Vitamin D deficiency is a recognized complication of β-thalassemia major (β-TM), impacting cardiac function. Speckle tracking echocardiography (STE) offers a sensitive assessment of myocardial deformation, particularly global longitudinal strain (GLS). This study aimed to assess the association between vitamin D levels and LV function in β-TM children and to evaluate the impact of vitamin D supplementation on cardiac parameters. Seventy-five β-TM children underwent vitamin D level assessment, conventional echocardiography, and STE. Patients with vitamin D deficiency/insufficiency (25-OHD3 < 30 ng/ml) received vitamin D supplementation (4000–5000 IU/day). Follow-up assessments were conducted after vitamin D normalization. Vitamin D insufficiency (81.3%) and deficiency (18.7%) were prevalent. Vitamin D levels were inversely correlated with age and disease duration (p < 0.001) and positively correlated with transfusion/chelation therapy onset. Conventional echocardiography showed an inverse correlation between vitamin D level and left ventricular end diastolic diameter (p < 0.001) and deceleration time (p = 0.003). STE revealed a positive correlation between vitamin D and GLS (p < 0.001). Vitamin D supplementation significantly increased median vitamin D levels (from 16.0 to 39.0 ng/ml, p < 0.001) and improved STE parameters, including AP4L, AP3L, AP2L, and GLS (p < 0.001), indicating enhanced myocardial function. Conclusion: Vitamin D deficiency in β-TM children was correlated with impaired cardiac function. Vitamin D supplementation significantly improved cardiac function. Regular monitoring and maintenance of adequate vitamin D levels are crucial for preventing adverse cardiac effects. <Table Float="No" ID="Taba"> <tgroup cols="1"> <colspec align="left" colname="c1" colnum="1" /> <tbody> <row> <entry align="left" colname="c1"> What is Known: • β-Thalassemia major is frequently complicated by cardiac dysfunction, a major contributor to mortality. • Cardiac iron overload is a primary driver of cardiac dysfunction in β-TM. </entry> </row> <row> <entry align="left" colname="c1"> What is New: • Vitamin D deficiency leads to impaired cardiac function, beyond iron overload, in β-TM children. • Vitamin D supplementation could improve cardiac function in β-thalassemia major patients. </entry> </row> </tbody> </tgroup> </Table>

Correlation between vitamin D level and left ventricular myocardial function demonstrated by speckle tracking echocardiography among β-thalassemia major children

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2025年6月16日

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Eman Gamal Abdelrahman,
Ahmed Mahmoud Ezzat,
Lina Abdelhady Mohammed,
Reem Zaki Mohamed Fakher,
Samar Mahmoud Elbahy

摘要

Vitamin D deficiency is a recognized complication of β-thalassemia major (β-TM), impacting cardiac function. Speckle tracking echocardiography (STE) offers a sensitive assessment of myocardial deformation, particularly global longitudinal strain (GLS). This study aimed to assess the association between vitamin D levels and LV function in β-TM children and to evaluate the impact of vitamin D supplementation on cardiac parameters. Seventy-five β-TM children underwent vitamin D level assessment, conventional echocardiography, and STE. Patients with vitamin D deficiency/insufficiency (25-OHD3 < 30 ng/ml) received vitamin D supplementation (4000–5000 IU/day). Follow-up assessments were conducted after vitamin D normalization. Vitamin D insufficiency (81.3%) and deficiency (18.7%) were prevalent. Vitamin D levels were inversely correlated with age and disease duration (p < 0.001) and positively correlated with transfusion/chelation therapy onset. Conventional echocardiography showed an inverse correlation between vitamin D level and left ventricular end diastolic diameter (p < 0.001) and deceleration time (p = 0.003). STE revealed a positive correlation between vitamin D and GLS (p < 0.001). Vitamin D supplementation significantly increased median vitamin D levels (from 16.0 to 39.0 ng/ml, p < 0.001) and improved STE parameters, including AP4L, AP3L, AP2L, and GLS (p < 0.001), indicating enhanced myocardial function. Conclusion: Vitamin D deficiency in β-TM children was correlated with impaired cardiac function. Vitamin D supplementation significantly improved cardiac function. Regular monitoring and maintenance of adequate vitamin D levels are crucial for preventing adverse cardiac effects.

What is Known:

• β-Thalassemia major is frequently complicated by cardiac dysfunction, a major contributor to mortality.

• Cardiac iron overload is a primary driver of cardiac dysfunction in β-TM.

What is New:

• Vitamin D deficiency leads to impaired cardiac function, beyond iron overload, in β-TM children.

• Vitamin D supplementation could improve cardiac function in β-thalassemia major patients.