Wal, H.H. van der (Haye) (2014) Vitamin B12 and Folate Deficiency: Prevalence, Clinical Correlates and Outcome in Chronic Heart Failure. thesis, Medicine.
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Abstract
Iintroduction: Chronic Heart Failure (HF) is a clinical syndrome which is charac-terized by cardiac dysfunction and/or abnormalities in cardiac structures. Although treat-ment possibilities have improved over the past decades, chronic HF is still characterized by a poor clinical status and a five-year survival rate of 50%. Several comorbidities may have a negative influence on prognosis. Iron deficiency, for example, is common in chronic HF and associated with impaired exercise capacity and worse clinical outcome. Other nutritional deficiencies (vitamin B12 and folate deficiency) may also negatively im-pact functional status and prognosis in patients with chronic HF. Unfortunately, studies on hematinic deficiencies in chronic HF are scarce, and the clinical correlates of these deficiencies and their influence on outcome is currently unknown. Methods: In an international pooled study cohort comprising 610 patients with stable chronic HF, we studied the prevalence of vitamin B12 and folate deficiency, their clinical correlates, and the prognostic value. The main outcome of both deficiencies was all-cause mortality. Results: Mean age (± standard deviation) of the patients was 68 ± 12 years, mean left ventricular ejection fraction was 33 ± 13%, and median serum NT-proBNP level was 1801 pg/mL (interquartile range 705 – 4335 pg/mL). Vitamin B12 deficiency (serum level <200 pg/mL), folate deficiency (serum level <4.0 ng/mL), and iron deficiency (serum fer-ritin <100 μg/L, or 100 – 299 μg/L with a transferrin saturation <20%) were present in 5%, 4%, and 58% of all patients, respectively. Serum vitamin B12 levels were positively associated with higher serum NT-proBNP and ferritin levels (p <0.001), whereas clinical associates of folic acid included systolic blood pressure, hemoglobin, transferrin satura-tion, renal function, and atrial fibrillation (all p<0.05). No significant correlation between mean corpuscular volume (MCV) and serum vitamin B12, folic acid or ferritin levels was observed. Lower serum folic acid levels were associated with an impaired quality of life (p = 0.003). During a median follow-up of 2.10 years (interquartile range 1.31 – 3.60 years) 254 patients (42%) died. In multivariate Cox proportional hazard regression mod-els, serum vitamin B12 and folic acid levels were not significantly associated with all-cause mortality. Conclusions: Vitamin B12 and folate deficiency are relatively rare in patients with chronic HF, in contrast to iron deficiency. No significant correlation was found between MCV and serum levels of vitamin B12 and folic acid. MCV may be an unreliable screen-ing marker to differentiate between possible etiologies of anemia in chronic HF. In con-trast to iron deficiency, folic acid and vitamin B12 were not related to prognosis.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Meer, P. van der MD and Klip, I.T. MD |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:38 |
| Last Modified: | 25 Jun 2020 10:38 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/31 |
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