Abstract
ObjectivesThe aims of this paper were to evaluate the levels of Vitamin D (VitD) in patients with heart failure (HF), compared to a control group, to assess the effects of VitD on HF outcome and to compare VitD measurement between LIAISON immunoassay and HPLC-MS-MS methods in this population.Design and MethodsWe collected clinical, biochemical and outcome data from 247 patients with HF and in a subgroup of 151 patients, we measured VitD both with LIAISON and HPLC-MS-MS.ResultsHF patients had statistically lower 25OHD levels (45.2 ± 23.7 nmol/L vs 58.2 ± 24.0 nmol/L, P < 0.001) and a statistically higher prevalence of VitD insufficiency (61.1% vs 39.5%, P < 0.001) and deficiency (24.7% vs 6.6%, P < 0.001), compared to healthy controls. There was a significant inverse relationship between baseline 25OHD and risk of HF-related death, with a HR of 0.59 (95% CI 0.37–0.92, P = 0.02), confirmed in a multivariate adjusted analysis. Kaplan–Meier survival analyses showed that VitD insufficiency was associated with reduced survival in HF patients (log rank P = 0.017). There was a good agreement between LIAISON and HPLC-MS-MS (Cohen’s kappa coefficient 0.70), but the prevalence of VitD insufficiency was significantly higher with the former compared to the latter method (58.3%, n = 88 vs 55.6%, n = 84, P < 0.001). LIAISON underestimated the 25OHD levels and showed a mean relative bias of −0.739% with 95% of limits of agreement (−9.00 to +7.52%), when compared to HPLC-MS-MS.Conclusions25OHD levels adequately measured by HPLC-MS-MS showed to be low in HF population and to be correlated with HF-related risk of death.
Highlights
Heart failure (HF) is a complex and chronic condition and despite advances in therapeutic options, its prognosis remains poor, with high mortality and morbidity
We demonstrated the high prevalence of hypovitaminosis D in a large cohort of patients with mild-to-moderate HF and the association between 25OHD levels and HF prognosis
25OHD levels were measured with HPLC-MS-MS, which was demonstrated to be the gold standard for Vitamin D (VitD) status assessment
Summary
Heart failure (HF) is a complex and chronic condition and despite advances in therapeutic options, its prognosis remains poor, with high mortality and morbidity. Vitamin D (VitD) has been recently emerged as a factor for HF risk and outcome evaluation [1, 2]. It is known that it is involved in the pathophysiology of HF, with different mechanisms (downregulation of the renin– angiotensin system, enhancement of insulin secretion and sensitivity, protection against angiogenesis and modulation of inflammatory processes) and low levels of VitD are associated with worse prognosis [7, 8, 9, 10, 11]. Liquid chromatographytandem mass spectrometry (LC-MS-MS) has been arisen as the ‘gold standard’ method due to its high sensitivity and accuracy and the possibility to measure multiple VitD compounds at the same time [12, 13]
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