AbstractIntroductionCardiovascular 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.MethodWe 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.ResultsOur 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; I2 = 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; I2 = 0%, p = .005) compared to those with normal vitamin D.ConclusionsCRT 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.