Left Ventricular Geometry Indicators in Patients with Arterial Hypertension with Vitamin D Deficiency
Year: 2024
Type: article
Study design: Observational Study
Abstract: Left ventricular hypertrophy (LVH) and left ventricular diastolic dysfunction (LVDD) are important prognostic factors that increase the risk of cardiovascular complications and mortality. Even with asymptomatic arterial hypertension (AH), patients with LVH have a worse prognosis than without it. It has been proven that the diagnosis of LVH is very important in clinical practice, because early detection of LVH and adequately prescribed treatment, which is aimed at restoring the parameters of the geometry, is of great importance to reduce the frequency of cardiovascular events. The objective: to analyze the features of the structural and functional state of the heart and LV diastolic function in patients with hypertension against the background of vitamin D deficiency or insufficiency. Materials and methods. 97 patients aged 45 to 74 years with uncomplicated hypertension of stage II of the 1st and 2nd degrees and 25 practically healthy people were examined, they were randomized by age and sex, the persons were included in the control group to determine normative reference values. Patients with hypertension were divided into three groups depending on the level of vitamin D in blood serum according to the Endocrine Practice Guidelines Committee. To assess the structural and functional state of the myocardium and LVDD, patients underwent transthoracic echocardiography with the study of transmitral blood flow in pulsed and continuous tissue Doppler mode. Results. An analysis of the frequency and structure of LVH showed that patients with hypertension with vitamin D deficiency have the highest frequency of detection of severe LVH, which is determined more often by 55.3% than in patients with vitamin D deficiency, and more often by 93.8% than in patients with a normal level of vitamin D (р < 0.05). For hypertensive patients with vitamin D deficiency the detection of cavity dilatation is more common – eccentric LVH with dilatation is 4.1 times more frequent than in the group of patients with a normal level of vitamin D and 2.1 times more often with vitamin D deficiency (p < 0.05). It has been proven that the indicators of LV myocardial mass (LVMM) and LV myocardial mass index (LVMMI) in patients with hypertension when combined with vitamin D deficiency reliably outweigh the corresponding indicators in patients with vitamin D insufficiency and a normal level, namely: LVMM by 10.9% and 22.3%, and LVMMI by 12.1% and 24.4%, respectively (p < 0.05). Similar changes are typical for the indicators of the thickness of the interventricular membrane, which were higher by 5.1% and 16.9%, respectively (p < 0.05), and the thickness of the back wall of the LV – by 9.8% and 30.2% (p < 0.05) respectively. The results of the study indicate that not only the age of the patients and the duration of hypertension, but also the low vimtain D concentration causes LV hypertrophy – an increase in the size and mass of cardiomyocytes and an increase in the amount of intercellaurl matrix. Conclusions. When combining hemodynamic and metabolic changes in hypertension with vitamin D deficiency, there is a potentiation of negative effects that affect the development of LV hypertrophy and dialytic dysfunction. In hypertensive patients combined with vitamin D deficiency a high frequency of LVH (93.9%) is determined, the structure of which is dominated by a severe form of LVH, as well as the inherent prognostically most unfavorable eccentric type of LVH with LV dilatation.
Authors: Alina Tarasiuk, Vitalii Kondratiuk, Oleh Bychkov, Serhii Sova, Mariana Seliuk, Olha Selіuk
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4406740171