title: Poor outcome in end-stage heart failure patients with low circulating calcitriol levels.
abstract: BACKGROUND
  Vitamin D receptor knockout mice develop typical signs of congestive heart failure (CHF). In approximately 20% of stable CHF patients, frankly low concentrations of the vitamin D hormone calcitriol are found.
  
  
  OBJECTIVE
  We investigated whether serum calcitriol concentrations predict clinical outcome in end-stage CHF.
  
  
  RESULTS
  We collected blood samples in 383 end-stage CHF patients who were on a waiting list for cardiac transplantation. We assessed associations of calcitriol with disease severity and freedom from event (death or cardiac transplantation) during 1-year follow-up. In electively listed patients (n=325), 31% had deficient calcitriol levels (<43 pmol/l) compared to 47% in urgently/high urgently listed patients (n=58; P<0.001). As determined by multivariable logistic regression, calcitriol was an independent predictor of the listing status 'urgent/high urgent' (P<0.001). Calcitriol concentrations were also significantly lower in patients with an event (n=233) compared to those who survived on the waiting list (P<0.001). Cox regression analysis revealed that patients in the highest calcitriol tertile had a hazard ratio (95% CI) for an event of 0.506 (0.334-0.767) compared with patients in the lowest calcitriol tertile (P=0.005), after adjustment for potential confounders.
  
  
  CONCLUSIONS
  Data indicate that low serum calcitriol concentrations are independently associated with poor clinical outcome in end-stage CHF.
authors.affiliation: Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum NRW, Ruhr Universität Bochum, Georgstrasse 11, D-32545 Bad Oeynhausen, Germany. azittermann@hdz-nrw.de
authors.forename: Armin
authors.initials: A
authors.lastname: Zittermann
authors.forename: Stefanie S
authors.initials: SS
authors.lastname: Schleithoff
authors.forename: Christian
authors.initials: C
authors.lastname: Götting
authors.forename: Oxana
authors.initials: O
authors.lastname: Dronow
authors.forename: Uwe
authors.initials: U
authors.lastname: Fuchs
authors.forename: Joachim
authors.initials: J
authors.lastname: Kuhn
authors.forename: Knut
authors.initials: K
authors.lastname: Kleesiek
authors.forename: Gero
authors.initials: G
authors.lastname: Tenderich
authors.forename: Reiner
authors.initials: R
authors.lastname: Koerfer
mesh_terms: D002117:Calcitriol / Q000097:blood*; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index
chemical_list: D002117:Calcitriol