Introduction and aims: Heart failure (HF) is a health problem with poor prognosis, despite many treatments available. Vitamin D is the pre-hormone of the active calcitriol (1,25(OH)2D3). It is involved in bone homeostasis, but recent studies suggest extraskeletal functions, including pleiotropic effects on cardiovascular system and a relationship between low levels of 25OHvitamin D and worse HF prognosis. The aims of the study were: 1) to define 25OH-D levels in the HF population, 2) to correlate25 OHD levels and HF outcome markers (biochemical and instrumental evaluation) in the hypothesis that vitamin D represents a potential modifiable factor risk in HF.
Materials and Methods: We performed a retrospective study on 261 consecutive HF patients (NHYA1-3), collecting clinical, biochemical and instrumental data (echocardiography and cardiopulmonary exercise test CPET). We retrieved stored blood samples collected at the baseline and developed a fast isotope dilution Mass Spectrometry coupled with Liquid Chromatography (HPLC-MS-MS) method for accurate measurement of 25OHvitaminD levels.
Results: Patients were 47 females and 214 males (ratio M:F=4:1), with a mean age of 65±12 years and mean BMI of 28±14. They had stable HF disease in prevalent NYHA2 class. Mean EF (ejection fraction) was 33±8%; patients had mild kidney failure (creatinine 1.12±0.3 mg/dl) and they were normocalcemic and normo PTH. Levels of 25OH vitamin ranged 245 ng/ml, with mean of 17±9 ng/ml. Twenty-five pecent (n=65) patients had vitamin deficiency (<10 ng/ml), 62% (n=161) had vitamin insufficiency (between10 and 30 ng/ml) and 13% (n=35) had vitamin > 30 ng/ml, without any supplementation. The linear regression analysis showed that 25OHvitaminD levels were positively correlated with CPET paramethers and negatively with mortality Mecki score and this relation was even stronger in patient with Vitamin D insufficiency.
Conclusion: Our study revealed a strong association between variables from CPET, a well-recognized valuable tool for HF prognosis and 25OHvitaminD levels, detected with a new and accurate method, HPLCMS-MS.