Alterations of Serum Parathormone, Calcium, and Vitamin D Levels in End-Stage Heart Failure Cases Performed with Left Ventricular Assist Device Implantation

Objective: Determination of the osteoporosis susceptibility in end-stage heart failure (ESHF) cases who underwent left ventricular assist device (LVAD) implantation by examining the alterations of serum parathormone (PTH), calcium, and vitamin D levels. Materials and Methods: Records of 375 patients who underwent continuous-flow LVAD implantation with diagnosis of ESHF in our clinic were retrospectively scanned. Thirty three patients with a minimum three months of follow-up, who had complete data about serum PTH, calcium, 25-hydroxyvitamin-D (25-OH-D), and pro-brain natriuretic peptide (pro-BNP) levels for pre and postoperative periods, as well as those with a bone mineral density (BMD) measurement were included in the study. In cases whose bone mineral density measurements made for lomber and hip region, for parameters that were worked with demographic data, initial and last follow-up serum values were recorded and statistical changes were examined. Furthermore, the effects of implanted LVAD type on the studied parameters were evaluated comparatively. Results: Totally 33 cases, four of female (12.1%), mean age and body mass index were found 52.7±12.0 years and 27.3±4.3 kg/m2. Postoperative BMD examinations revealed that 50% of cases osteoporosis and 35.7% of osteopenia. Preoperative serum PTH, calcium, 25-OH-D, osteocalcin, urea, creatinine, glomerular filtration rate, and pro-BNP concentrations were 100.9±39.5 pg/mL, 8.9±0.8 mg/dL, 26.7±17.4 ng/mL, 6.98±5.46 ng/mL, 80.2±57.9 mg/dL, 1.48±0.89 mg/dL, 52.99±13.32 mL/minute/1.73 m2, and 9348.7±8176.7 pg/mL; whereas, at the end of the mean follow-up period of 14.2±7.7 months, these values were determined as 78.3±26.3 pg/mL, 9.2±0.5 mg/dL, 29.8±13.8 ng/mL, 7.55±3.14 ng/mL, 36.2±17.2 mg/dL, 0.98±0.26 mg/dL, 59.72±1.21 mL/minute/1.73 m2, and 1838.9±1853.2 pg/mL, respectively (p<0.001, p=0.033, p=0.038, p=0.841, p<0.001, p=0.003, p=0.006, and p<0.001, respectively). There was no statistically significant difference when the cases of two different LVAD type implanted were compared in terms of changes in study parameters. Conclusion: Close control of calcium, 25-OH-D, and PTH serum levels is necessary in patients with ESHF underwent with left ventricular assist device; regarding those who have osteoporosis or osteopenia according to BMD measurements except the daily calcium-rich dietary advice, the regulation of medical treatment should be planned.