Hypocalcaemia and vitamin D deficiency: an important, but preventable, cause of life-threatening infant heart failure

Abstract

Background: In recent large paediatric cardiomyopathy population studies from North America and Australia, vitamin D deficiency was not identified as a cause of infant heart failure. However, rickets is resurgent in developed countries. Objective: To review the prevalence of this cardiomyopathy in paediatric cardiology units of southeast England and determine the prognosis. Methods and results: A retrospective review from 2000 to 2006 in southeast England. Sixteen infants (6 Indian subcontinent, 10 black ethnicity) were identified: median (range) age at presentation was 5.3 months (3 weeks-8 months). All had been breast fed. Ten presented at the end of the British winter (February-May). Median shortening fraction was 10% (range 5-18%) and median left ventricular end diastolic dimension z score was 4.1 (range 3.1-7.0). Six had a cardiac arrest; three infants died. Eight were ventilated, two required mechanical circulatory support and 12 required intravenous inotropic support. Two were referred for cardiac transplantation. Median (range) of biochemical values on admission was: total calcium 1.5 (1.07-1.74) mmol/l; alkaline phosphatase 646 (340-1057) IU/l; 25-hydroxyvitamin D 18.5 (0-46) nmol/l (normal range .35) and parathyroid hormone 34.3 (8.9-102) pmol/l (normal range ,6

Vitamin D deficiency and myocardial diseases

“…Several case reports highlight pediatric cardiomyopathies, which are associated with vitamin D deficiency or rickets [73][74][75][76][77][78][79][80][81]. Importantly, children with vitamin D deficiency associated heart failure showed in most cases a significant clinical improvement after vitamin D and calcium supplementation [73][74][75][76][77][78][79][80].…”

“…Importantly, children with vitamin D deficiency associated heart failure showed in most cases a significant clinical improvement after vitamin D and calcium supplementation [73][74][75][76][77][78][79][80]. A post mortem examination of a child who died due to vitamin D deficiency associated cardiomyopathy showed a large pericardial effusion and an enlarged heart with a dilated and concentric hypertrophic left ventricle [73].…”

“…A post mortem examination of a child who died due to vitamin D deficiency associated cardiomyopathy showed a large pericardial effusion and an enlarged heart with a dilated and concentric hypertrophic left ventricle [73]. There was a mild increase in interstitial fibrous tissue, particularly in the subendocardial regions and the cardiomyocytes were thin and elongated in keeping with dilated cardiomyopathy [73].…”

The effect of vitamin D on women’s reproductive health

“…• Более высокий риск развития гестоза [67] • Ассоциация с развитием гестационного сахарного диабета [71] • Повышенный риск спонтанных абортов на ранних сроках гестации • Более высокий процент первичного родоразрешения путем операции кесарева сечения [72] • Повышен риск развития бактериальных вагинозов [66] Плод и новорожденный • Более низкая масса тела при рождении [36] • Чаще риск развития краниотабеса [73] • Развитие острых заболеваний респираторного тракта [31] • Гипокальциемический криз [74] • Снижение скорости роста берцовой кости внутриутробно [75] • Развитие сердечной недостаточности внутриутробно [76] …”

Állásfoglalás

“…Több esettanulmány is leírt olyan, súlyos Dvitaminhiányban kialakuló szívelégtelenséget, ami a megfelelő D 3 vitaminpótlást követően reverzíbilisnek bizonyult [116,117,118]. Egy 54 betegen végzett vizsgálatban korrelációt találtak a Dvitaminszint és a szívelégtelenség súlyossága között [119].…”