Role of Inflammatory Markers on Left Ventricular Functions in Vitamin D Deficiency Rickets
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- Category: Vol. 81, December 2013
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Role of Inflammatory Markers on Left Ventricular Functions in Vitamin D Deficiency Rickets, WAFAA S. MOHAMMED and KOTB A. METWALLEY
Abstract
Background: Circulating 25 hydroxyvitamin D (25 (OH)D), an accurate measure of vitamin D status, is markedly reduced in rachitic infants. Aside from the known relationship between vitamin D and bone, vitamin D has also been impli-cated in cardiovascular homeostasis, immune function and inflammation. Furthermore, a mass of evidence is accumulating that vitamin D deficiency could lead to cardiovascular com-plications and imbalance of cytokines profile. Our objective was to study the relationship between vitamin D status (as determined by serum 25(OH) D concentrations) and inflam-matory markers and left ventricular function in rachitic infants. Also, to evaluate the effect of vitamin D supplementation on the above parameters.
Subjects and Methods: This study included two groups; vitamin D deficiency rickets (VDDR) group (25 infants) and an age matched control group (15 infants). After subsiding of the acute illness, the rachitic infants received vitamin D supplementation for 6 months. Blood samples were collected in the morning before the start of treatment and analyzed for serum 25(OH)D, intact parathyroid hormone (iPTH), Alkaline phosphtase (ALP), calcium (Ca), Phosphorus (Ph) and inflam-matory markers [interleukin-6 (IL-6), and C-reactive protein (CRP). Electrocardiogram (ECG) and echocardiography mea-suring left ventricular functions were done. The biochemical variables, ECG and echocardiography were assessed at baseline and after 6 months of vitamin D supplementation.
Results: VDDR group had significant lower 25(OH)D, Ca, Ph and significant higher iPTH, ALP, IL-6 and CRP compared to the age matched control group at baseline. Echocardiographic finding revealed significant increase in LVEDD and LVESD and significant decrease in EF% and FS% in VDDR group compared to the age matched control group at the study entry. Also, ECG finding showed abnor-mality in some patients at baseline. The biochemical, echocar-diogrphic and ECG variables improved significantly after 6 months of vitamin D supplementation and reached to those levels found in the age matched control group. Finally, we found negative correlations between 25(OH)D level and IL-6, CRP, LVEDD and LVESD. Also, positive correlations were found between 25(OH)D and EF% and FS%. These correlation were observed at baseline and after 6 months of vitamin D treatment.
Conclusion: VDDR is associated with increased inflam-matory markers and impairment of left ventricular functions in rachitic infants. Vitamin D supplementation ameliorated these effects. Also, results gleaned from this investigation support the possible contributing role of the elevated inflam-matory markers in the pathophysiology of left ventricular impairment in vitamin D deficiency rachitic infants. More studies are needed to fully characterize the relationship between Vitamin D induced inflammation and cardiac function in rachitic infants.