March 6, 2015-San Diego-In patients with chronic heart failure, the metabolite of vitamin D 1,25-dihydroxyvitamin D3 or calcitriol, and its relationship with parathyroid hormone (PTH) may help predict cardiovascular death, patients with decreased calcitriol and lower ratio of PTH to calcitriol could benefit from more aggressive supplements. This result was announced a review of the association of calcitriol levels and cardiovascular death in chronic heart failure (in ENDO 15, the Endocrine Society 97 th Annual Meeting and Expo in San Diego, California, from 5 to March 8 2015.
Damien Gruson, PhD, of Cliniques Universitaires Saint Luc, Brussels, Belgium, said vitamin D deficiency and hyperparathyroidism are common in patients with heart failure. A growing body of evidence supports the role of vitamin D and PTH in cardiac remodeling and worsening of heart failure. However, the prognosis of calcitriol, the most potent biologically active metabolite of vitamin D, value remains unclear. He added that biomarkers may help doctors predict heart failure and intervene to optimize survival.
The study included 170 patients with chronic heart failure (women, n = 36; men, n = 134; NYHA II-IV, with a mean age, 67 years; ischemic etiology, n = 119; dilated cardiomyopathy, n = 51 ; mean ejection fraction, 23%). The primary outcome was cardiovascular death.
Calcitriol levels were determined at baseline with a fully automated and sensitive immunoassay using a specific recombinant fusion protein to capture calcitriol (DiaSorin). Calcitriol levels, B-type natriuretic peptide (BNP) were also measured (Gal-3) N-terminal proBNP (NT-proBNP) and galectin-3.
Serum calcitriol markedly decreased according to the severity of heart failure and were 30.9 pg / mL in NYHA class II, 22.0 pg / mL in NYHA class III, and 14.9 pg / mL in NYHA class IV ( P & lt; 0.01). Decreased relations calcitriol PTH also significantly they related to the severity of heart failure. In contrast, calcitriol levels were not significantly different according to the NYHA functional class. Calcitriol and its relation to PTH showed significant negative correlation with BNP, NT-proBNP and Gal-3. Calcitriol levels were only related to BNP and NT-proBNP.
After eight years of follow-up, 106 patients reached the primary endpoint. Cox multivariate analysis revealed calcitriol and calcitriol ratio of PTH to be highly predictive of results. In the analysis of receiver operating characteristic, the area under the curve (AUC) for the ratio calcitriol and calcitriol / PTH were 0.72 and 0.74, respectively, which was similar to BNP and NT-proBNP, but clearly Gal-3 above and calcitriol.
“We were surprised by the strong predictive power of calcitriol and its relation to PTH. It is noteworthy that calcitriol was measured by a free extraction of novel, fully automated assay based on a murine monoclonal antibody that recognizes the unique conformational change induced by the union calcitriol to a recombinant fusion protein, “said Dr. Gruson.” We provide doctors a new tool calcitriol PTH ratio to risk stratify patients with heart failure. according to the relationship between the values of lower relationship and increased mortality, clinicians may try to modulate the ratio of increased levels of calcitriol more supplementation with calcitriol / or analogs of PTH decreased with aldosterone blockers, eg “.
Dr. Gruson concluded:
The authors plan to conduct a larger study to confirm the findings of the benefit of supplementation with calcitriol in patients with heart failure.