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

84 Scopus citations

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 (US)
Pages (from-to)902-903.e2
JournalAmerican Heart Journal
Volume164
Issue number6
DOIs
StatePublished - Dec 2012

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    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, B. T., Andress, D., Zhang, W., Singh, B., Zehnder, D., Pachika, A., Manning, W. J., ... Thadhani, R. (2012). Vitamin D reduces left atrial volume in patients with left ventricular hypertrophy and chronic kidney disease. American Heart Journal, 164(6), 902-903.e2. https://doi.org/10.1016/j.ahj.2012.09.018