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Poor outcome in end‐stage heart failure patients with low circulating calcitriol levels
Author(s) -
Zittermann Armin,
Schleithoff Stefanie S.,
Götting Christian,
Dronow Oxana,
Fuchs Uwe,
Kuhn Joachim,
Kleesiek Knut,
Tenderich Gero,
Koerfer Reiner
Publication year - 2008
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2008.01.013
Subject(s) - calcitriol , medicine , heart failure , vitamin d and neurology , heart transplantation , proportional hazards model , hazard ratio , logistic regression , confounding , endocrinology , cardiology , transplantation , gastroenterology , confidence interval
Background: Vitamin D receptor knockout mice develop typical signs of congestive heart failure (CHF). In approximately 20% of stable CHF patients, frankly low concentrations of the vitamin D hormone calcitriol are found. Aims: We investigated whether serum calcitriol concentrations predict clinical outcome in end‐stage CHF. Methods and results: We collected blood samples in 383 end‐stage CHF patients who were on a waiting list for cardiac transplantation. We assessed associations of calcitriol with disease severity and freedom from event (death or cardiac transplantation) during 1‐year follow‐up. In electively listed patients ( n =325), 31% had deficient calcitriol levels (<43pmol/l) compared to 47% in urgently/high urgently listed patients ( n =58; P <0.001). As determined by multivariable logistic regression, calcitriol was an independent predictor of the listing status ‘urgent/high urgent’ ( P <0.001). Calcitriol concentrations were also significantly lower in patients with an event ( n =233) compared to those who survived on the waiting list ( P <0.001). Cox regression analysis revealed that patients in the highest calcitriol tertile had a hazard ratio (95% CI) for an event of 0.506 (0.334–0.767) compared with patients in the lowest calcitriol tertile ( P =0.005), after adjustment for potential confounders. Conclusion: Data indicate that low serum calcitriol concentrations are independently associated with poor clinical outcome in end‐stage CHF.