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Hypovitaminosis D and valvular calcification in patients with dilated cardiomyopathy
Dwight A Dishmon1, Jimmy L Dotson, Ahmad Munir
1Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA.
Insights
Valvular calcification is common in dilated cardiomyopathy (DCM) patients with low vitamin D. This study suggests vitamin D deficiency may influence the extent of calcification in DCM, warranting further investigation.
Area of Science:
- Cardiology
- Endocrinology
- Biochemistry
Background:
- Dilated cardiomyopathy (DCM) is associated with unknown valvular calcification prevalence and hypovitaminosis D.
- Hypovitaminosis D may predispose tissues to calcification.
- Understanding this association is crucial for patient management.
Purpose of the Study:
- To assess echocardiographic evidence of valvular calcification in DCM patients with hypovitaminosis D.
- To prospectively evaluate serum 25(OH)D levels in DCM patients with valvular calcification.
Main Methods:
- Retrospective analysis of 48 DCM patients with hypovitaminosis D and valvular calcification.
- Prospective analysis of 20 elderly DCM patients with valvular calcification and monitored 25(OH)D levels.
- Echocardiography and serum 25(OH)D and parathyroid hormone (PTH) measurements were utilized.
Main Results:
- In the retrospective cohort, 31% of DCM patients with valvular calcification had hypovitaminosis D and elevated PTH.
- In the prospective cohort, 80% of elderly DCM patients with valvular calcification had hypovitaminosis D and normal PTH.
- These findings indicate a link between hypovitaminosis D and valvular calcification in DCM.
Conclusions:
- Valvular calcification is frequently observed in DCM patients with hypovitaminosis D, especially those without significant renal dysfunction.
- Hypovitaminosis D is common in elderly DCM patients with valvular calcification.
- The duration of vitamin D deficiency may impact the severity of valvular calcification, necessitating further research.
Background:
In patients with dilated (idiopathic) cardiomyopathy (DCM), little is known about the presence of valvular calcification and its association with hypovitaminosis D, which may predispose affected tissues to calcification. Our objectives were 2-fold: to conduct a retrospective assessment of echocardiographic evidence of valvular calcification in patients with DCM who were known to have hypovitaminosis D (25(OH)D <30 ng/mL) and to conduct a prospective assessment of serum 25(OH)D in patients with DCM, who had demonstrated echocardiographic evidence of valvular calcification.
Methods:
The retrospective study consisted of 48 African American patients (34 men, 14 women; 52.3 +/- 1.5 years) having DCM and ejection fraction <35% with serum creatinine <2.0 mg/dL and 25(OH)D <30 ng/mL; and 20 white patients in the prospective study (20 men; 71.0 +/- 3.0 years) having DCM and ejection fraction <35% with serum creatinine <2.0 mg/dL and echocardiographic evidence of valvular calcification. In the retrospective study, a transthoracic echocardiogram was obtained to address mitral valvular and annular calcification, aortic valvular calcification, and sinotubular calcification; whereas in the prospective study, serum 25(OH)D level was monitored in patients with known valvular calcification. Serum parathyroid hormone (PTH) was monitored in both studies.
Results:
In the retrospective study, hypovitaminosis D was found in 19 patients (31%) with valvular calcification and in whom serum PTH was increased (83 +/- 8 pg/mL). In the prospective study, 15 of 20 elderly patients (80%) with known DCM and valvular calcification were found to have hypovitaminosis D (25(OH)D <30 ng/mL), whereas serum PTH was normal (43 +/- 4 pg/mL).
Conclusions:
In patients with DCM without marked renal dysfunction, valvular calcification was seen more frequently and associated with hypovitaminosis D, whereas in elderly patients with valvular calcification, hypovitaminosis D is common, suggesting that the duration of vitamin D deficiency may determine the extent of valvular calcification. The role of hypovitaminosis D in the appearance of valvular calcification deserves further study.
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