Association between vitamin D levels and left ventricular function and NT-proBNP levels among thalassemia major children with iron overload

Abstract

Background:Heart disease is the major cause of death in thalassemia patients. Repeated blood transfusions and hemolysis cause iron overload and also disrupts the hydroxylation and synthesis of vitamin D, causing vitamin D deficiency. Vitamin D deficiency is associated with cardiac dysfunction.Objective:The purpose of this study was to determine the association between vitamin D levels and left ventricular function and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in thalassemia major children with iron overload.Patients and Methods:A cross-sectional study was conducted in March-April 2015 in the thalassemia clinic, Department of Child Health, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. Thirty-four children with thalassemia were enrolled consecutively. Serum vitamin D and NT-proBNP levels were measured with electrochemiluminescence (ECLIA) method and echocardiography was performed to assess ventricular function.Results:Significant correlations were found between vitamin D levels and left ventricular ejection fraction (LVEF) (r = 0.399, P = 0.019) and fractional shortening (FS) (r = 0.394, P = 0.021). There was also significant correlation between vitamin D and NT-proBNP levels (r = -0.444, P = 0.008). Chi-square analysis also showed a relationship between vitamin D and NT-proBNP (P = 0.019) levels. There was a difference in NT-proBNP levels among thalassemia major children with iron overload (P = 0.020). Post hoc analysis showed that there was a significant difference in NT-proBNP levels between those with vitamin D deficiency and those with normal vitamin D levels (P = 0.012).Conclusion:There is an association between vitamin D and left ventricular function and NT-proBNP levels in children with thalassemia major and iron overload. Vitamin D can be considered in patients with thalassemia having vitamin D deficiency.

Correlation of vitamin D3 and serum calcium level with left ventricular hypertrophy patients.

“…The role of vitamin D and NT-pro BNP levels in thalassemic children and their correlation with LV functions were reported by Ambarwati et al 15 from Indonesia. The study reported significant negative correlation among serum levels vitamin D and LVEF (left ventricular ejection fraction) similar outcomes were also noted in the present study.…”

Vitamin and Mineral Supplementation for β-Thalassemia During COVID-19 Pandemic

“…Iron deposition in the liver might disrupt the hydroxylation of vitamin D in 25-OHD before the next hydroxylation in the kidneys in 1,25 OH 2 D 3 . Moreover, its deposition in the skin might affect vitamin D level due to disrupting vitamin D synthesis [ 62 ].…”

“…The fact that transfusion-dependent thalassemia was more prone to bacterial infection supports the alteration of immune function in this genetic disease [ 64 ]. The correlation of vitamin D deficiency in β-thalassemia has been known to alter the cardiovascular system [ 62 , 65 ], endocrines [ 66 ] and the bone [ 15 , 67 ]. A study involving all types of thalassemia, including β-thalassemia, supplementation of 50,000 IU of ergocalciferol (vitamin D 2 ) could increase the 25-OHD level; however, the effect of this supplementation on the immune system was not investigated [ 61 ].…”

The Effects of Vitamin D on Myocardial Function Demonstrated by Speckle Tracking Echocardiography in Children With Βeta Thalassemia

“…Ambarwati et al reported that N-terminal pro-brain natriuretic peptide levels, which can be used to diagnose preclinical cardiac dysfunction, were higher in thalassemia major children with vitamin D de ciency than those with normal vitamin D levels. They also stated that thalassemic patients with cardiac dysfunction in conventional echocardiography have signi cantly lower vitamin D levels [23].…”