Löffler Friederike, Garlichs Justus Christian, Uehlein Sabrina, Löffler Lena, Leitolf Holger, Terkamp Christoph, Bauersachs Johann, Westhoff-Bleck Mechthild
Medizinische Hochschule Hannover, Department of Cardiology and Angiology, Hannover, Germany.
Medizinische Hochschule Hannover, Department of Gastroenterology, Hepatology, Infectiology and Endocrinology, Hannover, Germany.
Int J Cardiol Congenit Heart Dis. 2024 Jun 18;17:100521. doi: 10.1016/j.ijcchd.2024.100521. eCollection 2024 Sep.
The prevalence of vitamin D deficiency and secondary hyperparathyroidism (sHPT) in adult Fontan patients remains unstudied, and the role of vitamin D and parathyroid hormone (PTH) levels in assessing heart and circulatory failure in these patients is unclear.
We compared vitamin D deficiency and sHPT prevalence in adult Fontan patients (n = 35; mean age 33 ± 7.5 years) to adults with mild congenital heart disease (ACHD, n = 14). We analyzed associations between laboratory measurements, patient characteristics, and clinical events.
Vitamin D deficiency was highly prevalent in both Fontan patients and ACHD controls (76.5 % vs. 71.4 %, p = 0.726). sHPT was exclusively present in Fontan patients (31.4 %). PTH levels correlated with NYHA class (r = 0.412), O2 saturation (r = -0.39), systemic ventricular function (r = 0.465), and NT-proBNP levels (r = 0.742). 25-hydroxyvitamin D showed an inverse correlation with NYHA class and systemic ventricular function (both r ≤ -0.38). Fontan patients with sHPT had a higher incidence of prior hospitalization for worsening heart failure and atrial arrhythmias compared to Fontan patients without HPT or ACHD controls. (Hospitalization: Fontan with HPT vs. Fontan without HPT: OR 5.46 [95 % CI 1.25-23.86], p = 0.021; arrhythmia: Fontan with HPT vs. Fontan without HPT: OR 1.96 [95 % CI 1.13-3.4], p = 0.035; ACHD: OR 11.45 [95 % CI 1.7-77.28], p=<0.001). PTH showed significant correlation with inflammatory markers, particularly with GDF-15 (r = 0.8).
Our study is the first to demonstrate a high prevalence of vitamin D deficiency and sHPT in adult Fontan patients. As PTH strongly correlates with heart failure severity, it seems to be a promising biomarker in Fontan patients.
成人Fontan患者维生素D缺乏症和继发性甲状旁腺功能亢进（sHPT）的患病率尚未得到研究，维生素D和甲状旁腺激素（PTH）水平在评估这些患者的心脏和循环衰竭中的作用尚不清楚。
我们比较了成人Fontan患者（n = 35；平均年龄33±7.5岁）与轻度先天性心脏病成人患者（ACHD，n = 14）的维生素D缺乏症和sHPT患病率。我们分析了实验室测量值、患者特征和临床事件之间的关联。
Fontan患者和ACHD对照组中维生素D缺乏症的患病率都很高（76.5%对71.4%，p = 0.726）。sHPT仅见于Fontan患者（31.4%）。PTH水平与纽约心脏协会（NYHA）心功能分级（r = 0.412）、血氧饱和度（r = -0.39）、体循环心室功能（r = 0.465）和N末端脑钠肽前体（NT-proBNP）水平（r = 0.742）相关。25-羟维生素D与NYHA心功能分级和体循环心室功能呈负相关（两者r≤-0.38）。与没有HPT的Fontan患者或ACHD对照组相比，患有sHPT的Fontan患者因心力衰竭恶化和房性心律失常而先前住院的发生率更高。（住院：患有HPT的Fontan患者与没有HPT的Fontan患者相比：比值比5.46 [95%置信区间1.25 - 23.86]，p = 0.021；心律失常：患有HPT的Fontan患者与没有HPT的Fontan患者相比：比值比1.96 [95%置信区间1.13 - 3.4]，p = 0.035；ACHD：比值比11.45 [95%置信区间1.7 - 77.28]，p < 0.001）。PTH与炎症标志物显著相关，尤其是与生长分化因子15（GDF-15）（r = 0.8）。
我们的研究首次证明成人Fontan患者中维生素D缺乏症和sHPT的患病率很高。由于PTH与心力衰竭严重程度密切相关，它似乎是Fontan患者中有前景的生物标志物。
