Background Left ventricular ejectionfraction (LVEF) has beendirectlyassociatedwith BMD in patientswithheartfailure. Nevertheless, no study has linked yet the left ventricular ejection fraction to bone mineral density and fragility fractures in cardiac transplantation.
Objectives The main aim of this study was to evaluate the possible relationship between LVEF and BMD in heart transplantation and the association of LVEF with 25 OH vitamin D, paratohormone (PTH) and markers of bone remodeling in patients with heart transplantation (osteocalcin, telopeptide C terminal (CTX).
Methods Seventy nine patients (66 male) were included in this cross-sectional study with a mean age of 55,75±14,81 years, body mass index (BMI) values of 26,95±5,35 kg/m2 and an average post-transplantation period of 8,46±8,71 years. Transthoracic doppler echocardiography measuring LVEF (%) was calculated for each of patients, as well as bone mass study that included: bone mineral density scans of lumbar spine and hip, spine radiography, biomarkers of bone metabolism (calcium, phosphorus, osteocalcin,CTX,Parathyroid hormone and vitamin D). The association of LVEF with BMD and biomarkers of bone remodeling was determined by performing multiple linear regression analysis adjusted for variables directly related to BMD (age, sex, BMI, post-transplantation period and pharmacological treatment (daily corticoids dose, immunosuppressive treatment).
Results A total of 79 patients were included in this present study. BMD in osteoporotic range was found in 31.2% of patients (17.7% in spine,16.52% in femoral neck and 13% in hip). Vitamin D deficiency (≤20ng/d) was detected in 68.4% of patients. Vertebral fracture was found in 30.4% and a 2.6% hip fracture. Bivariate analysis showed that the group of patients with FEVI ≤65% had a higher proportion of femoral neck osteoporosis (p=0.04), higher proportion of osteoporosis in total hip (p=0.03) and higher percentage of vertebral fractures (p=0.04) compared with group with LVEF>65%.
The multiple linear regression analysis indicated that LVEF was independently associated with osteoporosis in spine (B = -5.225, p=0.011), femoral neck osteoporosis (B = -5.411, p=0.015) and vertebral fractures (B = -5.433, p=0.002). In addition, LVEF was associated with osteocalcin levels (B = -0.105, p=0.002).
Conclusions These results suggest that post-transplantation LVEF may have an influence on bone remodeling. However, further studies are neededin order to consider LVEF as a risk factor for osteoporosis and fractures due to fragility after heart transplantation.
Disclosure of Interest None declared