而短轴缩短率较低（p<0.05）。25(OH)D 的对数与 LV 收缩末期直径和容积呈负相关（r=-0.28；p<0.05）。在亚组分析中，这些结果仅在男性患者中持续存在。
在老年 CHF 患者中，维生素 D 缺乏症非常普遍，且往往较为严重。这项首次针对超声心动图的研究表明，维生素 D 缺乏与 LV 扩张之间存在性别特异性关联。由于更容易获得进一步的超声心动图数据，因此需要进行更大规模的研究。
