Relation between serum levels of vitamin D and echocardiographic determinants of systolic and diastolic functions in patients with and without cardiorenal syndrome

Background: vitamin D is a fat-soluble vitamin; it has skeletal and non-skeletal functions. The effect of Vitamin D on CV disease had several mechanisms including elevated PTH and Calcium-phosphate metabolism. It decreases the pro- remodeling of Angiotensin II on the cardiomyocytes

The Objectives: To study relation between serum levels of vitamin D and echocardiographic determinants of systolic and diastolic functions in patients with and without cardio-renal syndrome

Patients and Methods: Prospective study was conducted on 90 patients of all age groups and both sexes, admitted to Ain-Shams University hospital. The study included 3 groups of patients: Group 1: systolic dysfunction and renal insufficiency [30 patients], Group 2: systolic dysfunction only [30 patients]. Group 3: renal insufficiency only [30 patients], in addition 10 healthy controls were taken as controls. Patients were subjected to full comprehensive echocardiography and KFT with estimation of creatinine clearance, and Vitamin D level that was statistically studied against echocardiographic parameters of cardiac systolic and diastolic function

Results: Our study found that, compared to patients with normal vitamin D level, patients with vitamin D deficiency [defined as having vitamin D level <20 ng/ml] had significantly higher ventricular thickness [IVS, PW and mean wall thickness] [P value < 0.001], and higher LV mass which seems to be linked eventually to worse outcomes with no significant impact on worsening Diastolic dysfunction. A ROC curve was done revealing a sensitivity of 80% for the mean wall thickness [>/= 10 mm] to identify patients with vitamin D deficiency

Conclusion: Vitamin D deficiency was associated with ventricular hypertrophy with worsening outcomes with no impact on diastolic function

Simplifying proximal isovelocity surface area as an assessment method of mitral valve area in patients with rheumatic mitral stenosis by fixing aliasing velocity and mitral valve angle

We aimed to test the ability of a simple equation using proximal isovelocity surface area method [PISA], created by fixing the angle to 100° and the aliasing velocity to 33 cm/s, to calculate mitral valve area [MVA] and assess severity in patients with rheumatic mitral stenosis [MS]. In a series of 51 consecutive patients with rheumatic MS, MVA was assessed by four methods, conventional PISA equation PISA[conventional], simple PISA equation PISA[simple], pressure half time [PHT], and planimetry [PLN] which was taken as the reference method. All methods correlated significantly with PLN with the highest correlation found in case of PISA[conventional] and PISA[simple] [r = 0.97, 0.96, p < 0.001], while the correlation in case PHT was relatively weaker [r = 0.69, p < 0.001]. Bland-Altman analysis revealed that the level of agreement with PLN was better in case of both PISA methods than PHT and, moreover, were close to each other. The number of cases that showed agreement of severity grade with planinetry was better in case of PISA[conventional] [42 cases] and PISA simple [44 cases] than that in case of PHT [34 cases, p = 0.037]. Finally, the measure of agreement with Cohen's Kappa test was better in case of PISA[conventional] and PISA[simple] than that in case of PHT. Provided that aliasing velocity is fixed at 33 cm/s, PISA can effectively predict mitral valve area and severity of MS by a simple equation, with the advantage of easy and accurate calculation over other methods