Otaal Parminder S, Pachipala Sudheer, Uppal Lipi, Bootla Dinakar
Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, IND.
Department of Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, IND.
Cureus. 2021 Feb 23;13(2):e13522. doi: 10.7759/cureus.13522.
Introduction Chronic heart failure (CHF) is a major cause of mortality and morbidity in spite of tremendous advances in medical therapies. Vitamin D deficiency has been increasingly recognised in heart failure and its therapeutic as well as prognostic implications are debated. This study was carried out to examine the relationship of Vitamin D levels with severity of heart failure as assessed by NYHA functional class and serum N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels in vitamin D deficient patients with CHF. Methodology and results In this cross-sectional analysis, 119 patients of symptomatic CHF presenting to the outpatient/inpatient department of cardiology in a tertiary care institute in North India were screened. Patients were categorised according to their functional class as New York Heart Association (NYHA) class II, III, IV and their serum levels of vitamin D and NT-pro-BNP were measured. Out of 119 patients, 107 (90%) were found to have low vitamin D levels which were classified as insufficient (20-30 ng/ml) (n=25, 23%) or deficient (<20 ng/ml) (n=82,77%). The mean NT-pro-BNP levels increased significantly across functional class as 3783±6132 pg/ml, 7866±4383 pg/ml, 21115±11905 pg/ml in NYHA class II, III and IV respectively (p=0.000). The respective mean serum Vitamin D3 levels of 11.6±5.8ng/ml, 12.2±7.9 ng/ml, 14.4±8.9 ng/ml were not significantly different between classes (p=0.234). We found no correlation between serum NT-pro-BNP and serum vitamin D levels in the study cohort across various NYHA classes. In multivariate regression model, after adjusting for various co-variates, vitamin D levels were not significantly associated with NT-pro-BNP or functional class in patients with CHF. Conclusion Patients with CHF have a high prevalence (90%) of vitamin D deficiency. Although NT-pro-BNP levels increase significantly, vitamin D levels do not vary significantly with worsening NYHA classes. Further, no consistent significant correlation of vitamin D deficiency with NT-pro-BNP across different NYHA classes was observed. Thus, low levels of vitamin D didn't predict the severity and prognosis of patients with heart failure. .
尽管医学治疗取得了巨大进展，但慢性心力衰竭（CHF）仍是导致死亡和发病的主要原因。心力衰竭患者中维生素D缺乏的情况日益受到关注，其治疗及预后意义仍存在争议。本研究旨在探讨维生素D水平与心力衰竭严重程度之间的关系，心力衰竭严重程度通过纽约心脏协会（NYHA）心功能分级以及血清N末端脑钠肽前体（NT-pro-BNP）水平进行评估，研究对象为维生素D缺乏的CHF患者。
在这项横断面分析中，对印度北部一家三级医疗机构心内科门诊/住院部的119例有症状的CHF患者进行了筛查。根据心功能分级将患者分为纽约心脏协会（NYHA）II级、III级、IV级，并测量其血清维生素D和NT-pro-BNP水平。119例患者中，107例（90%）维生素D水平较低，其中维生素D不足（20 - 30 ng/ml）的有25例（23%），维生素D缺乏（<20 ng/ml）的有82例（77%）。随着心功能分级的升高，NT-pro-BNP平均水平显著增加，NYHA II级、III级、IV级患者的NT-pro-BNP平均水平分别为3783±6132 pg/ml、7866±4383 pg/ml、21115±11905 pg/ml（p = 0.000）。各级患者血清维生素D3的平均水平分别为11.6±5.8 ng/ml、12.2±7.9 ng/ml、14.4±8.9 ng/ml，差异无统计学意义（p = 0.234）。在整个研究队列中，不同NYHA分级的患者血清NT-pro-BNP与血清维生素D水平之间均未发现相关性。在多变量回归模型中，对各种协变量进行校正后，CHF患者的维生素D水平与NT-pro-BNP或心功能分级无显著相关性。
CHF患者维生素D缺乏的患病率较高（90%）。尽管NT-pro-BNP水平显著升高，但随着NYHA分级的恶化，维生素D水平并无显著变化。此外，在不同NYHA分级中，未观察到维生素D缺乏与NT-pro-BNP之间存在一致的显著相关性。因此，低水平的维生素D并不能预测心力衰竭患者的严重程度和预后。
