649
Effect of Vitamin D Replacement on Atrial Electromechanical Delay in Subjects with Vitamin D Deficiency ˘ ˘ YAYLA, M.D., MEHMET KADRI AKBOGA, ˘ M.D., UGUR CANPOLAT, M.D., C¸AGRI ¨ ¨ ELIF HANDE OZCAN, M.D., OSMAN TURAK, M.D., FIRAT OZCAN, M.D., ˘ SERKAN TOPALOGLU, M.D., and DURSUN ARAS, M.D. From the Cardiology Clinic, T¨urkiye Y¨uksek Ihtisas Training and Research Hospital, Ankara, Turkey
AEMD and Vitamin D Deficiency. Objectives: Limited data are available regarding cardiac arrhythmias in vitamin D (VitD) deficiency. Therefore, we aimed to assess whether atrial electromechanical delay (AEMD) measured by tissue Doppler imaging (TDI), which is an indicator for atrial fibrillation (AF) development, is prolonged in patients with VitD deficiency as compared to the control group. The effect of vitD replacement on AEMD was also evaluated. Methods: In this prospective study a total of 28 VitD-deficient and 56 age-, gender-, and BMImatched VitD-sufficient healthy participants were enrolled. P-wave dispersion (PWd) was calculated on the 12-lead electrocardiogram. Both intra- and inter-AEMD were calculated by TDI. Measurements were performed at baseline in both groups and were repeated after 6-month replacement therapy in subjects with vitD deficiency. Results: PWd and inter- and left intra-AEMD were significantly prolonged in patients with VitD deficiency compared to the control group (P < 0.001). While serum 25(OH)D levels were significantly and negatively correlated with left intra-AEMD (r = −0.657, P < 0.001), there was a positive correlation between serum 25(OH)D level and PWd (r = 0.523, P < 0.001). The serum 25(OH)D level was found as the independent predictor of the both left intra- and inter-AEMD in the multivariate linear regression analysis (β:−0.552, P < 0.001 and β:−0.555, P < 0.001, respectively). The serum 25(OH)D level was significantly increased after replacement therapy. While inter-AEMD was significantly decreased (P = 0.013), there was no change in PWD and left and right intra-AEMD (P > 0.05) following replacement therapy. Conclusion: PWd and left intra- and inter-AEMD are increased in patients with VitD deficiency. The serum 25(OH)D level was found as an independent predictor for AEMD in patients with VitD deficiency. Also a significant decrement was observed in inter-AEMD following vitD replacement therapy. Studies with longer follow-up are needed to investigate whether vitD-deficient patients with prolonged AEMD develop clinical arrhythmia and vitD replacement reduces the risk of atrial arrhythmias. (J Cardiovasc Electrophysiol, Vol. 26, pp. 649-655, June 2015) atrial electromechanical delay, vitamin D deficiency, tissue Doppler echocardiography, P waves, atrial conduction abnormality Introduction Vitamin D (VitD) is known as an essential hormone in bone metabolism. However, adequate VitD status is also important for physiological functioning of various extraskeletal tissues and organs including the cardiovascular system.1 The 25hydroxyvitamin D [25(OH)D] is usually used as a circulating biomarker of VitD status.2 It has been evidenced that VitD receptors have been found in cardiomyocytes, smooth muscle cells, and endothelial cells.3-5 Also 1,25(OH)D acts on the renin–angiotensin system and inflammatory pathways.6,7 Given the associations of vitD status with several atrial fibrillation (AF) risk factors and the potential link between vitD, renin–angiotensin system, and inflammation, patients with Disclosures: None.
vitD deficiency might have an increased risk for the development of AF. However, previous studies regarding the association of vitD status with AF revealed conflictory data.8-10 Tissue Doppler imaging (TDI) by using tramsthoracic echocardiography can be a useful technique to evaluate atrial conduction times.11 Also prolonged intra- and inter-atrial electromechanical delay (AEMD) measured by TDI have been significantly associated with a higher prevalence of new or recurrent AF.12 To our knowledge, there was no study evaluating the intraand inter-AEMD in patients with VitD deficiency. Also, the effect of VitD replacement therapy on AEMD has not been evaluated in clinical studies. Therefore, in this study we aimed to evaluate atrial conduction times by using TDI in apparently healthy subjects with VitD deficiency and impact of VitD replacement therapy on AEMD.
Address for correspondence: U˘gur Canpolat, M.D., T¨urkiye Y¨uksek _Ihtisas Training and Research Hospital, Cardiology Clinic, Sıhhiye, 06100, Ankara, Turkey. Fax: 90-312-306-1134; E-mail: [email protected] Manuscript received 4 January 2015; Revised manuscript received 27 February 2015; Accepted for publication 9 March 2015. doi: 10.1111/jce.12656
Methods Study Population In this prospective study, we enrolled a total of 84 apparently healthy subjects (39 [46.4%] female; mean age
650
Journal of Cardiovascular Electrophysiology
Vol. 26, No. 6, June 2015
37.6 ± 6.9 years) who were admitted for routine check-up and examined at outpatient clinics between June 2013 and December 2013 in Ankara. The 25-OH-D levels were assessed because of the widespread musculoskeletal pain in all participants. Vitamin D deficiency is defined as a 25(OH)D below 20 ng/mL (50 nmol/L) according to The Endocrinology Society guidelines.13 The study population was divided into 2 as VitD sufficient (n = 56, 25(OH)D ࣙ30 ng/mL) and VitD-deficient (n = 28, 25(OH)D
Effect of Vitamin D Replacement on Atrial Electromechanical Delay in Subjects with Vitamin D Deficiency ˘ ˘ YAYLA, M.D., MEHMET KADRI AKBOGA, ˘ M.D., UGUR CANPOLAT, M.D., C¸AGRI ¨ ¨ ELIF HANDE OZCAN, M.D., OSMAN TURAK, M.D., FIRAT OZCAN, M.D., ˘ SERKAN TOPALOGLU, M.D., and DURSUN ARAS, M.D. From the Cardiology Clinic, T¨urkiye Y¨uksek Ihtisas Training and Research Hospital, Ankara, Turkey
AEMD and Vitamin D Deficiency. Objectives: Limited data are available regarding cardiac arrhythmias in vitamin D (VitD) deficiency. Therefore, we aimed to assess whether atrial electromechanical delay (AEMD) measured by tissue Doppler imaging (TDI), which is an indicator for atrial fibrillation (AF) development, is prolonged in patients with VitD deficiency as compared to the control group. The effect of vitD replacement on AEMD was also evaluated. Methods: In this prospective study a total of 28 VitD-deficient and 56 age-, gender-, and BMImatched VitD-sufficient healthy participants were enrolled. P-wave dispersion (PWd) was calculated on the 12-lead electrocardiogram. Both intra- and inter-AEMD were calculated by TDI. Measurements were performed at baseline in both groups and were repeated after 6-month replacement therapy in subjects with vitD deficiency. Results: PWd and inter- and left intra-AEMD were significantly prolonged in patients with VitD deficiency compared to the control group (P < 0.001). While serum 25(OH)D levels were significantly and negatively correlated with left intra-AEMD (r = −0.657, P < 0.001), there was a positive correlation between serum 25(OH)D level and PWd (r = 0.523, P < 0.001). The serum 25(OH)D level was found as the independent predictor of the both left intra- and inter-AEMD in the multivariate linear regression analysis (β:−0.552, P < 0.001 and β:−0.555, P < 0.001, respectively). The serum 25(OH)D level was significantly increased after replacement therapy. While inter-AEMD was significantly decreased (P = 0.013), there was no change in PWD and left and right intra-AEMD (P > 0.05) following replacement therapy. Conclusion: PWd and left intra- and inter-AEMD are increased in patients with VitD deficiency. The serum 25(OH)D level was found as an independent predictor for AEMD in patients with VitD deficiency. Also a significant decrement was observed in inter-AEMD following vitD replacement therapy. Studies with longer follow-up are needed to investigate whether vitD-deficient patients with prolonged AEMD develop clinical arrhythmia and vitD replacement reduces the risk of atrial arrhythmias. (J Cardiovasc Electrophysiol, Vol. 26, pp. 649-655, June 2015) atrial electromechanical delay, vitamin D deficiency, tissue Doppler echocardiography, P waves, atrial conduction abnormality Introduction Vitamin D (VitD) is known as an essential hormone in bone metabolism. However, adequate VitD status is also important for physiological functioning of various extraskeletal tissues and organs including the cardiovascular system.1 The 25hydroxyvitamin D [25(OH)D] is usually used as a circulating biomarker of VitD status.2 It has been evidenced that VitD receptors have been found in cardiomyocytes, smooth muscle cells, and endothelial cells.3-5 Also 1,25(OH)D acts on the renin–angiotensin system and inflammatory pathways.6,7 Given the associations of vitD status with several atrial fibrillation (AF) risk factors and the potential link between vitD, renin–angiotensin system, and inflammation, patients with Disclosures: None.
vitD deficiency might have an increased risk for the development of AF. However, previous studies regarding the association of vitD status with AF revealed conflictory data.8-10 Tissue Doppler imaging (TDI) by using tramsthoracic echocardiography can be a useful technique to evaluate atrial conduction times.11 Also prolonged intra- and inter-atrial electromechanical delay (AEMD) measured by TDI have been significantly associated with a higher prevalence of new or recurrent AF.12 To our knowledge, there was no study evaluating the intraand inter-AEMD in patients with VitD deficiency. Also, the effect of VitD replacement therapy on AEMD has not been evaluated in clinical studies. Therefore, in this study we aimed to evaluate atrial conduction times by using TDI in apparently healthy subjects with VitD deficiency and impact of VitD replacement therapy on AEMD.
Address for correspondence: U˘gur Canpolat, M.D., T¨urkiye Y¨uksek _Ihtisas Training and Research Hospital, Cardiology Clinic, Sıhhiye, 06100, Ankara, Turkey. Fax: 90-312-306-1134; E-mail: [email protected] Manuscript received 4 January 2015; Revised manuscript received 27 February 2015; Accepted for publication 9 March 2015. doi: 10.1111/jce.12656
Methods Study Population In this prospective study, we enrolled a total of 84 apparently healthy subjects (39 [46.4%] female; mean age
650
Journal of Cardiovascular Electrophysiology
Vol. 26, No. 6, June 2015
37.6 ± 6.9 years) who were admitted for routine check-up and examined at outpatient clinics between June 2013 and December 2013 in Ankara. The 25-OH-D levels were assessed because of the widespread musculoskeletal pain in all participants. Vitamin D deficiency is defined as a 25(OH)D below 20 ng/mL (50 nmol/L) according to The Endocrinology Society guidelines.13 The study population was divided into 2 as VitD sufficient (n = 56, 25(OH)D ࣙ30 ng/mL) and VitD-deficient (n = 28, 25(OH)D
