Background 

Vitamin D [25(OH)D] deficiency and degenerative aortic stenosis represent emerging conditions, linked to a progressive ageing of the population and increased frailty. Previous studies have associated lower levels of 25 (OH)D to the pathogenesis of atherosclerosis and vascular calcifications. However, few studies have evaluated, so far, the impact of vitamin D deficiency in patients with aortic stenosis, which was therefore the aim of present study.

Methods 

Consecutive patients with severe degenerative aortic stenosis undergoing nonurgent coronary angiography were included. Aortic stenosis was defined as aortic valve area (AVA) less than 1 cm² and/or mean gradient more than 40 mmHg. Indexed area and stroke volume or dobutamine stress evaluation were performed when indicated. Fasting samples were collected at admission for 25 (OH)D levels assessment.

Results 

We included 137 patients with severe degenerative aortic stenosis (48.9% men, mean age 78.4 ± 6.4 years) who were divided according to vitamin D median values (≥12.4 ng/ml). Patients with lower vitamin D had a more frequent history of coronary artery bypass graft (P = 0.02) and received more often angiotensin-converting enzyme-inhibitors (P = 0.03). Among them, 38.7% had vitamin D levels less than 10 ng/ml and only five patients were in therapy with vitamin D supplementation. We observed no significant relationship between vitamin D levels and echocardiographic parameters for the severity of aortic stenosis (AVA, peak and mean gradients, volumes, ejection fraction) except for a greater wall thickness in patients with lower vitamin D levels (r = −0.34, P = 0.03). Results did not change when excluding patients with renal failure or treated with vitamin D supplementation.

Conclusion 

Among patients with severe degenerative aortic stenosis, vitamin D deficiency is common. We found a significant association between left ventricular wall thickness and vitamin D levels, suggesting a potential role of this hormone in modulating hypertrophic remodelling in these patients. However, future larger studies are certainly needed to confirm our findings and to define their prognostic implications.

中文翻译：

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低维生素D水平会影响严重的主动脉瓣狭窄左心室壁厚度

背景 

维生素D [25（OH）D]缺乏症和主动脉退行性狭窄代表着新出现的状况，与人口的逐步衰老和脆弱性增加有关。先前的研究已将较低水平的25（OH）D与动脉粥样硬化和血管钙化的发病机制相关联。但是，迄今为止，很少有研究评估维生素D缺乏症对主动脉瓣狭窄患者的影响，因此这是本研究的目的。

方法 

包括患有严重变性主动脉瓣狭窄的连续患者，接受非紧急冠状动脉造影。主动脉瓣狭窄定义为主动脉瓣面积（AVA）小于1 cm ²和/或平均梯度大于40 mmHg。指示时进行索引面积和中风量或多巴酚丁胺应力评估。入院时收集禁食样品以评估25（OH）D水平。

结果 

我们纳入了137例严重的变性主动脉瓣狭窄患者（男性48.9％，平均年龄78.4±6.4岁），根据维生素D中位数（≥12.4ng / ml）进行划分。维生素D含量较低的患者有更频繁的冠状动脉搭桥术（P = 0.02），并且接受血管紧张素转换酶抑制剂的频率更高（P = 0.03）。其中38.7％的维生素D水平低于10 ng / ml，只有5名接受维生素D补充治疗的患者。我们观察到维生素D之间没有显着关系维生素D水平较低的患者壁厚较大时，主动脉瓣狭窄严重程度的水平和超声心动图参数（AVA，峰值和平均梯度，体积，射血分数）（r = -0.34，P = 0.03）。排除肾衰竭或补充维生素D的患者时，结果没有改变。

结论 

在严重的变性主动脉瓣狭窄患者中，维生素D缺乏症很常见。我们发现左心室壁厚与维生素D水平之间存在显着关联，表明该激素在调节这些患者肥大性重构中的潜在作用。但是，肯定需要将来进行更大的研究，以证实我们的发现并确定其预后含义。