Research Article
BibTex RIS Cite

D vitamini eksikliği yaşlılarda ventriküler repolarizasyonu etkiliyor mu?

Year 2024, , 440 - 447, 05.07.2024
https://doi.org/10.31362/patd.1382849

Abstract

Amaç: Bu çalışmanın amacı, D vitamini eksikliğinin yaşlı hastalarda anormal ventriküler repolarizasyonun elektrokardiyografik indeksleri ile ilişkili olup olmadığını belirlemektir.
Gereç ve yöntem: 138 hasta üç gruba ayrıldı: D vitamini eksikliği olan hastalar, D vitamini yetersizliği olan hastalar ve yeterli D vitamini düzeyine sahip hastalar. 12 derivasyonlu elektrokardiyografi ve laboratuvar verileri toplandı.
Bulgular: İstirahat kalp hızı, PR aralığı, QRS süresi, QTd ve Tp-e dispersiyonu gruplar arasında benzerdi. Ancak, D vitamini eksikliği olan hastalarda QTc aralığı, D vitamini düzeyi yeterli olan hastalara kıyasla anlamlı derecede uzamıştı. D vitamini düzeyi QTc aralığının tek bağımsız belirleyicisi olarak bulundu. ROC analizinde QTc aralığında anlamlı uzamayı belirleyen D vitamini düzeyinin eşik değeri 20 ng/ml olarak bulundu (Eğri Altındaki Alan: 0,629±0,051 (%95 GA: 0,530-0,728, p=0,013).
Sonuç: Düşük D vitamini düzeyleri yaşlılarda QTc uzaması ile ilişkilidir. D vitamini eksikliği olan yaşlı hastalar rutin EKG taramasından fayda görebilir. D vitamini eksikliğinin zamanında teşhis ve tedavisi, bu hasta popülasyonunda aritmi oranını azaltmaya yardımcı olabilir.

References

  • 1. Khanolkar S, Hirani S, Mishra A, et al. Exploring the role of vitamin D in atherosclerosis and its impact on cardiovascular events: a comprehensive review. Cureus 2023;15:e42470. https://doi.org/10.7759/cureus.42470
  • 2. Reddy Vanga S, Good M, Howard PA, Vacek JL. Role of vitamin D in cardiovascular health. Am J Cardiol 2010;106:798-805. https://doi.org/10.1016/j.amjcard.2010.04.042
  • 3. Sánchez Martínez R, Castillo AI, Steinmeyer A, Aranda A. The retinoid X receptor ligand restores defective signalling by the vitamin D receptor. EMBO Rep 2006;7:1030-1034. https://doi.org/10.1038/sj.embor.7400776
  • 4. Muscogiuri G, Annweiler C, Duval G, et al. Vitamin D and cardiovascular disease: from atherosclerosis to myocardial infarction and stroke. Int J Cardiol 2017;230:577-584. https://doi.org/10.1016/j.ijcard.2016.12.053
  • 5. Chowdhury R, Kunutsor S, Vitezova A, et al. Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies. BMJ 2014;348:g1903. https://doi.org/10.1136/bmj.g1903
  • 6. Wang TJ, Pencina MJ, Booth SL, et al. Vitamin D deficiency and risk of cardiovascular disease. Circulation 2008;117:503-511. https://doi.org/10.1161/CIRCULATIONAHA.107.706127
  • 7. Płudowski P, Kos Kudła B, Walczak M, et al. Guidelines for preventing and treating Vitamin D deficiency: a 2023 update in Poland. Nutrients 2023;15:695. https://doi.org/10.3390/nu15030695
  • 8. Zareba W, Moss AJ, le Cessie S. Dispersion of ventricular repolarization and arrhythmic cardiac death in coronary artery disease. Am J Cardiol 1994;74:550-553. https://doi.org/10.1016/0002-9149(94)90742-0
  • 9. Galinier M, Vialette JC, Fourcade J, et al. QT interval dispersion as a predictor of arrhythmic events in congestive heart failure. Importance of aetiology. Eur Heart J 1998;19:1054-1062. https://doi.org/10.1053/euhj.1997.0865
  • 10. Kors JA, Ritsema van Eck HJ, van Herpen G. The meaning of the Tp-Te interval and its diagnostic value. J Electrocardiol 2008;41:575-580. https://doi.org/10.1016/j.jelectrocard.2008.07.030
  • 11. Barsan M, Brata AM, Ismaiel A, et al. The pathogenesis of cardiac arrhythmias in vitamin D deficiency. Biomedicines 2022;10:1239. https://doi.org/10.3390/biomedicines10061239
  • 12. Bekdas M, Inanir M, Ilhan Z, Ildes E. Effects of serum vitamin D level on ventricular repolarization in children and adolescents. Bratisl Lek Listy 2021;122:816-820. https://doi.org/10.4149/BLL_2021_130
  • 13. Bagrul D, Atik F. Association of vitamin D deficiency with ventricular repolarization abnormalities. Kardiol Pol 2019;77:853-858. https://doi.org/10.33963/KP.14888
  • 14. Nibbelink KA, Tishkoff DX, Hershey SD, Rahman A, Simpson RU. 1,25(OH)2-vitamin D3 actions on cell proliferation, size, gene expression, and receptor localization, in the HL-1 cardiac myocyte. J Steroid Biochem Mol Biol 2007;103:533-537. https://doi.org/10.1016/j.jsbmb.2006.12.099
  • 15. McGreevy C, Williams D. New insights about vitamin D and cardiovascular disease: a narrative review. Ann Intern Med 2011;155:820-826. https://doi.org/10.7326/0003-4819-155-12-201112200-00004
  • 16. Chen WR, Liu ZY, Shi Y, et al. Relation of low vitamin D to nonvalvular persistent atrial fibrillation in Chinese patients. Ann Noninvasive Electrocardiol 2014;19:166-73. https://doi.org/10.1111/anec.12105
  • 17. Kara H, Yasim A. Effects of high-dose vitamin D supplementation on the occurrence of post-operative atrial fibrillation after coronary artery bypass grafting: randomized controlled trial. Gen Thorac Cardiovasc Surg 2020;68:477-484. https://doi.org/10.1007/s11748-019-01209-0
  • 18. Turin A, Bax JJ, Doukas D, et al. Interactions among Vitamin D, atrial fibrillation, and the renin-angiotensin-aldosterone system. Am J Cardiol 2018;122:780-784. https://doi.org/10.1016/j.amjcard.2018.05.013
  • 19. D’Imperio S, Monasky MM, Micaglio E, Negro G, Pappone C. Impact of dietary factors on brugada syndrome and long QT syndrome. Nutrients 2021;13:2482. https://doi.org/10.3390/nu13082482
  • 20. Deo R, Katz R, Shlipak MG, et al. Vitamin D, parathyroid hormone, and sudden cardiac death: results from the Cardiovascular Health Study. Hypertension 2011;58:1021-1028. https://doi.org/10.1161/HYPERTENSIONAHA.111.179135
  • 21. Yetkin DO, Kucukkaya B, Turhan M, Oren M. The effect of 25-hydroxyvitamin D levels on QT interval duration and dispersion in type 2 diabetic patients. Croat Med J 2015;56:525-530. https://doi.org/10.3325/cmj.2015.56.525
  • 22. Locati ET, Bagliani G, Cecchi F, Johny H, Lunati M, Pappone C. Arrhythmias due to inherited and acquired abnormalities of ventricular repolarization. Card Electrophysiol Clin 2019;11:345-362. https://doi.org/10.1016/j.ccep.2019.02.009
  • 23. Galluzzo A, Gallo C, Battaglia A, et al. Prolonged QT interval in ST-elevation myocardial infarction: predictors and prognostic value in medium-term follow-up. J Cardiovasc Med (Hagerstown) 2016;17:440-445. https://doi.org/10.2459/JCM.0000000000000317
  • 24. Perrier E, Kerfant BG, Lalevee N, et al. Mineralocorticoid receptor antagonism prevents the electrical remodeling that precedes cellular hypertrophy after myocardial infarction. Circulation 2004;110:776-783. https://doi.org/10.1161/01.CIR.0000138973.55605.38
  • 25. Tishkoff DX, Nibbelink KA, Holmberg KH, Dandu L, Simpson RU. Functional vitamin D receptor (VDR) in the t-tubules of cardiac myocytes: VDR knockout cardiomyocyte contractility. Endocrinology 2008;149:558-564. https://doi.org/10.1210/en.2007-0805
  • 26. Li YC, Kong J, Wei M, Chen ZF, Liu SQ, Cao LP. 1,25-Dihydroxyvitamin D(3) is a negative endocrine regulator of the renin-angiotensin system. J Clin Invest 2002;110:229-238. https://doi.org/10.1172/JCI15219

Does vitamin D deficiency affect ventricular repolarization in the elderly?

Year 2024, , 440 - 447, 05.07.2024
https://doi.org/10.31362/patd.1382849

Abstract

Purpose: In this study, we aimed to establish if vitamin D deficiency interacts with the electrocardiographic indices of abnormal ventricular repolarization in elderly patients.
Material and methods: 138 patients were divided into three groups: patients with vitamin D deficiency, patients with vitamin D insufficiency, and patients with adequate vitamin D levels. 12-lead electrocardiography and laboratory data were collected.
Results: The resting heart rate, PR interval, Tp-e interval, QRS duration, Tp-e/QTc, QT dispersion, and Tp-e dispersion were similar among the groups. However, the QTc interval was significantly prolonged in patients with vitamin D deficiency when compared to patients with sufficient vitamin D levels. Vitamin D level was found as the only independent predictor of the QTc interval. The cut-off value of Vitamin D level determining the significant prolongation of QTc interval was found to be 20 ng/ml on ROC analysis (Area Under Curve: 0.629±0.051 (95% CI: 0.530-0.728, p=0.013).
Conclusion: Low vitamin D levels are related to QTc prolongation in the elderly. Vitamin D-deficient elderly patients may benefit from routine ECG screening. Timely diagnosis and treatment of vitamin D deficiency may aid in reducing the rate of arrhythmias in this patient population.

References

  • 1. Khanolkar S, Hirani S, Mishra A, et al. Exploring the role of vitamin D in atherosclerosis and its impact on cardiovascular events: a comprehensive review. Cureus 2023;15:e42470. https://doi.org/10.7759/cureus.42470
  • 2. Reddy Vanga S, Good M, Howard PA, Vacek JL. Role of vitamin D in cardiovascular health. Am J Cardiol 2010;106:798-805. https://doi.org/10.1016/j.amjcard.2010.04.042
  • 3. Sánchez Martínez R, Castillo AI, Steinmeyer A, Aranda A. The retinoid X receptor ligand restores defective signalling by the vitamin D receptor. EMBO Rep 2006;7:1030-1034. https://doi.org/10.1038/sj.embor.7400776
  • 4. Muscogiuri G, Annweiler C, Duval G, et al. Vitamin D and cardiovascular disease: from atherosclerosis to myocardial infarction and stroke. Int J Cardiol 2017;230:577-584. https://doi.org/10.1016/j.ijcard.2016.12.053
  • 5. Chowdhury R, Kunutsor S, Vitezova A, et al. Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies. BMJ 2014;348:g1903. https://doi.org/10.1136/bmj.g1903
  • 6. Wang TJ, Pencina MJ, Booth SL, et al. Vitamin D deficiency and risk of cardiovascular disease. Circulation 2008;117:503-511. https://doi.org/10.1161/CIRCULATIONAHA.107.706127
  • 7. Płudowski P, Kos Kudła B, Walczak M, et al. Guidelines for preventing and treating Vitamin D deficiency: a 2023 update in Poland. Nutrients 2023;15:695. https://doi.org/10.3390/nu15030695
  • 8. Zareba W, Moss AJ, le Cessie S. Dispersion of ventricular repolarization and arrhythmic cardiac death in coronary artery disease. Am J Cardiol 1994;74:550-553. https://doi.org/10.1016/0002-9149(94)90742-0
  • 9. Galinier M, Vialette JC, Fourcade J, et al. QT interval dispersion as a predictor of arrhythmic events in congestive heart failure. Importance of aetiology. Eur Heart J 1998;19:1054-1062. https://doi.org/10.1053/euhj.1997.0865
  • 10. Kors JA, Ritsema van Eck HJ, van Herpen G. The meaning of the Tp-Te interval and its diagnostic value. J Electrocardiol 2008;41:575-580. https://doi.org/10.1016/j.jelectrocard.2008.07.030
  • 11. Barsan M, Brata AM, Ismaiel A, et al. The pathogenesis of cardiac arrhythmias in vitamin D deficiency. Biomedicines 2022;10:1239. https://doi.org/10.3390/biomedicines10061239
  • 12. Bekdas M, Inanir M, Ilhan Z, Ildes E. Effects of serum vitamin D level on ventricular repolarization in children and adolescents. Bratisl Lek Listy 2021;122:816-820. https://doi.org/10.4149/BLL_2021_130
  • 13. Bagrul D, Atik F. Association of vitamin D deficiency with ventricular repolarization abnormalities. Kardiol Pol 2019;77:853-858. https://doi.org/10.33963/KP.14888
  • 14. Nibbelink KA, Tishkoff DX, Hershey SD, Rahman A, Simpson RU. 1,25(OH)2-vitamin D3 actions on cell proliferation, size, gene expression, and receptor localization, in the HL-1 cardiac myocyte. J Steroid Biochem Mol Biol 2007;103:533-537. https://doi.org/10.1016/j.jsbmb.2006.12.099
  • 15. McGreevy C, Williams D. New insights about vitamin D and cardiovascular disease: a narrative review. Ann Intern Med 2011;155:820-826. https://doi.org/10.7326/0003-4819-155-12-201112200-00004
  • 16. Chen WR, Liu ZY, Shi Y, et al. Relation of low vitamin D to nonvalvular persistent atrial fibrillation in Chinese patients. Ann Noninvasive Electrocardiol 2014;19:166-73. https://doi.org/10.1111/anec.12105
  • 17. Kara H, Yasim A. Effects of high-dose vitamin D supplementation on the occurrence of post-operative atrial fibrillation after coronary artery bypass grafting: randomized controlled trial. Gen Thorac Cardiovasc Surg 2020;68:477-484. https://doi.org/10.1007/s11748-019-01209-0
  • 18. Turin A, Bax JJ, Doukas D, et al. Interactions among Vitamin D, atrial fibrillation, and the renin-angiotensin-aldosterone system. Am J Cardiol 2018;122:780-784. https://doi.org/10.1016/j.amjcard.2018.05.013
  • 19. D’Imperio S, Monasky MM, Micaglio E, Negro G, Pappone C. Impact of dietary factors on brugada syndrome and long QT syndrome. Nutrients 2021;13:2482. https://doi.org/10.3390/nu13082482
  • 20. Deo R, Katz R, Shlipak MG, et al. Vitamin D, parathyroid hormone, and sudden cardiac death: results from the Cardiovascular Health Study. Hypertension 2011;58:1021-1028. https://doi.org/10.1161/HYPERTENSIONAHA.111.179135
  • 21. Yetkin DO, Kucukkaya B, Turhan M, Oren M. The effect of 25-hydroxyvitamin D levels on QT interval duration and dispersion in type 2 diabetic patients. Croat Med J 2015;56:525-530. https://doi.org/10.3325/cmj.2015.56.525
  • 22. Locati ET, Bagliani G, Cecchi F, Johny H, Lunati M, Pappone C. Arrhythmias due to inherited and acquired abnormalities of ventricular repolarization. Card Electrophysiol Clin 2019;11:345-362. https://doi.org/10.1016/j.ccep.2019.02.009
  • 23. Galluzzo A, Gallo C, Battaglia A, et al. Prolonged QT interval in ST-elevation myocardial infarction: predictors and prognostic value in medium-term follow-up. J Cardiovasc Med (Hagerstown) 2016;17:440-445. https://doi.org/10.2459/JCM.0000000000000317
  • 24. Perrier E, Kerfant BG, Lalevee N, et al. Mineralocorticoid receptor antagonism prevents the electrical remodeling that precedes cellular hypertrophy after myocardial infarction. Circulation 2004;110:776-783. https://doi.org/10.1161/01.CIR.0000138973.55605.38
  • 25. Tishkoff DX, Nibbelink KA, Holmberg KH, Dandu L, Simpson RU. Functional vitamin D receptor (VDR) in the t-tubules of cardiac myocytes: VDR knockout cardiomyocyte contractility. Endocrinology 2008;149:558-564. https://doi.org/10.1210/en.2007-0805
  • 26. Li YC, Kong J, Wei M, Chen ZF, Liu SQ, Cao LP. 1,25-Dihydroxyvitamin D(3) is a negative endocrine regulator of the renin-angiotensin system. J Clin Invest 2002;110:229-238. https://doi.org/10.1172/JCI15219
There are 26 citations in total.

Details

Primary Language English
Subjects Cardiovascular Medicine and Haematology (Other)
Journal Section Research Article
Authors

İrem Müge Akbulut 0000-0002-9190-0009

Büşra Yurumez 0000-0002-6426-6583

Volkan Atmış 0000-0002-0080-6448

Murat Varlı 0000-0003-1176-5255

Early Pub Date March 22, 2024
Publication Date July 5, 2024
Submission Date October 29, 2023
Acceptance Date March 22, 2024
Published in Issue Year 2024

Cite

AMA Akbulut İM, Yurumez B, Atmış V, Varlı M. Does vitamin D deficiency affect ventricular repolarization in the elderly?. Pam Tıp Derg. July 2024;17(3):440-447. doi:10.31362/patd.1382849
Creative Commons Lisansı
Pamukkale Tıp Dergisi, Creative Commons Atıf-GayriTicari 4.0 Uluslararası Lisansı ile lisanslanmıştır