GALECTİN-3 VE DİĞER KARDİYAK BELİRTEÇLERİN EJEKSİYON FRAKSİYONU KORUNMUŞ KALP YETMEZLİĞİNİ BELİRLEMEDEKİ ROLLERİNİN VİTAMİN D DURUMU İLE İLİŞKİSİ

Abstract

Erdevir M., The relationship between the roles of Galectin-3 and other cardiac markers in determining heart failure with preserved ejection fraction and Vitamin D status. Hacettepe University Faculty of Medicine, Medical Specialty, Thesis in Internal Medicine. Ankara, 2021. Vitamin D affects the contraction of the heart muscle through its direct and indirect effects on calcium and phosphorus. A lot of research has been done on this subject and the relationship between coronary artery disease and systolic heart failure with vitamin D deficiency has been examined. In this study, in patients with heart failure with preserved systolic function, N-Terminal Pro-Brain Natriuretic Peptide (NT-ProBNP), High sensitive Troponin-I (HsTpn-I), Galectin-3(Gal-3), Fibroblast Growth Factor-23(FGF-23), Suppression of tumorigenesis-2 (ST2) marker levels and vitamin D level were measured. Parathyroid hormone (PTH) was also included in the study due to its relationship with vitamin D and its cardiac effects. The aim of the study is to investigate the effect of vitamin D status on the detection levels of these markers in heart failure with preserved ejection fraction. 71 patients diagnosed with preserved ejection fraction heart failure (HFpEF) and 61 healthy individuals without a diagnosis of heart failure formed two groups for the baseline. The effect of vitamin D status on heart failure detection levels of these markers in heart failure with preserved ejection fraction was evaluated using Mann Whitney U, ROC analysis and logistic regression analysis. As a result of the analysis, Vitamin D levels were lower in the patient group, and NTproBNP, Gal-3, PTH, ST2 levels were higher in the patient group. The AUC (area under the curve) values of these four markers in the ROC analysis were significant for the diagnosis of heart failure with preserved ejection fraction. HsTpn-I and Galectin-3 did not differ statistically between the two groups. In the logistic regression analysis, a one-unit decrease in Vitamin D increased the chance of catching the disease 1.084 times, while a 10-unit categorical decrease in vitamin D increased the risk of catching the disease 2.27 times. We also repeated the ROC analysis values in different Vitamin D groups. When Vitamin D>20 ng/ml, NTproBNP, Gal-3, ST2, PTH increase the chance of success in diagnosing HFpEF. As a result, NTproBNP, Gal-3, ST2, PTH Ejection Fraction were found to be associated with Vitamin D status in determining Preserved Heart Failure. Further prospective studies are needed to understand whether vitamin D replacement in patients with vitamin D deficiency will change the power of these markers in detecting HFpEF cases.