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Newer ultrasound technique shows distinct cardiac differences in vitamin D deficient adolescents

Posted on: February 29, 2016   by  John Cannell, MD


A recent study determined that low vitamin D status is associated with myocardial dysfunction in adolescents by the use of the TDI ultrasound.

Ultrasound is a rapidly advancing procedure that is now so refined that an ultrasound of an 8 month old fetus looks like it was taken with a camera.

This new technique – called tissue Doppler imaging (TDI) ultrasound – was recently used to measure cardiac function in a group of 84 adolescents, 30 of which had vitamin D levels less than 20 ng/ml and 54 with levels above 30 ng/ml.

Matter M, El-Sherbiny E, Elmougy A, Abass M, Aldossary S, Ali WA. Myocardial function in Saudi adolescents with vitamin D deficiency: Tissue Doppler imaging study. J Saudi Heart Assoc. 2016 Jan;28(1):22-30.

Here are some interesting baseline differences:

25(OH)D <20 ng/ml25(OH)D >30 ng/ml
25(OH)D (ng/mL)17.6236.20(p <0.0001)
iPTH (pg/mL)70.542.12(p <0.0001)
BNP level (pg/mL)33.6210.07(p <0.0001)


However, the cardiac differences from the TDI ultrasound on these otherwise normal adolescents were amazing.

For our cardiologist readers, here are the TDI-derived cardiac ultrasound variables between the studied groups.

Vitamin D deficient group (n = 30)Control (n = 54)P value
Mitral annulus  
Sm (cm/s) 6.99 ± 1.9210.69 ± 0.310.0001
Em (cm/s) 10.27 ± 1.8418.63 ± 1.380.0001
Am (cm/s) 13.39 ± 2.4911.67 ± 3.190.009
Em/Am ratio 0.77 ± 0.121.72 ± 0.5140.0001
ICT (ms) 85.12 ± 12.4977.36 ± 1.390.0001
IRT (ms) 88.00 ± 16.2062.38 ± 2.390.0001
Mitral E/Em 8.51 ± 2.175.90 ± 0.980.0001
Tricuspid annulus  
Sm (cm/s) 12.30 ± 2.1413.89 ± 0.290.0001
Em (cm/s) 13.21 ± 3.4516.29 ± 1.290.0001
Am (cm/s) 15.97 ± 5.4910.54 ± 1.430.0001
Em/Am ratio 0.89 ± 0.311.54 ± 0.070.0001
ICT (ms) 62.62 ± 11.9857.60 ± 8.850.040
IRT (ms) 68.25 ± 13.0561.58 ± 2.110.002
Tricuspid E/Em 5.71 ± 1.014.03 ± 0.60.005
LV Tei index 0.61 ± 0.110.32 ± 0.050.0001
RV Tei index 0.54 ± 0.140.40 ± 0.060.0001

Legend: Am = late diastolic annular velocity; E/Em = ratio of early filling velocity wave/early diastolic annular velocity; Em = early diastolic annular velocity; ICT = isovolumetric contraction time; IRT = isovolumetric relaxation time; LV = left ventricular; RV = right ventricular; Sm = peak systolic annular velocity

Do you see those p values? They are incredible. Most are 0.0001!

The authors concluded:

“Vitamin D deficiency in is associated with subtle systolic and diastolic myocardial dysfunction in Saudi adolescents. TDI is a useful tool for detecting early changes in the myocardium in this particular group.”

TDI studies should be used in cardiac ultrasounds of adults to see if supplementing with natural doses of vitamin D may improve heart TDI measurements.

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