Morphometric variants of remodeling and diastolic function of the left ventricle in late postmenopausal patients with vitamin D deficiency

Clinical Medicine (Russian Journal) Pub Date : 2024-02-22 DOI:10.30629/0023-2149-2023-101-12-623-629

M. Shambatov, N. V. Izmozherova, A. A. Popov, I. Grishina, A. A. Vikhareva, A. V. Ryabinina

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Abstract

Aim. To reveal the features of the structural-geometric remodeling of the left chambers of the heart, the diastolic function of the left ventricle and to assess the presence of calcification of the valvular structures of the heart in late postmenopausal women with different levels of vitamin D. Material and methods. The cross-sectional study included 123 postmenopausal women. A standard transthoracic echocardiography was performed with an assessment of morphometric variants of remodeling of the left chambers of the heart and its diastolic function according to the transmitral flow. The significance of differences was assessed using the Mann–Whitney test, χ2 Pearson. Differences and correlations were considered significant at p < 0.05. Results. The median concentration of 25(OH)D in the sample was 20.51 ng/ml (15.8÷26.73). Adequate serum concentration of 25(OH)D was observed in 23 (19%) patients (group 1), in 100 (81%) cases vitamin D deficiency was detected (group 2). In group 1 — 7 (31%) patients had normal geometry (NG) of the left ventricle (LV), LV concentric remodeling (CR) was diagnosed in 1 (4%) case, LV concentric hypertrophy (CH) was diagnosed in 3 (13%) cases, and LV eccentric hypertrophy (EH) was detected in 12 (52%) cases. In Group 2, LV NG was diagnosed in 27 (27%) cases, LV CR was detected in 8 (8%) cases, LV CH was detected in 31 (31%) cases, and LV EH was verified in 34 (34%) cases, the differences are insignificant (p = 0.24). Patients of group 2 showed a statistically significant increase in the volume of the right atrium (RA) and thickness of the posterior wall of the left ventricle (TZSLV). In group 1, in 11 (50%) cases, rigid-type diastolic dysfunction (DD) was detected, and in 11 (50%) cases, a pseudo-normal type of DD was detected. In group 2, pseudonormal myocardial DD was detected in 26 (26%) patients, 74 (74%) patients had rigid-type DD, differences between groups were significant (p < 0.001). Calcifications were found in the annulus fibrosus in 16 (70%) cases in group 1 and in 88 (88%) patients in group 2, the differences were significant (p = 0.04). Conclusion. In the study, data were obtained indicating a significant contribution of vitamin D deficiency to changes in the geometry of the left chambers of the heart, diastolic function of the left ventricle, and calcification of valvular structures.

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维生素 D 缺乏症绝经后晚期患者左心室重塑和舒张功能的形态学变异

目的揭示不同维生素 D 水平的绝经后晚期妇女的心脏左腔结构几何重塑特征、左心室舒张功能，并评估心脏瓣膜结构是否存在钙化。这项横断面研究包括 123 名绝经后妇女。进行了标准的经胸超声心动图检查，并根据透射流量评估了心脏左腔重塑的形态变异及其舒张功能。采用 Mann-Whitney 检验和 χ2 Pearson 检验评估差异的显著性。P<0.05为差异和相关性显著。结果样本中 25（OH）D 的中位浓度为 20.51 纳克/毫升（15.8÷26.73）。在 23 名（19%）患者（第 1 组）中观察到 25（OH）D 血清浓度充足，在 100 名（81%）患者（第 2 组）中检测到维生素 D 缺乏。在第 1 组中，7 例（31%）患者的左心室几何形状正常（NG），1 例（4%）患者被诊断出左心室同心重塑（CR），3 例（13%）患者被诊断出左心室同心肥厚（CH），12 例（52%）患者被检测出左心室偏心肥厚（EH）。在第 2 组中，27 例（27%）确诊为左心室 NG，8 例（8%）检测到左心室 CR，31 例（31%）检测到左心室 CH，34 例（34%）验证了左心室 EH，差异不显著（P = 0.24）。第 2 组患者的右心房容积（RA）和左心室后壁厚度（TZSLV）均有统计学意义的显著增加。在第 1 组中，11 例（50%）患者发现了僵硬型舒张功能障碍（DD），11 例（50%）患者发现了假性正常型舒张功能障碍。在第二组中，26 例（26%）患者发现假性正常心肌舒张功能障碍，74 例（74%）患者为僵硬型舒张功能障碍，组间差异显著（P < 0.001）。第一组 16 例（70%）和第二组 88 例（88%）患者的纤维环中发现钙化，差异有显著性（P = 0.04）。结论本研究获得的数据表明，维生素 D 缺乏对心脏左腔几何形状、左心室舒张功能和瓣膜结构钙化的变化有显著影响。

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Clinical Medicine (Russian Journal)

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