Vitamin D reduces left atrial volume in patients with left ventricular hypertrophy and chronic kidney disease

Hector Tamez, Carmine Zoccali, David Packham, Julia Wenger, Ishir Bhan, Evan Appelbaum, Yili Pritchett, Yuchiao Chang, Rajiv Agarwal, Christoph Wanner, Donald Lloyd-Jones, Jorge Cannata, B. Taylor Thompson, Dennis Andress, Wuyan Zhang, Bhupinder Singh, Daniel Zehnder, Ajay Pachika, Warren J. Manning, Amil ShahScott D. Solomon, Ravi Thadhani

Research output: Contribution to journalArticle

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Abstract

Background: Left atrial enlargement, a sensitive integrator of left ventricular diastolic function, is associated with increased cardiovascular morbidity and mortality. Vitamin D is linked to lower cardiovascular morbidity, possibly modifying cardiac structure and function; however, firm evidence is lacking. We assessed the effect of an activated vitamin D analog on left atrial volume index (LAVi) in a post hoc analysis of the PRIMO trial (clinicaltrials.gov: NCT00497146). Methods and results: One hundred ninety-six patients with chronic kidney disease (estimated glomerular filtration rate 15-60 mL/min per 1.73m2), mild to moderate left ventricular hypertrophy, and preserved ejection fraction were randomly assigned to 2 μg of oral paricalcitol or matching placebo for 48 weeks. Two-dimensional echocardiography was obtained at baseline and at 24 and 48 weeks after initiation of therapy. Over the study period, there was a significant decrease in LAVi (-2.79 mL/m 2, 95% CI -4.00 to -1.59 mL/m2) in the paricalcitol group compared with the placebo group (-0.70 mL/m2 [95% CI -1.93 to 0.53 mL/m2], P =.002). Paricalcitol also attenuated the rise in levels of brain natriuretic peptide (10.8% in paricalcitol vs 21.3% in placebo, P =.02). For the entire population, the change in brain natriuretic peptide correlated with change in LAVi (r = 0.17, P =.03). Conclusions: Forty-eight weeks of therapy with an active vitamin D analog reduces LAVi and attenuates the rise of BNP. In a population where only few therapies alter cardiovascular related morbidity and mortality, these post hoc results warrant further confirmation.

Original languageEnglish
JournalAmerican Heart Journal
Volume164
Issue number6
DOIs
StatePublished - Dec 2012

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Left Ventricular Hypertrophy
Chronic Renal Insufficiency
Vitamin D
Brain Natriuretic Peptide
Placebos
Morbidity
Mortality
Glomerular Filtration Rate
Left Ventricular Function
Population
Echocardiography
Therapeutics
paricalcitol

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Vitamin D reduces left atrial volume in patients with left ventricular hypertrophy and chronic kidney disease. / Tamez, Hector; Zoccali, Carmine; Packham, David; Wenger, Julia; Bhan, Ishir; Appelbaum, Evan; Pritchett, Yili; Chang, Yuchiao; Agarwal, Rajiv; Wanner, Christoph; Lloyd-Jones, Donald; Cannata, Jorge; Thompson, B. Taylor; Andress, Dennis; Zhang, Wuyan; Singh, Bhupinder; Zehnder, Daniel; Pachika, Ajay; Manning, Warren J.; Shah, Amil; Solomon, Scott D.; Thadhani, Ravi.

In: American Heart Journal, Vol. 164, No. 6, 12.2012.

Research output: Contribution to journalArticle

Tamez, H, Zoccali, C, Packham, D, Wenger, J, Bhan, I, Appelbaum, E, Pritchett, Y, Chang, Y, Agarwal, R, Wanner, C, Lloyd-Jones, D, Cannata, J, Thompson, BT, Andress, D, Zhang, W, Singh, B, Zehnder, D, Pachika, A, Manning, WJ, Shah, A, Solomon, SD & Thadhani, R 2012, 'Vitamin D reduces left atrial volume in patients with left ventricular hypertrophy and chronic kidney disease', American Heart Journal, vol. 164, no. 6. https://doi.org/10.1016/j.ahj.2012.09.018
Tamez, Hector ; Zoccali, Carmine ; Packham, David ; Wenger, Julia ; Bhan, Ishir ; Appelbaum, Evan ; Pritchett, Yili ; Chang, Yuchiao ; Agarwal, Rajiv ; Wanner, Christoph ; Lloyd-Jones, Donald ; Cannata, Jorge ; Thompson, B. Taylor ; Andress, Dennis ; Zhang, Wuyan ; Singh, Bhupinder ; Zehnder, Daniel ; Pachika, Ajay ; Manning, Warren J. ; Shah, Amil ; Solomon, Scott D. ; Thadhani, Ravi. / Vitamin D reduces left atrial volume in patients with left ventricular hypertrophy and chronic kidney disease. In: American Heart Journal. 2012 ; Vol. 164, No. 6.
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abstract = "Background: Left atrial enlargement, a sensitive integrator of left ventricular diastolic function, is associated with increased cardiovascular morbidity and mortality. Vitamin D is linked to lower cardiovascular morbidity, possibly modifying cardiac structure and function; however, firm evidence is lacking. We assessed the effect of an activated vitamin D analog on left atrial volume index (LAVi) in a post hoc analysis of the PRIMO trial (clinicaltrials.gov: NCT00497146). Methods and results: One hundred ninety-six patients with chronic kidney disease (estimated glomerular filtration rate 15-60 mL/min per 1.73m2), mild to moderate left ventricular hypertrophy, and preserved ejection fraction were randomly assigned to 2 μg of oral paricalcitol or matching placebo for 48 weeks. Two-dimensional echocardiography was obtained at baseline and at 24 and 48 weeks after initiation of therapy. Over the study period, there was a significant decrease in LAVi (-2.79 mL/m 2, 95{\%} CI -4.00 to -1.59 mL/m2) in the paricalcitol group compared with the placebo group (-0.70 mL/m2 [95{\%} CI -1.93 to 0.53 mL/m2], P =.002). Paricalcitol also attenuated the rise in levels of brain natriuretic peptide (10.8{\%} in paricalcitol vs 21.3{\%} in placebo, P =.02). For the entire population, the change in brain natriuretic peptide correlated with change in LAVi (r = 0.17, P =.03). Conclusions: Forty-eight weeks of therapy with an active vitamin D analog reduces LAVi and attenuates the rise of BNP. In a population where only few therapies alter cardiovascular related morbidity and mortality, these post hoc results warrant further confirmation.",
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AU - Tamez, Hector

AU - Zoccali, Carmine

AU - Packham, David

AU - Wenger, Julia

AU - Bhan, Ishir

AU - Appelbaum, Evan

AU - Pritchett, Yili

AU - Chang, Yuchiao

AU - Agarwal, Rajiv

AU - Wanner, Christoph

AU - Lloyd-Jones, Donald

AU - Cannata, Jorge

AU - Thompson, B. Taylor

AU - Andress, Dennis

AU - Zhang, Wuyan

AU - Singh, Bhupinder

AU - Zehnder, Daniel

AU - Pachika, Ajay

AU - Manning, Warren J.

AU - Shah, Amil

AU - Solomon, Scott D.

AU - Thadhani, Ravi

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Y1 - 2012/12

N2 - Background: Left atrial enlargement, a sensitive integrator of left ventricular diastolic function, is associated with increased cardiovascular morbidity and mortality. Vitamin D is linked to lower cardiovascular morbidity, possibly modifying cardiac structure and function; however, firm evidence is lacking. We assessed the effect of an activated vitamin D analog on left atrial volume index (LAVi) in a post hoc analysis of the PRIMO trial (clinicaltrials.gov: NCT00497146). Methods and results: One hundred ninety-six patients with chronic kidney disease (estimated glomerular filtration rate 15-60 mL/min per 1.73m2), mild to moderate left ventricular hypertrophy, and preserved ejection fraction were randomly assigned to 2 μg of oral paricalcitol or matching placebo for 48 weeks. Two-dimensional echocardiography was obtained at baseline and at 24 and 48 weeks after initiation of therapy. Over the study period, there was a significant decrease in LAVi (-2.79 mL/m 2, 95% CI -4.00 to -1.59 mL/m2) in the paricalcitol group compared with the placebo group (-0.70 mL/m2 [95% CI -1.93 to 0.53 mL/m2], P =.002). Paricalcitol also attenuated the rise in levels of brain natriuretic peptide (10.8% in paricalcitol vs 21.3% in placebo, P =.02). For the entire population, the change in brain natriuretic peptide correlated with change in LAVi (r = 0.17, P =.03). Conclusions: Forty-eight weeks of therapy with an active vitamin D analog reduces LAVi and attenuates the rise of BNP. In a population where only few therapies alter cardiovascular related morbidity and mortality, these post hoc results warrant further confirmation.

AB - Background: Left atrial enlargement, a sensitive integrator of left ventricular diastolic function, is associated with increased cardiovascular morbidity and mortality. Vitamin D is linked to lower cardiovascular morbidity, possibly modifying cardiac structure and function; however, firm evidence is lacking. We assessed the effect of an activated vitamin D analog on left atrial volume index (LAVi) in a post hoc analysis of the PRIMO trial (clinicaltrials.gov: NCT00497146). Methods and results: One hundred ninety-six patients with chronic kidney disease (estimated glomerular filtration rate 15-60 mL/min per 1.73m2), mild to moderate left ventricular hypertrophy, and preserved ejection fraction were randomly assigned to 2 μg of oral paricalcitol or matching placebo for 48 weeks. Two-dimensional echocardiography was obtained at baseline and at 24 and 48 weeks after initiation of therapy. Over the study period, there was a significant decrease in LAVi (-2.79 mL/m 2, 95% CI -4.00 to -1.59 mL/m2) in the paricalcitol group compared with the placebo group (-0.70 mL/m2 [95% CI -1.93 to 0.53 mL/m2], P =.002). Paricalcitol also attenuated the rise in levels of brain natriuretic peptide (10.8% in paricalcitol vs 21.3% in placebo, P =.02). For the entire population, the change in brain natriuretic peptide correlated with change in LAVi (r = 0.17, P =.03). Conclusions: Forty-eight weeks of therapy with an active vitamin D analog reduces LAVi and attenuates the rise of BNP. In a population where only few therapies alter cardiovascular related morbidity and mortality, these post hoc results warrant further confirmation.

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