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DOI: 10.1055/s-0036-1571573
Deficiency of Vitamin D among LVAD Patients - Potential Risk for Bone and Blood Health
Objectives: Patients with end-stage heart failure are at high risk for vitamin D deficiency because of limited sunlight exposure, reduced intestinal absorption, and hepato-renal disease. However, there is a lack of information about vitamin D deficiency and its consequences in patients with ventricular assist device (VAD). The purpose of our retrospective study was to examine epidemiology and clinical outcomes associated with vitamin d deficiency during long-term support with LVAD.
Methods: In our outpatient clinic, 65 patients with LVAD (HeartWare) were evaluated for vitamin D deficiency, which was defined as a serum 25-hydroxy-vitamin D (25OHD) level < 20ng/mL according to the recommendations of the US Institute of Medicine. Severe deficiency was defined as 25OHD level < 12ng/ml. Secondary outcome parameters were bone strength, measured by densitometry, and anemia, defined as a hemoglobin < 13mg/dl for men and < 12mg/dl for women.
Results: Mean patient age was 57 ± 12 years, comprising 87% males. Patients suffered from dilated cardiomyopathy (48%), ischemic cardiomyopathy (41%) and myocarditis (11%). Indication for LVAD was bridge to recovery in 10 (14%), bridge to transplantation in 22 (34%) and destination therapy in 33 (52%) patients. Mean time on device was 530 ± 337 days.
Vitamin D deficiency was diagnosed in 81% of patients. Mean 25OHD level was 15 ± 12.4 ng/mL. Severe 25OHD deficiency was found in 52% of the patients, respectively.
Densitometry was only performed in bridge to transplant patients; 33% of those patients had normal bone strength, 48% were diagnosed with osteopenia and 19% with osteoporosis. Only 10% of patient with reduced bone strength showed normal vitamin D levels.
The prevalence of preoperative anemia was 72% respectively. After one and two years the prevalence of anemia declined to 59% and 51%. Patients with anemia had reduced vitamin D levels (mean 12,3 ± 8,8ng/mL) compared with non-anemic patients (mean 16,1 ± 7,5ng/mL).
Conclusions: We showed that vitamin D deficiency is highly prevalent among LVAD patients. In addition, vitamin D deficiency was associated with reduced bone density and anemia. However, the existing evidence on vitamin D deficiency and its clinical consequences is limited to date. Beyond that, the benefit of vitamin D supplementation remains currently inconclusive. Further research is necessary to investigate the role of vitamin D in patients with end stage heart failure.