Vitamin D as a predictor of clinical response among patients with cardiac resynchronization therapy (CRT)
Phuuwadith Wattanachayakul1,2, Thitiphan Srikulmontri1,2, Vitchapong Prasitsumrit3
1Department of Medicine Jefferson Einstein Hospital Philadelphia Pennsylvania USA.
Insights
Higher vitamin D levels predict better response to cardiac resynchronization therapy (CRT). Vitamin D insufficiency increases the risk of nonresponse to CRT, highlighting the need for monitoring and management in patients undergoing this therapy.
Area of Science:
- Cardiology
- Endocrinology
- Nutritional Science
Background:
- Comorbidities impact cardiac resynchronization therapy (CRT) response.
- Previous data on vitamin D as a predictor of CRT response are conflicting.
Purpose of the Study:
- To investigate the association between pre-implantation 25-OH vitamin D levels and outcomes in patients receiving CRT.
- To clarify the role of vitamin D status in predicting CRT response.
Main Methods:
- A meta-analysis of four studies identified through MEDLINE and Embase searches (up to May 2024).
- Extracted 25-OH vitamin D levels and CRT response data.
- Calculated pooled mean difference for vitamin D levels and risk ratios for vitamin D insufficiency and lack of CRT response.
Main Results:
- CRT responders exhibited significantly higher 25-OH vitamin D levels (pooled MD: 8.04 ng/mL).
- Vitamin D insufficiency was associated with a 3.28-fold increased odds of lacking response to CRT (pooled RR: 3.28).
Conclusions:
- Higher pre-implantation 25-OH vitamin D levels are linked to positive CRT response.
- Vitamin D insufficiency is a significant risk factor for nonresponse to CRT.
- Monitoring and managing vitamin D levels may optimize CRT outcomes.
Introduction:
Cardiovascular and noncardiovascular comorbidities have been recognized as predictors of clinical response in patients receiving cardiac resynchronization therapy (CRT). However, data on vitamin D as a predictor of CRT response are conflicting.
Method:
We identified studies from MEDLINE and Embase databases, searching from inception to May 2024, to investigate the association between 25-OH vitamin D levels before CRT implantation and outcomes. Studies had to report 25-OH vitamin D levels or the proportion of patients with vitamin D insufficiency and categorize outcomes as CRT responders or nonresponders. We extracted mean 25-OH vitamin D and standard deviations for both groups from each study and calculated the pooled mean difference (MD). We also retrieved risk ratios, and 95% confidence intervals (CIs) for the association between vitamin D insufficiency and lack of CRT response, combining them using the generic inverse variance method.
Results:
Our meta-analysis included four studies. CRT responders had higher levels of 25-OH vitamin D than nonresponders, with a pooled MD of 8.04 ng/mL (95% CI: 3.16-12.93; I 2 = 48%, p < .001). Patients with vitamin D insufficiency before implantation had higher odds of lacking response to CRT, with a pooled RR of 3.28 (95% CI: 1.43-7.50; I 2 = 0%, p = .005) compared to those with normal vitamin D.
Conclusions:
CRT responders had higher 25-OH vitamin D levels compared to nonresponders. Vitamin D insufficiency was associated with a higher risk of nonresponse to CRT. These findings highlight the importance of monitoring and managing vitamin D levels in these patients.
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