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Solela G. Prevalence and prognostic role of hypochloremia in patients with acute heart failure in Ethiopia: A single-center retrospective analysis. PLoS One 2024; 19:e0310251. [PMID: 39264907 PMCID: PMC11392231 DOI: 10.1371/journal.pone.0310251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 08/28/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND In patients with heart failure (HF), multiple electrolyte disorders are common, and recent studies have shown that chloride disorders play a significant role in the prognosis of HF. Data about the prevalence and prognostic role of hypochloremia in patients with acute HF (AHF) are scarce in African nations, including Ethiopia. Hence, this study aimed to assess the prevalence, associated factors, and prognostic role of hypochloremia in patients with AHF in Ethiopia. METHODS This was a single-center retrospective analysis of AHF patients, aged ≥15 years, with chloride determination upon admission to the medical wards and medical ICU of Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia, from July 1, 2022, to July 1, 2023. Statistical Package for Social Sciences, version 26, was used to enter and analyze the data. Descriptive analysis was used to summarize clinical profiles, laboratory data, and outcomes of AHF patients stratified by the presence and absence of hypochloremia. Logistic regression analysis was used to determine the factors associated with hypochloremia and to assess the association of hypochloremia and other factors with in-hospital mortality in patients with AHF. A two-tailed P value <0.05 was regarded as statistically significant. RESULTS A total of 267 AHF patients who had chloride determination on admission were included in this study; the mean age was 56.7 years (standard deviation: 18.6), and the gender-based distribution of the patients was nearly equal. The prevalence of hypochloremia was 36.7%. Diastolic blood pressure <60 mm Hg [adjusted odds ratio (AOR) = 3.63, 95% confidence interval (CI), 1.04, 12.72] and hyponatremia (AOR = 29.20, 95% CI, 13.21, 64.56) were significantly associated with hypochloremia. The in-hospital mortality rate was higher in AHF patients with hypochloremia (16.3%) compared to those without hypochloremia (4.7%). The odds of in-hospital mortality among AHF patients with hypochloremia were 2.8 times higher compared to patients without hypochloremia (AOR = 2.82, 95% CI: 1.08, 7.04) after adjusting for ICU admission, systolic blood pressure < 120 mm Hg and diastolic blood pressure < 60 mm Hg. CONCLUSIONS This study revealed a high prevalence of hypochloremia among patients with AHF. Low diastolic blood pressure and hyponatremia were significantly associated with the development of hypochloremia. Most importantly, AHF patients with hypochloremia had a higher in-hospital mortality rate compared to those without hypochloremia. Hence, hypochloremia on admission should be considered a potential prognostic factor in patients with AHF, and further research with a larger sample size is needed to support the findings of this study.
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Affiliation(s)
- Gashaw Solela
- Department of Internal Medicine, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
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2
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Fernando MB, Ferreira I, Lourenço P. Admission and discharge sodium: Chloride ratio in acute heart failure - The importance of electrolytes. Int J Cardiol 2024; 417:132528. [PMID: 39251073 DOI: 10.1016/j.ijcard.2024.132528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 08/15/2024] [Accepted: 09/04/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND Chloride has prognostic implications in heart failure (HF). The sodium:chloride (Na:Cl) ratio gathers information of both ions. OBJECTIVES To study the prognostic impact of Na:Cl ratio in acute HF. METHODS We retrospectively analysed patients included in an acute HF cohort in 2009-2010. PRIMARY ENDPOINT all-cause mortality. FOLLOW-UP 1-year from admission to study the impact of admission Na:Cl ratio; 1-year post-discharge to study the discharge ratio impact. ROC curves of the association of Na, Cl, and the Na:Cl ratio with 1-year mortality were determined and the AUC compared. The association of Na:Cl ratio with mortality was assessed in multivariate analyses. RESULTS We studied 616 patients. Median admission Na:Cl ratio = 1.34 (1.31-1.38). During 1-year since admission, 229 patients died, AUC for death-association of admission Na, Cl and Na:Cl ratio = 0.42 (0.38-0.47), 0.39 (0.35-0.44) and 0.58 (0.53-0.63), respectively, with significant difference between Na:Cl ratio curve and the others. When admission Na:Cl ratio ≥ 1.34, the multivariate-adjusted death-risk was 1.41 (1.04-1.89); 1.32 (1.04-1.68), per each 0.1 increase in ratio. In-hospital death rate was 4.1 %, median discharge Na:Cl ratio = 1.40 (1.37-1.45). During 1-year post-discharge, 205 patients (34.9 %) died; AUC for Na, Cl and Na:Cl ratio: 0.45 (0.40-0.50), 0.41 (0.36-0.46) and 0.57 (0.52-0.62), with differences between Na:Cl ratio curve and the others. When discharge Na:Cl ratio ≥ 1.43 (percentile 66.7), the adjusted-HR of death was 1.43 (1.04-1.97), p = 0.03, 1.54 (1.23-1.92) per 0.1 increase. CONCLUSIONS Elevated Na:Cl ratio is independently associated with all-cause death. Per each 0.1 increase in Na:Cl ratio at admission and discharged, there was a 32 % and 54 % higher risk, respectively.
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Affiliation(s)
| | - Inês Ferreira
- Internal Medicine Department, Centro Hospitalar Universitário São João, Portugal
| | - Patrícia Lourenço
- Internal Medicine Department, Centro Hospitalar Universitário São João, Portugal; Faculty of Medicine, Porto University, Department of Medicine, Portugal.
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Stankowski K, Villaschi A, Tartaglia F, Figliozzi S, Pini D, Chiarito M, Stefanini G, Cannata F, Condorelli G. Prognostic value of hypochloremia on mortality in patients with heart failure: a systematic review and meta-analysis. J Cardiovasc Med (Hagerstown) 2024; 25:499-510. [PMID: 38809244 DOI: 10.2459/jcm.0000000000001644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
AIMS Electrolyte imbalances are common in patients with heart failure. Several studies have shown that a low serum chloride level is associated with adverse outcomes in hospitalized patients with acute heart failure and in outpatients with chronic heart failure. We performed a systematic review and meta-analysis to assess the association of hypochloremia with all-cause mortality in patients with heart failure. METHODS Data search was conducted from inception through 1 February 2023, using the following MeSH terms: ('chloride' OR 'hypochloremia') AND 'heart failure'. Studies evaluating the association between serum chloride and all-cause mortality in patients with heart failure were included. The predefined primary outcome was all-cause mortality. Pooled hazard ratios and 95% confidence intervals (CIs) were used as effect estimates and calculated with a random-effects model; fixed-effects model and leave-one-out sensitivity analyses were also performed. RESULTS A total of 15 studies, involving 25 848 patients, were included. The prevalence of hypochloremia ranged from 8.6 to 31.5%. Follow-up time ranged from 6 to 67 months. Hypochloremia as a categorical variable was associated with an increased risk of all-cause mortality [hazard ratio 1.56; 95% confidence interval (CI) 1.38-1.75; P < 0.001]. As a continuous variable, serum chloride was associated with all-cause mortality (hazard ratio per mmol/l decrease in serum chloride: 1.06; 95% CI 1.05-1.07; P < 0.001). Results were confirmed by using several sensitivity analyses. CONCLUSION Hypochloremia exhibits a significant prognostic value in patients with heart failure. Serum chloride can be used as an effective tool for risk stratifying in patients with heart failure.
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Affiliation(s)
- Kamil Stankowski
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele
- IRCCS Humanitas Research Hospital, Rozzano, Milan
| | - Alessandro Villaschi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele
- IRCCS Humanitas Research Hospital, Rozzano, Milan
| | - Francesco Tartaglia
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele
- IRCCS Humanitas Research Hospital, Rozzano, Milan
| | | | - Daniela Pini
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza
| | - Mauro Chiarito
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele
- IRCCS Humanitas Research Hospital, Rozzano, Milan
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele
- IRCCS Humanitas Research Hospital, Rozzano, Milan
| | - Francesco Cannata
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele
- IRCCS Humanitas Research Hospital, Rozzano, Milan
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Yoshimura Y, Wakabayashi H, Nagano F, Matsumoto A, Shimazu S, Shiraishi A, Kido Y, Bise T, Kuzuhara A, Hori K, Hamada T, Yoneda K, Maekawa K. Hyponatremia as a predictor of cognitive deterioration in hospitalized post-stroke patients. J Clin Neurosci 2024; 124:115-121. [PMID: 38703471 DOI: 10.1016/j.jocn.2024.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/07/2024] [Accepted: 04/29/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE Evidence is scarce regarding the association between hyponatremia and alterations in cognitive function among hospitalized older patients. We aimed to investigate the associations between hyponatremia and the baseline cognitive status, as well as the improvement in cognitive function, in hospitalized post-stroke patients. METHODS This retrospective cohort study included consecutive hospitalized post-stroke patients. Serum sodium concentrations were extracted from medical records based on blood tests performed within 24 h of admission, with hyponatremia defined as a serum sodium concentration < 135 mEq/L. The main outcomes included admission and discharge scores for cognitive levels, assessed through the cognitive domain of the Functional Independence Measure (FIM-cognition), as well as the score changes observed during the hospitalization period. Multivariate linear regression analyses were used to determine the association between hyponatremia and outcomes of interest, adjusted for potential confounders. RESULTS Data from 955 patients (mean age 73.2 years; 53.6 % men) were included in the analysis. The median baseline blood sodium level was 139 [137, 141], and 84 patients (8.8 %) exhibited hyponatremia. After full adjustment for confounders, the baseline hyponatremia was significantly and negatively associated with FIM-cognition values at admission (β = -0.009, p = 0.016), discharge (β = -0.038, p = 0.043), and the gain during hospital stay (β = -0.040, p = 0.011). CONCLUSION Baseline hyponatremia has demonstrated a correlation with decline in cognitive level over the course of rehabilitation in individuals after stroke. Assessing hyponatremia at the outset proves to be a pivotal prognostic indicator.
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Affiliation(s)
- Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan.
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo 162-8666, Japan
| | - Fumihiko Nagano
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
| | - Ayaka Matsumoto
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
| | - Sayuri Shimazu
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
| | - Ai Shiraishi
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
| | - Yoshifumi Kido
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
| | - Takahiro Bise
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
| | - Aomi Kuzuhara
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
| | - Kota Hori
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
| | - Takenori Hamada
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
| | - Kouki Yoneda
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
| | - Kenichiro Maekawa
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto 869-1106, Japan
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Gurbuz M, Acehan S, Satar S, Gulen M, Sevdımbas S, Ince C, Onan E. Mortality predictors of patients diagnosed with severe hyponatremia in the emergency department. Ir J Med Sci 2024; 193:1561-1572. [PMID: 38291136 DOI: 10.1007/s11845-024-03615-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024]
Abstract
PURPOSE To determine the factors affecting mortality as a result of the analysis of the demographic and clinical characteristics and laboratory parameters of patients whose serum Na value was determined to be 125 mEq/L or below at the time of admission to the emergency department (ED). METHOD Patients over 18 years of age who admitted to the ED of a tertiary hospital between September 2021 and September 2022 and whose serum sodium level was determined to be 125 mEq/L and below were included in the study. Demographic and clinical characteristics, admission complaints, medications used, Charles comorbidity index (CCI), laboratory parameters, and outcomes of the patients included in the study were recorded in the data form. RESULTS Three hundred ninety-nine patients were included in the study. When the 30-day mortality of the patients is examined, the mortality rate was found to be 21.6%. In the analyses performed for the predictive power of laboratory parameters for mortality, it was determined that the highest predictive power among the predictive values determined by the area under the curve (AUC) was the albumin level (AUC 0.801, 95% CI 0.753-0.849, p < 0.001). In the binary logistic regression analysis, urea and albumin were independent predictors of 30-day mortality. CONCLUSION According to study data, albumin and urea levels are independent predictors of 30-day mortality in patients diagnosed with severe hyponatremia in the emergency department.
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Affiliation(s)
- Mesut Gurbuz
- Department of Emergency Medicine, Ministry of Health Kilis Prof. Dr. Alaeddin Yavasca Hospital, Kilis, Turkey
| | - Selen Acehan
- Health Sciences University, Adana City Training and Research Hospital, Emergency Medicine Clinic, Adana, Turkey.
| | - Salim Satar
- Health Sciences University, Adana City Training and Research Hospital, Emergency Medicine Clinic, Adana, Turkey
| | - Muge Gulen
- Health Sciences University, Adana City Training and Research Hospital, Emergency Medicine Clinic, Adana, Turkey
| | - Sarper Sevdımbas
- Health Sciences University, Adana City Training and Research Hospital, Emergency Medicine Clinic, Adana, Turkey
| | - Cagdas Ince
- Department of Emergency Medicine, Ministry of Health Bursa Karacabey Hospital, Bursa, Turkey
| | - Engin Onan
- Department of Nephrology, Adana Baskent University, Adana, Turkey
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6
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Yoshimura Y, Wakabayashi H, Nagano F, Matsumoto A, Shimazu S, Shiraishi A, Kido Y, Bise T, Kuzuhara A, Hori K, Hamada T, Yoneda K, Maekawa K. Associations between Baseline Hyponatremia and Activities of Daily Living and Muscle Health in Convalescent Stroke Patients. Prog Rehabil Med 2024; 9:20240019. [PMID: 38827580 PMCID: PMC11136866 DOI: 10.2490/prm.20240019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/13/2024] [Indexed: 06/04/2024] Open
Abstract
Objectives Evidence is scarce regarding the association between hyponatremia and functional outcomes among older hospitalized patients. We aimed to evaluate the associations between baseline hyponatremia and improvement in activities of daily living (ADL) and muscle health in hospitalized post-stroke patients. Methods This retrospective cohort study included hospitalized post-stroke patients. Serum sodium concentrations were extracted from medical records based on blood tests performed within 24 h of admission, with hyponatremia defined as a serum sodium concentration below135 mEq/L. Primary outcome was the discharge ADL as assessed by the motor domain of the Functional Independence Measure (FIM-motor) and its corresponding gain during hospitalization. Other outcomes encompassed the discharge scores for skeletal muscle mass (SMI) and handgrip strength (HGS). Multivariate linear regression analyses were used to determine the association between hyponatremia and outcomes of interest, adjusted for potential confounders. Results Data from 955 patients (mean age 73.2 years; 53.6% men) were analyzed. The median baseline blood sodium level was 139 [interquartile range: 137, 141] mEq/L, and 84 patients (8.8%) exhibited hyponatremia. After full adjustment for confounders, baseline hyponatremia was significantly and negatively associated with FIM-motor at discharge (β=-0.036, P=0.033) and its gain during hospital stay (β=-0.051, P=0.033). Baseline hyponatremia exhibited an independent and negative association with discharge HGS (β=-0.031, P=0.027), whereas no significant association was found between baseline hyponatremia and discharge SMI (β=-0.015, P=0.244). Conclusions Baseline hyponatremia demonstrated a correlation with compromised ADL and muscle health in individuals undergoing rehabilitation after stroke.
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Affiliation(s)
- Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto
Rehabilitation Hospital, Kikuyo, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women’s Medical
University Hospital, Tokyo, Japan
| | - Fumihiko Nagano
- Center for Sarcopenia and Malnutrition Research, Kumamoto
Rehabilitation Hospital, Kikuyo, Japan
| | - Ayaka Matsumoto
- Center for Sarcopenia and Malnutrition Research, Kumamoto
Rehabilitation Hospital, Kikuyo, Japan
| | - Sayuri Shimazu
- Center for Sarcopenia and Malnutrition Research, Kumamoto
Rehabilitation Hospital, Kikuyo, Japan
| | - Ai Shiraishi
- Center for Sarcopenia and Malnutrition Research, Kumamoto
Rehabilitation Hospital, Kikuyo, Japan
| | - Yoshifumi Kido
- Center for Sarcopenia and Malnutrition Research, Kumamoto
Rehabilitation Hospital, Kikuyo, Japan
| | - Takahiro Bise
- Center for Sarcopenia and Malnutrition Research, Kumamoto
Rehabilitation Hospital, Kikuyo, Japan
| | - Aomi Kuzuhara
- Center for Sarcopenia and Malnutrition Research, Kumamoto
Rehabilitation Hospital, Kikuyo, Japan
| | - Kota Hori
- Center for Sarcopenia and Malnutrition Research, Kumamoto
Rehabilitation Hospital, Kikuyo, Japan
| | - Takenori Hamada
- Center for Sarcopenia and Malnutrition Research, Kumamoto
Rehabilitation Hospital, Kikuyo, Japan
| | - Kouki Yoneda
- Center for Sarcopenia and Malnutrition Research, Kumamoto
Rehabilitation Hospital, Kikuyo, Japan
| | - Kenichiro Maekawa
- Center for Sarcopenia and Malnutrition Research, Kumamoto
Rehabilitation Hospital, Kikuyo, Japan
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7
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Terlecki M, Kocowska-Trytko M, Kurzyca A, Pavlinec C, Zając M, Rusinek J, Lis P, Bednarski A, Wojciechowska W, Stolarz-Skrzypek K, Rajzer M. The sodium-chloride difference: A marker of prognosis in patients with acute myocardial infarction. Eur J Clin Invest 2024; 54:e14157. [PMID: 38226439 DOI: 10.1111/eci.14157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 12/30/2023] [Accepted: 01/01/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND The difference between serum sodium and chloride ion concentrations (SCD) may be considered as a surrogate of a strong ion difference and may help to identify patients with a worse prognosis. We aimed to assess SCD as an early prognostic marker among patients with myocardial infarction. METHODS Data of 594 consecutive patients with acute myocardial infarction treated with PCI (44.9% STEMI patients; 70.7% males) was analysed for SCD in relation to their 30-day mortality. A restricted cubic spline regression model was used to study the relationship between mortality and SCD. Cox regression models were used to assess the association between SCD and the mortality risk. RESULTS Patients with Killip class ≥3 had lower SCD values in comparison to patients with Killip class ≤2: (32.0 [30.0-34.0] vs. 33.0 [31.0-36.0], p = .006). The overall 30-day mortality was 7.7% (n = 46). There was a significant difference in SCD values between survivors and non-survivors groups of patients (median (IQR): (33.0 [31.0-36.0] vs. 31.5 [28.0-34.0] (mmol/L), p = .002). The restricted cubic splines model confirmed a non-linear association between SCD and mortality. Patients with SCD <30 mmol/L (in comparison to SCD ≥30 mmol/L) had an increased mortality risk (unadjusted HR 2.92, 95% CI 1.59-5.36, p = .001; and an adjusted HR 2.30, 95% CI 1.02-5.19, p = .04). CONCLUSIONS Low SCD on admission is associated with an increased risk of 30-day mortality in patients with acute myocardial infarction treated with PCI and may serve as a useful prognostic marker for these patients.
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Affiliation(s)
- Michał Terlecki
- Department of Interdisciplinary Intensive Care, Jagiellonian University Medical College, Kraków, Poland
| | - Maryla Kocowska-Trytko
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Aleksandra Kurzyca
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Christopher Pavlinec
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej Zając
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
- Student's Scientific Group in the 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Rusinek
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
- Student's Scientific Group in the 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Paweł Lis
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Adam Bednarski
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Wiktoria Wojciechowska
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Katarzyna Stolarz-Skrzypek
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Rajzer
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
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Zhen Z, Choy M, Dong B, Dong Y, Liang W, Liu C, Xue R. Prognostic impact of abnormal sodium burden in heart failure patients with preserved ejection fraction. Eur J Clin Invest 2024; 54:e14115. [PMID: 37877605 DOI: 10.1111/eci.14115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 10/08/2023] [Accepted: 10/13/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Sodium abnormality is common in patients with heart failure (HF) and is associated with adverse clinical outcomes. The aim of this study is to determine the impact of abnormal sodium burden on long-term mortality and hospitalization in HF with preserved ejection fraction (HFpEF). METHODS We analysed participants from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial with available baseline and follow-up data (n = 1717). Abnormal sodium burden was defined as the proportion of days with abnormal sodium plasma levels (either <135 mmol/L or > 145 mmol/L). To determine the independent prognostic impact of abnormal sodium burden on the long-term clinical adverse outcomes (The primary outcome was any cause death, the secondary outcomes include cardiovascular disease death, HF hospitalization, any cause hospitalization and the primary endpoint of the original study), a multivariable Cox proportional hazard model and time-updated Cox regression model were performed. RESULTS Abnormal sodium burden occurred in 717 patients (41.76%). A high abnormal sodium burden was associated with 1.47 (95% CI, 1.15-1.89) higher risk with any cause mortality, 1.51 (95% CI, 1.08-2.09) higher risk with CVD death and 1.31 (95% CI, 1.02-1.69) higher risk with HF hospitalization when compared with no burden group. When sodium level changes over time were accounted for in time-updated models, abnormal sodium level was still associated with poor clinical outcomes. Diuretic and spironolactone usage did not show a statistical interaction effect on the prognostic significance. CONCLUSIONS In HFpEF patients, abnormal sodium burden was an independent predictor long-term any-cause mortality and HF hospitalization.
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Affiliation(s)
- Zhe Zhen
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-sen University, Guangzhou, PR China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, PR China
| | - Manting Choy
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-sen University, Guangzhou, PR China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, PR China
| | - Bin Dong
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-sen University, Guangzhou, PR China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, PR China
| | - Yugang Dong
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-sen University, Guangzhou, PR China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, PR China
| | - Weihao Liang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-sen University, Guangzhou, PR China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, PR China
| | - Chen Liu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-sen University, Guangzhou, PR China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, PR China
| | - Ruicong Xue
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China
- NHC Key Laboratory of Assisted Circulation and Vascular Diseases, Sun Yat-sen University, Guangzhou, PR China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, PR China
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Qian A, Zheng L, He Z, Zhou J, Tang S, Xing W. Predictive value of hyponatremia for short-term mortality in supratentorial spontaneous intracerebral hemorrhage: a single center study. Front Neurol 2024; 15:1301197. [PMID: 38333609 PMCID: PMC10851875 DOI: 10.3389/fneur.2024.1301197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 01/10/2024] [Indexed: 02/10/2024] Open
Abstract
Background Hyponatremia is a common electrolyte disturbance in patients with neurological disease; however, its predictive role for outcome in patients with supratentorial spontaneous intracerebral hemorrhage (sICH) is controversial. This study aims to explore the association between hyponatremia within 7 days after bleeding and 90-day mortality in patients with supratentorial sICH. Methods A retrospective analysis was conducted at our institution. Patients with sICH meeting the inclusion criteria were enrolled in this study. Multivariate regression analyses were performed to determine the predictive value of hyponatremia (serum sodium <135 mmol/L) for 90-day mortality and functional outcome. Subgroup analysis was performed based on the degree and duration of hyponatremia and therapeutic strategies. The Spearman correlation test was performed to explore the relationship between hyponatremia severity and duration with variables in a multivariate regression model. Kaplan-Meier curve was depicted to reveal the relationship between hyponatremia and mortality. The receiver operating characteristic (ROC) curve was plotted to show the diagnostic effect of the minimum concentration of serum sodium (sodiummin) on 90-day mortality. Results A total of 960 patients were enrolled, 19.6% (188) of whom were patients with hyponatremia and 26.0% (250) had 90-day mortality. The incidence of hyponatremia was roughly 2.5 times in non-survivors compared with survivors (34.8% vs. 14.2%). Multivariate regression analysis revealed that hyponatremia was the independent predictor of 90-day mortality (OR 2.763, 95%CI 1.836-4.157) and adverse outcome (OR 3.579, 95%CI 2.332-6.780). Subgroup analysis indicated an increased trend in mortality risk with both duration (more or less than 48 h) and severity of hyponatremia (mild, moderate, and severe) and confirmed the predictive value of hyponatremia for mortality in patients undergoing surgical intervention (external ventricular drainage, craniotomy, and decompressive craniectomy; all p < 0.05). The Spearman correlation test indicated no moderate or strong relationship between hyponatremia severity and duration with other variables in the multivariate model (all |rs| < 0.4). The ROC curve suggested the moderate diagnostic performance of sodiummin for mortality in both general patients and subgroups of therapeutic method patients (AUC from 0.6475 to 0.7384). Conclusion Hyponatremia occurring in the first 7 days after bleeding is an independent predictor of 90-day morality and adverse outcome. Rigorous electrolyte scrutiny in patients treated surgically is required.
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Affiliation(s)
- Ao Qian
- Department of Cerebrovascular Disease, Suining Central Hospital, Suining, Sichuan, China
| | - Longyi Zheng
- Department of Radiology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Zeyuan He
- Department of Cerebrovascular Disease, Suining Central Hospital, Suining, Sichuan, China
| | - Jing Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shuang Tang
- Department of Cerebrovascular Disease, Suining Central Hospital, Suining, Sichuan, China
| | - Wenli Xing
- Department of Cerebrovascular Disease, Suining Central Hospital, Suining, Sichuan, China
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Biagetti B, Sánchez-Montalvá A, Puig-Perez A, Campos-Varela I, Pilia MF, Anderssen-Nordahl E, González-Sans D, Miarons M, Simó R. Hyponatremia after COVID-19 is frequent in the first year and increases re-admissions. Sci Rep 2024; 14:595. [PMID: 38182711 PMCID: PMC10770325 DOI: 10.1038/s41598-023-50970-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/27/2023] [Indexed: 01/07/2024] Open
Abstract
Hyponatremia on admission has been related to worse outcomes in patients with COVID-19 infection. However, little is known about the frequency and the associated risk factors of hyponatremia after COVID-19 discharge. We performed an observational 24-month follow-up study of patients admitted during the first COVID-19 wave. Kaplan-Meier curves and Cox proportional hazard models were used to assess the main variables in predicting hyponatremia on follow-up (HYPO-FU). A total of 161 out of 683 (24.4%) developed HYPO-FU. The group with HYPO-FU comprised of more men [(62.3%) vs. (49.2%); p < 0.01], older [65.6 ± 18.2 vs. 60.3 ± 17.0; p < 0.01] and more frequently re-admitted [(16.2%) vs. (3.8%); p < 0.01). The rate of HYPO-FU was higher in the first year 23.6 per 100 individuals per year. After Cox regression analysis, the independent risk factors of HYPO-FU were diabetes [OR 2.12, IC 95% (1.48-3.04)], hypertension [OR 2.18, IC 95% (1.53-3.12)], heart failure [OR 3.34, IC 95% (1.72-6.48)] and invasive ventilation support requirement [OR: 2.38, IC 95% (1.63-3.50)]. To conclude, HYPO-FU was frequent in the first year after COVID-19 infection, and the risk was higher in older men with comorbidities, increasing rehospitalisation. Further studies aimed at evaluating the beneficial effects of correcting hyponatremia in these patients are warranted.
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Affiliation(s)
- Betina Biagetti
- Endocrinology Department, Diabetes and Metabolism Research Unit, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute (VHIR), Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Adrián Sánchez-Montalvá
- Infectious Diseases Department, Vall d'Hebrón University Hospital, Global Health Program from the Catalan Health Institute (PROSICS), Universitat Autònoma de Barcelona, Barcelona, Spain
- Mycobacterial Infection Study Group from the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIM-SEIMC), Barcelona, Spain
- Infectious Diseases Netword Biomedical Research Center (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Albert Puig-Perez
- Endocrinology Department, Diabetes and Metabolism Research Unit, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute (VHIR), Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Isabel Campos-Varela
- Liver Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut of Research (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - María Florencia Pilia
- Pneumology Department, Vall d'Hebron University Hospital, Department of Medicine, Autonomous University of Barcelona (UAB), Barcelona, Spain
- Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Emilie Anderssen-Nordahl
- Department of Clinical Pharmacology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Didac González-Sans
- Systemic Autoimmune Diseases Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Marta Miarons
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Rafael Simó
- Endocrinology Department, Diabetes and Metabolism Research Unit, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute (VHIR), Universidad Autónoma de Barcelona, Barcelona, Spain.
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11
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Lin R, Du N, Feng J, Li J, Li X, Cui Y, Ning S, Zhang M, Huang G, Wang H, Chen X, Ma L, Li J. Postoperative hypernatremia is associated with worse brain injuries on EEG and MRI following pediatric cardiac surgery. Front Cardiovasc Med 2023; 10:1320231. [PMID: 38188252 PMCID: PMC10768027 DOI: 10.3389/fcvm.2023.1320231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/11/2023] [Indexed: 01/09/2024] Open
Abstract
Objectives Dysnatremia is a common electrolyte disturbance after cardiopulmonary bypass (CPB) surgery for congenital heart disease (CHD) and a known risk factor for adverse neurological events and clinical outcomes. The objective of this study was to evaluate the association of dysnatremia with worse abnormal EEG patterns, brain injuries detected by magnetic resonance imaging (MRI) and early adverse outcomes. Methods We monitored continuous EEG in 340 children during the initial 48 h following cardiac surgery. Demographics and clinical characteristics were recorded. Sodium concentrations were measured in the arterial blood gas analysis every 6 h. Hyponatremia and hypernatremia were classified by the average of sodium concentrations over 48 h. Postoperative cerebral MRI was performed before hospital discharge. Results In our patient cohort, dysnatremia was present in 46 (13.5%) patients. Among them, hyponatremia occurred in 21 (6.2%) and hypernatremia in 25 (7.4%). When compared to patients with normonatremia, hyponatremia was not associated with EEG abnormalities and early adverse outcomes (Ps ≥ .14). In hypernatremia group, the CPB time was significantly longer and more frequent use of DHCA (Ps ≤ .049). After adjusting for time, CPB time and the use of DHCA, hypernatremia was significantly associated with worse EEG abnormalities (including background, seizures and pathological delta brushes), more severe brain injuries on MRI (Ps ≤ .04) and trended to be associated with longer postoperative mechanical ventilation time (P = .06). Conclusion Hypernatremia and hyponatremia were common in children after cardiac surgery. Hypernatremia, but not hyponatremia, was significantly associated with worse EEG abnormalities and more severe brain injuries on MRI and extended postoperative mechanical ventilation time.
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Affiliation(s)
- Rouyi Lin
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong, China
- Clinical Physiology Laboratory, Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong, China
| | - Na Du
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong, China
- Heart Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong, China
| | - Jinqing Feng
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong, China
- Clinical Physiology Laboratory, Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong, China
| | - Jianbin Li
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong, China
- Heart Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong, China
| | - Xiaowei Li
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong, China
- Heart Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong, China
| | - Yanqin Cui
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong, China
- Heart Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong, China
| | - Shuyao Ning
- Department of Electroneurophysiology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Mingjie Zhang
- Department of Radiology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Guodong Huang
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong, China
- Heart Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong, China
| | - Huaizhen Wang
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong, China
- Heart Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong, China
| | - Xinxin Chen
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong, China
- Heart Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong, China
| | - Li Ma
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong, China
- Heart Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong, China
| | - Jia Li
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong, China
- Clinical Physiology Laboratory, Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong, China
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12
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Alevroudis I, Kotoulas SC, Tzikas S, Vassilikos V. Congestion in Heart Failure: From the Secret of a Mummy to Today's Novel Diagnostic and Therapeutic Approaches: A Comprehensive Review. J Clin Med 2023; 13:12. [PMID: 38202020 PMCID: PMC10779505 DOI: 10.3390/jcm13010012] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/04/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
This review paper presents a review of the evolution of this disease throughout the centuries, describes and summarizes the pathophysiologic mechanisms, briefly discusses the mechanism of action of diuretics, presents their role in decongesting heart failure in patients, and reveals the data behind ultrafiltration in the management of acutely or chronically decompensated heart failure (ADHF), focusing on all the available data and advancements in this field. Acutely decompensated heart failure (ADHF) presents a critical clinical condition characterized by worsening symptoms and signs of heart failure, necessitating prompt intervention to alleviate congestion and improve cardiac function. Diuretics have traditionally been the mainstay for managing fluid overload in ADHF. Mounting evidence suggests that due to numerous causes, such as coexisting renal failure or chronic use of loop diuretics, an increasing rate of diuretic resistance is noticed and needs to be addressed. There has been a series of trials that combined diuretics of different categories without the expected results. Emerging evidence suggests that ultrafiltration may offer an alternative or adjunctive approach.
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Affiliation(s)
- Ioannis Alevroudis
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (V.V.)
- Intensive Care Medicine Clinic, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece;
| | | | - Stergios Tzikas
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (V.V.)
| | - Vassilios Vassilikos
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (V.V.)
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13
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Zhao K, Zheng Q, Zhou J, Zhang Q, Gao X, Liu Y, Li S, Shan W, Liu L, Guo N, Tian H, Wei Q, Hu X, Cui Y, Geng X, Wang Q, Cui W. Associations between serum electrolyte and short-term outcomes in patients with acute decompensated heart failure. Ann Med 2023; 55:155-167. [PMID: 36519243 PMCID: PMC9851236 DOI: 10.1080/07853890.2022.2156595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION There is a dearth of comprehensive studies on the association between serum electrolyte and adverse short-term prognosis of Chinese patients with acute decompensated heart failure (ADHF). PATIENTS AND METHODS A total of 5166 patients with ADHF were divided into four serum electrolyte-related study populations (potassium (n = 5145), sodium (n = 5135), chloride (n = 4966), serum total calcium (STC) (n = 4143)) under corresponding exclusions. Different logistic regression models were utilized to gauge the association between these electrolytes or the number of electrolyte abnormalities and the risk of a composite of all-cause mortality or 30-day heart failure (HF) readmission. RESULTS In multivariable adjusted analysis, patients with potassium below 3.5 mmol/L (odds ratios (ORs) 1.45; 95% confidence interval (CI):1.07-1.95), 4.01-4.50 mmol/L (OR: 1.29, CI: 1.02-1.62), 4.51-5.00 mmol/L (OR: 1.43, CI: 1.08-1.90) and above 5.00 mmol/L (OR: 1.74, CI: 1.21-2.51) had an increased risk of outcome when compared with potassium at 3.50-4.00 mmol/L. Sodium levels were inversely related to the risk of a composite outcome (<130 mmol/L: OR: 2.73 (95% CI, 1.81-4.12); 130-134 mmol/L: OR, 1.97 (CI, 1.45-2.68); 135-140 mmol/L: OR, 1.45 (CI, 1.17-1.81); p for trend < 0.001) in comparison with sodium at 141-145 mmol/L. Chloride < 95 mmol/L corresponded to a higher risk of a composite outcome with an OR of 1.65 (95% CI, 1.16-2.37) in contrast to chloride levels at 101-105 mmol/L. In addition, the adjusted ORs (95% CI) for a composite outcome comparing the STC < 2.00 and 2.00-2.24 vs. 2.25-2.58 mmol/L were 0.98 (0.69-1.43) and 1.13 (0.89-1.44), respectively. Besides that, the number of electrolyte abnormalities was positively related to the risk of a composite outcome (N = 1, OR 1.40, 95% CI: 1.13-1.73; N = 2, OR 2.51, 95% CI: 1.85-3.42; N = 3, OR 2.47, 95% CI: 1.45-4.19; p for trend < 0.001) in comparison with N = 0. CONCLUSIONS A deviation of potassium levels from 3.50 to 4.00 mmol/L, lower sodium levels and hypochloremia were associated with poorer short-term prognosis of ADHF. Furthermore, the number of electrolyte abnormalities positively correlated with adverse short-term prognosis of patients with ADHF. Key MessagesADHF patients with baseline serum potassium at first half part of normal range (3.50-4.00 mmol/L) may herald the lowest risk of recent cardiovascular events.Serum sodium and chloride levels exhibit discrepancies in terms of risk of short-term adverse events of ADHF patients.The number of electrolyte abnormalities is a significant predictor of poor short-term prognosis in patients with ADHF. CLINICAL TRIAL REGISTRATION URL http://www.chictr.org.cn/showproj.aspx?proj=23139. Unique identifier: ChiCTR-POC-17014020.
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Affiliation(s)
- Kai Zhao
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qun Zheng
- Department of Cardiology, Hengshui People's Hospital, Hengshui, China
| | - Jiang Zhou
- Department of Cardiology, Chengde Central Hospital, Chengde, China
| | - Qi Zhang
- Department of Cardiology, First Central Hospital of Baoding, Baoding, China
| | - Xiaoli Gao
- Department of Cardiology, Huabei Petroleum Administration Bureau General Hospital, Cangzhou, China
| | - Yinghua Liu
- Department of Cardiology, Huabei Petroleum Administration Bureau General Hospital, Cangzhou, China
| | - Senlin Li
- Department of Cardiology, First Hospital of Zhangjiakou, Zhangjiakou, China
| | - Weichao Shan
- Department of Cardiology, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Li Liu
- Department of Cardiology, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Nan Guo
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou, China
| | - Hongsen Tian
- Department of Cardiology, Handan Central Hospital, Handan, China
| | - Qingmin Wei
- Department of Cardiology, Xingtai People's Hospital, Xingtai, China
| | - Xitian Hu
- Department of Cardiology, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Yingkai Cui
- Department of Cardiology, The 252nd Hospital of People's Liberation Army, Baoding, China
| | - Xue Geng
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qian Wang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Cui
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Bhattacharjee P, Khan Z. Sacubitril/Valsartan in the Treatment of Heart Failure With Reduced Ejection Fraction Focusing on the Impact on the Quality of Life: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Cureus 2023; 15:e48674. [PMID: 38090453 PMCID: PMC10714125 DOI: 10.7759/cureus.48674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2023] [Indexed: 04/10/2024] Open
Abstract
There exists a paucity of research data reported by analyses performed on randomized clinical trials (RCTs) that encompass quality of life (QOL) and the aftermath for patients suffering from heart failure with reduced ejection fraction (HFrEF). This systematic review and meta-analysis of randomized clinical trials (RCTs) have been done to evaluate the drug sacubitril/valsartan in the treatment of heart failure (HF) with reduced ejection fraction (HFrEF) with a clear focus on the effect it bestows on measures of physical exercise tolerance and quality of life. A thorough systematic search was done in databases including Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, Embase, and PubMed from 1 January 2010 to 1 January 2023. The search only included published RCTs on adult patients aged 18 and above, with heart failure with reduced ejection fraction (HFrEF). Data analysis was performed by using the software RevMan 5.4 (Cochrane Collaboration, London, United Kingdom). The included studies' bias risk was assessed using the Cochrane Collaboration's Risk of Bias tool. The quality of evidence for the primary outcome was done using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. This systematic review and meta-analysis of RCTs yielded 458 studies, of which eight randomized clinical trials were included and analyzed. The meta-analysis of the included trials shows that the I2 value is 61% (i.e., I2 > 50%), demonstrating a substantial heterogeneity within the studies. The left ventricular ejection fraction (LVEF) expressed in percentage was reported in the five studies, and thereby, a subgroup analysis that yielded a confidence interval (CI) of 95% had the standard mean difference of 0.02 (-0.02, 0.07). The trials had disparity between the reporting of effect on peak oxygen consumption (VO2), measured through cardiopulmonary exercise testing (CPET) methods, six-minute walking test (6MWT), overall physical activity, and exercise capacity. Sacubitril/valsartan did not exponentially improve peak VO2 or 6MWT in these trials; however, the patient-reported data suggested that the quality of life was modestly influenced by the drug. A subgroup analysis was performed using the pooled effect value by the random effects model. The findings showed that the sacubitril/valsartan group significantly was better than the control group in improving HFrEF-associated health-related quality of life (HRQoL). This study is a systematic review and meta-analysis of randomized clinical trials that evaluated the drug sacubitril/valsartan in treating heart failure with reduced ejection fraction (HFrEF) and focused on its tangible effect on the measures of physical exercise tolerance and quality of life. It depicts that the statistical scrutiny due to the lack of significant data and parity across studies did not impart significant improvement of either LVEF, peak VO2, or 6MWT with the use of sacubitril/valsartan; however, the reported exercise tolerance, including daytime physical activity, had a modest impact with the said drug. The pooled values demonstrated that the sacubitril/valsartan group significantly outperformed the control group in improving HFrEF HRQoL.
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Affiliation(s)
| | - Zahid Khan
- Acute Medicine, Mid and South Essex NHS Foundation Trust, Southend-on-Sea, GBR
- Cardiology, Barts Heart Centre, London, GBR
- Cardiology and General Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
- Cardiology, Royal Free Hospital, London, GBR
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15
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Bondanelli M, Aliberti L, Gagliardi I, Ambrosio MR, Zatelli MC. Long-term low-dose tolvaptan efficacy and safety in SIADH. Endocrine 2023; 82:390-398. [PMID: 37507553 PMCID: PMC10543144 DOI: 10.1007/s12020-023-03457-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE Tolvaptan, a selective vasopressin V2-receptor antagonist, is approved for the treatment of SIADH-related hyponatremia, but its use is limited. The starting dose is usually 15 mg/day, but recent clinical experience suggests a lower starting dose (<15 mg/day) to reduce the risk of sodium overcorrection. However, long-term low-dose efficacy and safety has not been explored, so far. Aim of our study is to characterize safety and efficacy of long-term SIADH treatment with low-dose Tolvaptan. METHODS We retrospectively evaluated 11 patients receiving low-dose Tolvaptan (<15 mg/day) for chronic SIADH due to neurological, idiopathic and neoplastic causes. Plasma sodium levels were measured before and 1, 3, 5, 15 and 30 days after starting Tolvaptan and then at 3-month intervals. Anamnestic and clinical data were collected. RESULTS Mean time spanned 27.3 ± 29.8 months (range 6 months-7 years). Mean plasma sodium levels were within normal range 1, 3 and 6 months after starting Tolvaptan as well as after 1, 2, 3, 5 and 7 years of therapy. Neither osmotic demyelination syndrome nor overcorrection were observed. Plasma sodium levels normalization was associated with beneficial clinical effects. Neurological patients obtained seizures disappearance, improvement in neurological picture and good recovery from rehabilitation. Neoplastic patients were able to start chemotherapy and improved their general condition. Patients did not show hypernatremia during long-term follow-up and reported mild thirst and pollakiuria. CONCLUSIONS The present study shows that long-term low-dose Tolvaptan is safe and effective in SIADH treatment. No cases of overcorrection were documented and mild side effects were reported.
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Affiliation(s)
- Marta Bondanelli
- Section of Endocrinology, Geriatrics and Internal Medicine, Dept of Medical Sciences, University of Ferrara, Ferrara, Italy.
| | - Ludovica Aliberti
- Section of Endocrinology, Geriatrics and Internal Medicine, Dept of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Irene Gagliardi
- Section of Endocrinology, Geriatrics and Internal Medicine, Dept of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Maria Rosaria Ambrosio
- Section of Endocrinology, Geriatrics and Internal Medicine, Dept of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Maria Chiara Zatelli
- Section of Endocrinology, Geriatrics and Internal Medicine, Dept of Medical Sciences, University of Ferrara, Ferrara, Italy
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Pölzl G, Altenberger J, Comín-Colet J, Delgado JF, Fedele F, García-González MJ, Gustafsson F, Masip J, Papp Z, Störk S, Ulmer H, Maier S, Vrtovec B, Wikström G, Zima E, Bauer A. Repetitive levosimendan infusions for patients with advanced chronic heart failure in the vulnerable post-discharge period: The multinational randomized LeoDOR trial. Eur J Heart Fail 2023; 25:2007-2017. [PMID: 37634941 DOI: 10.1002/ejhf.3006] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/29/2023] Open
Abstract
AIM The LeoDOR trial explored the efficacy and safety of intermittent levosimendan therapy in the vulnerable phase following a hospitalization for acute heart failure (HF). METHODS AND RESULTS In this prospective multicentre, double-blind, two-armed trial, patients with advanced HF were randomized 2:1 at the end of an index hospitalization for acute HF to intermittent levosimendan therapy or matching placebo for 12 weeks. All patients had left ventricular ejection fraction (LVEF) ≤30% during index hospitalization. Levosimendan was administered according to centre preference either as 6 h infusion at a rate of 0.2 μg/kg/min every 2 weeks, or as 24 h infusion at a rate of 0.1 μg/kg/min every 3 weeks. The primary efficacy assessment after 14 weeks was based on a global rank score consisting of three hierarchical groups. Secondary clinical endpoints included the composite risk of tiers 1 and 2 at 14 and 26 weeks, respectively. Due to the COVID-19 pandemic, the planned number of patients could not be recruited. The final modified intention-to-treat analysis included 145 patients (93 in the combined levosimendan arm, 52 in the placebo arm), which reduced the statistical power to detect a 20% risk reduction in the primary endpoint to 60%. Compared with placebo, intermittent levosimendan had no significant effect on the primary endpoint: the mean rank score was 72.55 for the levosimendan group versus 73.81 for the placebo group (p = 0.863). However, there was a signal towards a higher incidence of the individual clinical components of the primary endpoint in the levosimendan group versus the placebo group both after 14 weeks (hazard ratio [HR] 2.94, 95% confidence interval [CI] 1.12-7.68; p = 0.021) and 26 weeks (HR 1.64, 95% CI 0.87-3.11; p = 0.122). CONCLUSIONS Among patients recently hospitalized with HF and reduced LVEF, intermittent levosimendan therapy did not improve post-hospitalization clinical stability.
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Affiliation(s)
- Gerhard Pölzl
- Department of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Johann Altenberger
- Cardiac Rehabilitation Center Grossgmain, Pensionsversicherungsanstalt, Teaching Hospital of Paracelsus Medical Private University, Salzburg, Austria
| | - Josep Comín-Colet
- Department of Cardiology, Bellvitge University Hospital and IDIBELL, University of Barcelona Hospitalet de Llobregat, CIBER CV, Barcelona, Spain
| | - Juan F Delgado
- Department of Cardiology, University Hospital 12 de Octubre, CIBERCV, Madrid, Spain
| | - Francesco Fedele
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Finn Gustafsson
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Josep Masip
- Research Direction. Consorci Sanitary Integral, University of Barcelona, Barcelona, Spain
| | - Zoltán Papp
- Department of Cardiology, Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Stefan Störk
- Department Clinical Research & Epidemiology, Comprehensive Heart Failure Center, and Dept. Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Hanno Ulmer
- Institute of Medical Statistics and Informatics, Medical University Innsbruck, Innsbruck, Austria
| | - Sarah Maier
- Institute of Medical Statistics and Informatics, Medical University Innsbruck, Innsbruck, Austria
| | - Bojan Vrtovec
- Department of Cardiology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Gerhard Wikström
- Department of Cardiology, Institute of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Endre Zima
- Cardiac Intensive Care Unit, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Axel Bauer
- Department of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
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17
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Gong H, Zhou Y, Huang Y, Liao S, Wang Q. Construction of risk prediction model for hyponatremia in patients with acute decompensated heart failure. BMC Cardiovasc Disord 2023; 23:520. [PMID: 37884881 PMCID: PMC10601100 DOI: 10.1186/s12872-023-03557-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 10/11/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Patients with Heart failure (HF) commonly have a water-electrolyte imbalance due to various reasons and mechanisms, and hyponatremia is one of the most common types. However, currently, there are very few local studies on hyponatremia risk assessment in patients with acute decompensated heart failure (ADHF), and there is a lack of specific screening tools. The aim of this study is to identify a prediction model of hyponatremia in patients with acute decompensated heart failure (ADHF) and verify the prediction effect of the model. METHODS A total of 532 patients with ADHF were enrolled from March 2014 to December 2019. Univariate and multivariate logistic regression analyses were performed to investigate the independently associated risk factors of hyponatremia in patients with ADHF. The prediction model of hyponatremia in patients with ADHF was constructed by R software, and validation of the model was performed using the area under the receiver operating characteristic curve (AUC) and calibration curves. RESULTS A total of 65 patients (12.2%) had hyponatremia in patients with ADHF. Multivariate logistic regression analysis demonstrated that NYHA cardiac function classification (NYHA III vs II, OR = 12.31, NYHA IV vs II, OR = 11.55), systolic blood pressure (OR = 0.978), serum urea nitrogen (OR = 1.046) and creatinine (OR = 1.006) were five independent prognostic factors for hyponatremia in patients with ADHF. The AUC was 0.757; The calibration curve was near the ideal curve, which showed that the model can accurately predict the occurrence of hyponatremia in patients with ADHF. CONCLUSIONS The prediction model constructed in our study has good discrimination and accuracy and can be used to predict the occurrence of hyponatremia in patients with ADHF.
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Affiliation(s)
- Huanhuan Gong
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ying Zhou
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yating Huang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shengen Liao
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Qin Wang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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18
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Sarastri Y, Zebua JI, Lubis PN, Zahra F, Lubis AC. Admission hyponatraemia as heart failure events predictor in patients with acute heart failure. ESC Heart Fail 2023; 10:2966-2972. [PMID: 37519045 PMCID: PMC10567628 DOI: 10.1002/ehf2.14472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 04/17/2023] [Accepted: 07/02/2023] [Indexed: 08/01/2023] Open
Abstract
AIMS Heart failure remained consistent as one of the biggest cardiovascular problems in Indonesia. Hyponatraemia is a common electrolyte disorder among patients presented with heart failure; however, the prognostic value for worsening heart failure has not been well defined. METHODS AND RESULTS We studied 134 patients admitted with acute heart failure and investigated the relationship between admission serum sodium and the composite clinical outcomes of all-cause mortality and hospitalization ambispectively with a follow-up duration of 6 months. We also try to look for low sodium-level impacts in several conditions. Among 134 patients, 84 patients presented with low sodium during admission, defined as a serum sodium level of <135 mEq/L, and it was associated with higher composite clinical outcome risk [odds ratio (OR), 5.9; 95% confidence interval (CI), 2.8-12.0; P < 0.001]. Moreover, hyponatraemia impacts on composite endpoints were driven by both parameters; it was independently associated with mortality (OR, 3.1; 95% CI, 1.4-6.8; P = 0.003) and rehospitalization (OR, 5.3; 95% CI, 2.4-11.7; P < 0.001). This result remained consistent in most subgroups. CONCLUSIONS On-admission hyponatraemia is a predictor for 6 month mortality and rehospitalization. Further work is needed to determine if correction of hyponatraemia translates into clinical benefit.
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Affiliation(s)
- Yuke Sarastri
- Faculty of MedicineUniversitas Sumatera UtaraMedanIndonesia
- Department of Cardiology and Vascular MedicineRSUP Haji Adam Malik MedanMedanIndonesia
| | - Juang Idaman Zebua
- Department of Cardiology and Vascular MedicineRSUP Haji Adam Malik MedanMedanIndonesia
| | - Puja Nastia Lubis
- Department of Cardiology and Vascular MedicineRSUP Haji Adam Malik MedanMedanIndonesia
| | - Fathi Zahra
- Faculty of MedicineUniversitas TrisaktiWest JakartaIndonesia
| | - Anggia Chairuddin Lubis
- Faculty of MedicineUniversitas Sumatera UtaraMedanIndonesia
- Department of Cardiology and Vascular MedicineRSUP Haji Adam Malik MedanMedanIndonesia
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19
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Kaneko T, Kagiyama N, Nakamura Y, Dotare T, Sunayama T, Ishiwata S, Maeda D, Iso T, Kato T, Suda S, Hiki M, Matsue Y, Kasai T, Minamino T. Usefulness of HANBAH Score in Japanese Patients With Acute Heart Failure. Am J Cardiol 2023; 203:45-52. [PMID: 37481811 DOI: 10.1016/j.amjcard.2023.06.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 06/22/2023] [Accepted: 06/29/2023] [Indexed: 07/25/2023]
Abstract
The HANBAH score is a novel simple risk score consisting of hemoglobin level, age, sodium (N) level, blood urea nitrogen level, atrial fibrillation, and high-density lipoprotein. We aimed to validate this score in an external population. This retrospective study included 744 patients hospitalized for acute heart failure between 2015 and 2019. Each of the following criteria was scored as 1 point: hemoglobin level (<13.0 g/L for men and <12.0 g/L for women), atrial fibrillation, age (>70 years), serum blood urea nitrogen level (>26 mg/100 ml for men and >28 mg/100 ml for women), serum high-density lipoprotein level (<25 mg/100 ml), and serum sodium level (<135 mg/100 ml). HANBAH scores were available for 736 patients (age, 75 ± 13 years; 60% male; reduced [<40%] and preserved ejection fraction [≥50%]: 35% and 49%, respectively). All-cause death during follow-up, a composite of death and heart failure rehospitalization, and in-hospital death were observed in 173, 274, and 51 patients, respectively. The HANBAH score was significantly associated with these end points after adjustment for covariates (adjusted hazard ratio 1.38 [95% confidence interval 1.16 to 1.64], p <0.001; 1.27 [1.11 to 1.45], p <0.001; and 1.66 [1.18 to 2.33], p <0.001, respectively). Receiver operating characteristic and net reclassification improvement analyses showed that the HANBAH score performed significantly better than AHEAD (atrial fibrillation, hemoglobin [anemia], elderly, abnormal renal parameters, diabetes mellitus) and AHEAD-U (AHEAD with uric acid) scores and similar to the multi-domain ACUTE HF score for all end points. In conclusion, the HANBAH score showed powerful risk stratification in this external Japanese cohort. Despite its simplicity, it performed better than other simple risk scores and similar to a multidomain risk score.
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Affiliation(s)
- Tomohiro Kaneko
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nobuyuki Kagiyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Digital Health and Telemedicine R&D, Juntendo University, Tokyo, Japan.
| | - Yutaka Nakamura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Taishi Dotare
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tsutomu Sunayama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Sayaki Ishiwata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Daichi Maeda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takashi Iso
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takao Kato
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shoko Suda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masaru Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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20
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Sasakawa Y, Tatematsu Y, Kato J, Fujii M, Okamoto N, Inaguma D. Relationship between serum sodium level at dialysis initiation and all-cause mortality. Clin Exp Nephrol 2023; 27:747-756. [PMID: 37264283 DOI: 10.1007/s10157-023-02363-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/24/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Hyponatremia is a common electrolyte disorder in patients with chronic kidney disease. In addition, hyponatremia is associated with mortality in patients with chronic kidney disease, including those on dialysis. However, few studies have examined this relationship in patients with incident dialysis. METHODS We used a database of multicenter prospective cohort studies that included 1520 incident dialysis patients. The baseline was set at the time of dialysis initiation. The enrolled patients were classified into five groups according to their serum sodium levels (< 130 mEq/L, 130-134 mEq/L, 135-139 mEq/L, 140-144 mEq/L, and ≥ 145 mEq/L). Multivariate Cox proportional hazards analysis was conducted to determine factors associated with all-cause mortality. RESULTS A total of 392 all-cause deaths occurred during the follow-up period. The ultrafiltration volume per body weight during the first dialysis session was more significant in the groups with the lowest and highest sodium levels. The percentage of patients using loop diuretics and thiazide was higher in the group with lower sodium levels (< 130 mEq/L and 130-134 mEq/L). All-cause mortality was significantly different among the five groups (p = 0.025). Multivariate analysis indicated that all-cause mortality was significantly higher in the group with the lowest sodium level compared to the group with a serum sodium level of 135-139 mEq/L (hazard ratio: 1.61, 95% confidence interval: 1.04-2.49). CONCLUSION Hyponatremia of < 130 mEq/L at dialysis initiation was significantly associated with all-cause mortality. We considered the results relevant to underlying conditions, including cardiovascular disease and medications.
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Affiliation(s)
- Yuji Sasakawa
- Department of Internal Medicine, Department of Nephrology, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa, Nagoya, Aichi, 4548509, Japan
| | - Yoshitaka Tatematsu
- Department of Internal Medicine, Department of Nephrology, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa, Nagoya, Aichi, 4548509, Japan
| | - Joichiro Kato
- Department of Internal Medicine, Department of Nephrology, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa, Nagoya, Aichi, 4548509, Japan
| | - Maya Fujii
- Department of Internal Medicine, Department of Nephrology, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa, Nagoya, Aichi, 4548509, Japan
| | - Naoki Okamoto
- Department of Internal Medicine, Department of Nephrology, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa, Nagoya, Aichi, 4548509, Japan
| | - Daijo Inaguma
- Department of Internal Medicine, Department of Nephrology, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa, Nagoya, Aichi, 4548509, Japan.
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21
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Krisanapan P, Tangpanithandee S, Thongprayoon C, Pattharanitima P, Kleindienst A, Miao J, Craici IM, Mao MA, Cheungpasitporn W. Safety and Efficacy of Vaptans in the Treatment of Hyponatremia from Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH): A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:5483. [PMID: 37685548 PMCID: PMC10488023 DOI: 10.3390/jcm12175483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
The utilization of vasopressin receptor antagonists, known as vaptans, in the management of hyponatremia among patients afflicted with the syndrome of inappropriate antidiuretic hormone (SIADH) remains a contentious subject. This meta-analysis aimed to evaluate the safety and efficacy of vaptans for treating chronic hyponatremia in adult SIADH patients. Clinical trials and observational studies were identified by a systematic search using MEDLINE, EMBASE, and Cochrane Database from inception through September 2022. The inclusion criteria were the studies that reported vaptans' safety or efficacy outcomes compared to placebo or standard therapies. The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD 42022357307). Five studies were identified, comprising three RCTs and two cohort studies, enrolling a total of 1840 participants. Regarding short-term efficacy on days 4-5, vaptans exhibited a significant increase in serum sodium concentration from the baseline in comparison to the control group, with a weighted mean difference of 4.77 mmol/L (95% CI, 3.57, 5.96; I2 = 34%). In terms of safety outcomes, the pooled incidence rates of overcorrection were 13.1% (95% CI 4.3, 33.6; I2 = 92%) in the vaptans group and 3.3% (95% CI 1.6, 6.6; I2 = 27%) in the control group. Despite the higher correction rate linked to vaptans, with an OR of 5.72 (95% CI 3.38, 9.70; I2 = 0%), no cases of osmotic demyelination syndrome were observed. Our meta-analysis comprehensively summarizes the efficacy and effect size of vaptans in managing SIADH. While vaptans effectively raise the serum sodium concentration compared to placebo/fluid restriction, clinicians should exercise caution regarding the potential for overcorrection.
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Affiliation(s)
- Pajaree Krisanapan
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (S.T.); (C.T.); (J.M.); (I.M.C.)
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand;
- Division of Nephrology, Department of Internal Medicine, Thammasat University Hospital, Pathum Thani 12120, Thailand
| | - Supawit Tangpanithandee
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (S.T.); (C.T.); (J.M.); (I.M.C.)
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan 10540, Thailand
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (S.T.); (C.T.); (J.M.); (I.M.C.)
| | - Pattharawin Pattharanitima
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand;
| | - Andrea Kleindienst
- Department of Neurosurgery, Friedrich-Alexander-University Nürnberg-Erlangen, 91054 Erlangen, Germany;
| | - Jing Miao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (S.T.); (C.T.); (J.M.); (I.M.C.)
| | - Iasmina M. Craici
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (S.T.); (C.T.); (J.M.); (I.M.C.)
| | - Michael A. Mao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA;
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (S.T.); (C.T.); (J.M.); (I.M.C.)
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Diaz‐Arocutipa C, Denegri‐Galvan J, Vicent L, Pariona M, Mamas MA, Hernandez AV. The added value of hypertonic saline solution to furosemide monotherapy in patients with acute decompensated heart failure: A meta-analysis and trial sequential analysis. Clin Cardiol 2023; 46:853-865. [PMID: 37340592 PMCID: PMC10436795 DOI: 10.1002/clc.24033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/20/2023] [Accepted: 05/08/2023] [Indexed: 06/22/2023] Open
Abstract
We assessed the effects of hypertonic saline solution (HSS) plus furosemide versus furosemide alone in patients with acute decompensated heart failure (ADHF). We searched four electronic databases for randomized controlled trials (RCTs) until June 30, 2022. The quality of evidence (QoE) was assessed using the GRADE approach. All meta-analyses were performed using a random-effects model. A trial sequential analysis (TSA) was also conducted for intermediate and biomarker outcomes. Ten RCTs involving 3013 patients were included. HSS plus furosemide significantly reduced the length of hospital stay (mean difference [MD]: -3.60 days; 95% confidence interval [CI]: -4.56 to -2.64; QoE: moderate), weight (MD: -2.34 kg; 95% CI: -3.15 to -1.53; QoE: moderate), serum creatinine (MD: -0.41 mg/dL; 95% CI: -0.49 to -0.33; QoE: low), and type-B natriuretic peptide (MD: -124.26 pg/mL; 95% CI: -207.97 to -40.54; QoE: low) compared to furosemide alone. HSS plus furosemide significantly increased urine output (MD: 528.57 mL/24 h; 95% CI: 431.90 to 625.23; QoE: moderate), serum Na+ (MD: 6.80 mmol/L; 95% CI: 4.92 to 8.69; QoE: low), and urine Na+ (MD: 54.85 mmol/24 h; 95% CI: 46.31 to 63.38; QoE: moderate) compared to furosemide alone. TSA confirmed the benefit of HSS plus furosemide. Due to the heterogeneity in mortality and heart failure readmission, meta-analysis was not performed. Our study shows that HSS plus furosemide, compared to furosemide alone, improved surrogated outcomes in ADHF patients with low or intermediate QoE. Adequately powered RCTs are still needed to assess the benefit on heart failure readmission and mortality.
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Affiliation(s)
| | | | - Lourdes Vicent
- Cardiology DepartmentHospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12)MadridSpain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV)MadridSpain
| | - Marcos Pariona
- Department of CardiologyHospital Nacional Edgardo Rebagliati MartinsLimaPeru
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis ResearchKeele UniversityKeeleUK
| | - Adrian V. Hernandez
- Vicerrectorado de InvestigaciónUniversidad San Ignacio de LoyolaLimaPeru
- Health Outcomes, Policy, and Evidence Synthesis (HOPES) GroupUniversity of Connecticut/Hartford Hospital Evidence‐Based Practice CenterHartfordCTUSA
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23
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Misumi K, Matsue Y, Nogi K, Fujimoto Y, Kagiyama N, Kasai T, Kitai T, Oishi S, Akiyama E, Suzuki S, Yamamoto M, Kida K, Okumura T, Nogi M, Ishihara S, Ueda T, Kawakami R, Saito Y, Minamino T. Derivation and validation of a machine learning-based risk prediction model in patients with acute heart failure. J Cardiol 2023; 81:531-536. [PMID: 36858175 DOI: 10.1016/j.jjcc.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/18/2023] [Accepted: 02/07/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Risk stratification is important in patients with acute heart failure (AHF), and a simple risk score that accurately predicts mortality is needed. The aim of this study is to develop a user-friendly risk-prediction model using a machine-learning method. METHODS A machine-learning-based risk model using least absolute shrinkage and selection operator (LASSO) regression was developed by identifying predictors of in-hospital mortality in the derivation cohort (REALITY-AHF), and its performance was externally validated in the validation cohort (NARA-HF) and compared with two pre-existing risk models: the Get With The Guidelines risk score incorporating brain natriuretic peptide and hypochloremia (GWTG-BNP-Cl-RS) and the acute decompensated heart failure national registry risk (ADHERE). RESULTS In-hospital deaths in the derivation and validation cohorts were 76 (5.1 %) and 61 (4.9 %), respectively. The risk score comprised four variables (systolic blood pressure, blood urea nitrogen, serum chloride, and C-reactive protein) and was developed according to the results of the LASSO regression weighting the coefficient for selected variables using a logistic regression model (4 V-RS). Even though 4 V-RS comprised fewer variables, in the validation cohort, it showed a higher area under the receiver operating characteristic curve (AUC) than the ADHERE risk model (AUC, 0.783 vs. 0.740; p = 0.059) and a significant improvement in net reclassification (0.359; 95 % CI, 0.10-0.67; p = 0.006). 4 V-RS performed similarly to GWTG-BNP-Cl-RS in terms of discrimination (AUC, 0.783 vs. 0.759; p = 0.426) and net reclassification (0.176; 95 % CI, -0.08-0.43; p = 0.178). CONCLUSIONS The 4 V-RS model comprising only four readily available data points at the time of admission performed similarly to the more complex pre-existing risk model in patients with AHF.
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Affiliation(s)
- Kayo Misumi
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan; Department of Critical Care, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan; Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Kazutaka Nogi
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Yudai Fujimoto
- Department of Cardiovascular Medicine, Saitama Medical Centre, Jichi Medical University, Saitama, Japan
| | - Nobuyuki Kagiyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Digital Health and Telemedicine R&D, Juntendo University, Tokyo, Japan; Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan; Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Shogo Oishi
- Department of Cardiogoly, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Japan
| | - Eiichi Akiyama
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Satoshi Suzuki
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Masayoshi Yamamoto
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Keisuke Kida
- Department of Pharmacology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Maki Nogi
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Satomi Ishihara
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Tomoya Ueda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Rika Kawakami
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, Tokyo, Japan
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Paraskevaidis I, Xanthopoulos A, Karamichalakis N, Triposkiadis F, Tsougos E. Medical Treatment in Heart Failure with Reduced Ejection Fraction: A Proposed Algorithm Based on the Patient's Electrolytes and Congestion Status. Med Sci (Basel) 2023; 11:38. [PMID: 37367737 PMCID: PMC10302950 DOI: 10.3390/medsci11020038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
In heart failure (HF) with reduced ejection fraction (HFrEF), four classes of drugs (β-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor neprilysin inhibitors, mineralocorticoid receptor antagonists, and the most recent Sodium-Glucose Co-Transporters 2 Inhibitors) have demonstrated positive results in randomized controlled trials (RCTs). Nevertheless, the latest RCTs are not proper for comparison since they were carried out at various times with dissimilar background therapies and the patients enrolled did not have the same characteristics. The difficulty of extrapolating from these trials and proposing a common framework appropriate for all cases is thus obvious. Despite the fact that these four agents are now the fundamental pillars of HFrEF treatment, the built-up algorithm of initiation and titration is a matter of debate. Electrolyte disturbances are common in HFrEF patients and can be attributed to several factors, such as the use of diuretics, renal impairment, and neurohormonal activation. We have identified several HFrEF phenotypes according to their sodium (Na+) and potassium (K+) status in a "real world" setting and suggest an algorithm on how to introduce the most appropriate drug and set up therapy based on the patients' electrolytes and the existence of congestion.
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Affiliation(s)
| | - Andrew Xanthopoulos
- Department of Cardiology, University Hospital of Larissa, 41110 Larissa, Greece
| | | | | | - Elias Tsougos
- 6th Department of Cardiology, Hygeia Hospital, 15123 Athens, Greece
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Çetin Güvenç R, Güvenç TS, Temizhan A, Çavuşuğlu Y, Çelik A, Yılmaz MB. Effect of renal function on the prognostic importance of chloride in patients with heart failure. J Investig Med 2023; 71:339-349. [PMID: 36680353 DOI: 10.1177/10815589221149186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Hypochloremia has recently gained interest as a potential marker of outcomes in patients with heart failure (HF). The exact pathophysiologic mechanism linking hypochloremia to HF is unclear but is thought to be mediated by chloride-sensitive proteins and channels located in kidneys. This analysis aimed to understand whether renal dysfunction (RD) affects the association of hypochloremia with mortality in patients with HF. Using data from a nationwide registry, 438 cases with complete data on serum chloride concentration and 1-year survival were included in the analysis. Patients with an estimated glomerular filtration rate of <60 mL/min/m2 at baseline were accepted as having RD. Hypochloremia was defined as a chloride concentration <96 mEq/L at baseline. For HF patients without RD at baseline, patients with hypochloremia had a significantly higher 1-year all-cause mortality than those without hypochloremia (41.6% vs 13.0%, log-rank p < 0.001) and the association remained significant after multivariate adjustment (odds ratio (OR): 2.55, 95% confidence interval (CI): 1.25-5.21). The evidence supporting the association was very strong in this subgroup (Bayesian Factor (BF)10: 48.25, log OR: 1.56, 95% CI: 0.69-2.43). For patients with RD at baseline, there was no statistically significant difference for 1-year mortality for patients with or without hypochloremia (36.3% vs 29.7, log-rank p = 0.35) and there was no evidence to support an association between hypochloremia and mortality (BF10: 1.18, log OR :0.66, 95% CI: -0.02 to 1.35). In patients with HF, the association between low chloride concentration and mortality is limited to those without RD at baseline.
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Affiliation(s)
- Rengin Çetin Güvenç
- Division of Cardiology, Department of Internal Medical Sciences, School of Medicine, Istanbul Okan University, Istanbul, Turkey
| | - Tolga Sinan Güvenç
- Division of Cardiology, Department of Internal Medical Sciences, School of Medicine, Istinye University, Istanbul, Turkey
| | - Ahmet Temizhan
- Department of Cardiology, Ankara City Hospital, Ankara, Turkey
| | - Yüksel Çavuşuğlu
- Division of Cardiology, Department of Internal Medical Sciences, School of Medicine, Eskisehir Osmangazi University, Istanbul, Turkey
| | - Ahmet Çelik
- Division of Cardiology, Department of Internal Medical Sciences, School of Medicine, Mersin University, Istanbul, Turkey
| | - Mehmet Birhan Yılmaz
- Division of Cardiology, Department of Internal Medical Sciences, School of Medicine, Dokuz Eylul University, Istanbul, Turkey
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Rask KA, Deis T, Larsson JE, Rossing K, Gustafsson F. Hyponatremia in Stable Patients with Advanced Heart Failure: Association to Hemodynamics and Outcome. Cardiology 2023; 148:187-194. [PMID: 36972577 DOI: 10.1159/000529967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/27/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Hyponatremia is associated with worse outcomes in patients with chronic heart failure (HF) and reduced ejection fraction (HFrEF). However, it is unclear whether the worse prognosis is driven by hemodynamic derangement and how this potentially could be associated with hyponatremia. METHODS The study included 502 patients with HFrEF evaluated for advanced HF therapies, who underwent a right heart catheterization (RHC). Hyponatremia was defined as p-Na ≤136 mmol/L. The risk of all-cause mortality and a composite endpoint including mortality, left ventricular assist device (LVAD) implantation, implantation of total artificial heart (TAH), or heart transplantation (HTx) was evaluated using Cox regression analyses and Kaplan-Meier models. RESULTS Included patients were predominantly men 79% and had a median age of 54 years (IQR: 43-62). A third (165) of the patients had hyponatremia. In both univariate and multivariate regression analyses, p-Na was associated with increased central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP), and mean pulmonary artery pressure (mPAP) but not with cardiac index. Hyponatremia was significantly associated with the combined endpoint (HR: 1.36 [95% CI, 1.07-1.74]; p = 0.01), but not all-cause mortality in adjusted Cox models. CONCLUSION In stable HFrEF patients evaluated for advanced HF therapies, lower p-Na was associated with more deranged invasive hemodynamic measurements. Hyponatremia remained significantly associated with the combined endpoint but not all-cause mortality in adjusted Cox models. The study suggests that the increased mortality associated with hyponatremia in HFrEF patients could partly be driven by hemodynamic derangement.
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Affiliation(s)
- Karoline Amalie Rask
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Tania Deis
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Johan Erik Larsson
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Kasper Rossing
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
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Zhao L, Zhao X, Zhuang X, Zhai M, Wang Y, Huang Y, Zhou Q, Tian P, Liang L, Huang B, Huang L, Feng J, Zhang Y, Zhang J. Hyponatremia and lower normal serum sodium levels are associated with an increased risk of all-cause death in heart failure patients. Nurs Open 2023; 10:3799-3809. [PMID: 36929057 PMCID: PMC10170941 DOI: 10.1002/nop2.1638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 10/04/2022] [Accepted: 01/19/2023] [Indexed: 03/17/2023] Open
Abstract
AIM To explore the relationship between the serum sodium level on admission and all-cause mortality in HF patients. DESIGN A single-center retrospective cohort study. METHODS Patients hospitalized with HF at the Heart Failure Center, Fuwai Hospital, from November 2008 to November 2018 were enrolled. RESULTS A total of 3649 patients were included, and the mean sodium level was 137.19 ± 4.36 mmol/L, with a range from 115.6 to 160.9 mmol/L. During a median follow-up of 1101 days, mortality occurred in 1413 (38.7%) hospital survivors. After adjustment for age, sex, and other potential confounders, patients with sodium levels <135 mmol/L (hazard ratio [HR]: 1.67; 95% confidence interval [CI]: 1.29-2.16) and 135-137 mmol/L (HR: 1.34; 95% CI: 1.01-1.78) had an increased risk of all-cause mortality compared to those with sodium levels of 139-141 mmol/L.
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Affiliation(s)
- Lang Zhao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Xuemei Zhao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Xiaofeng Zhuang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Mei Zhai
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Yunhong Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Yan Huang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Qiong Zhou
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Pengchao Tian
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Lin Liang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Boping Huang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Liyan Huang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Jiayu Feng
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Yuhui Zhang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Jian Zhang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
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Kurashima S, Kitai T, Matsue Y, Nogi K, Kagiyama N, Oishi S, Akiyama E, Suzuki S, Yamamoto M, Kida K, Okumura T, Nogi M, Ishihara S, Ueda T, Kawakami R, Furukawa Y, Saito Y, Izumi C. Trajectory of serum chloride levels during decongestive therapy in acute heart failure. Int J Cardiol 2023; 375:36-43. [PMID: 36584943 DOI: 10.1016/j.ijcard.2022.12.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/14/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Hypochloremia is a risk factor for poor outcomes in patients with acute heart failure (AHF). However, the changes in serum chloride levels during decongestion therapy and their impact on prognosis remain unknown. METHODS In total, 2798 patients with AHF were retrospectively studied and divided into four groups according to their admission and discharge serum chloride levels: (1) normochloremia (n=2,192, 78%); (2) treatment-associated hypochloremia, defined as admission normochloremia with a subsequent decrease (<98 mEq/L) during hospitalization (n=335, 12%); (3) resolved hypochloremia, defined as admission hypochloremia that disappeared at discharge (n=128, 5%); (4) persistent hypochloremia, defined as chloride <98 mEq/L at admission and discharge (n = 143, 5%). The primary outcome was all-cause death, and the secondary outcomes were cardiovascular death and a composite of cardiovascular death and rehospitalization for heart failure after discharge. RESULTS The mean age was 76 ± 12 years and 1584 (57%) patients were men. The mean left ventricular ejection fraction was 46 ± 16%. During a median follow-up period of 365 days, persistent hypochloremia was associated with an increased risk of all-cause death (adjusted hazard ratio [95% confidence interval]: 2.27 [1.53-3.37], p < 0.001), cardiovascular death (2.38 [1.46-3.87], p < 0.001), and a composite of cardiovascular death and heart failure rehospitalization (1.47 [1.06-2.06], p = 0.022). However, the outcomes were comparable between patients with resolved hypochloremia and normochloremia. CONCLUSIONS Persistent hypochloremia was associated with worse clinical outcomes, while resolved hypochloremia and normochloremia showed a comparable prognosis. Changes in serum chloride levels can help identify patients with poor prognoses and can be used to determine subsequent treatment strategies.
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Affiliation(s)
- Shinichi Kurashima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazutaka Nogi
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Nobuyuki Kagiyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Digital Health and Telemedicine R&D, Juntendo University, Tokyo, Japan; Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Shogo Oishi
- Department of Cardiology, Himeji Cardiovascular Center, Himeji, Japan
| | - Eiichi Akiyama
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Satoshi Suzuki
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Masayoshi Yamamoto
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Keisuke Kida
- Department of Pharmacology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Maki Nogi
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Satomi Ishihara
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Tomoya Ueda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Rika Kawakami
- Department of Cardiovascular Medicine, Saiseikai Imperial Gift Foundation Suita Hospital, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan; Nara Prefecture Seiwa Medical Center, Nara, Japan
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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Sendag R, Babus SB, Köse A, Temel GO, Turgutalp K, Tenekeci S. Retrospective analysis of patients diagnosed with severe hyponatraemia in the emergency department. THE NATIONAL MEDICAL JOURNAL OF INDIA 2023; 36:83-88. [PMID: 38692595 DOI: 10.25259/nmji_632_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Background . We investigated the demographic, aetiological and clinical characteristics of patients who presented to the emergency department and had severe hyponatraemia. Methods . We retrospectively evaluated 1171 patients who presented to the emergency department and were diagnosed with severe hyponatraemia. Results . Over half the patients studied were women (53.5%). The mean age of women was higher (p<0.0001). The most common complaint was dyspnoea (16.8%) and 42.5% of the patients had an oral intake disorder. In addition, 22.3% of the patients were on loop diuretics. About 76.3% of patients were conscious, and the mean sodium level of these patients was higher than the mean sodium level of those who responded to verbal and painful stimuli (p<0.001). Severe isolated hyponatraemia was observed in 61.8% of the patients. The mortality rate was 12.8%. There was no difference between the mean sodium levels of the deceased and discharged patients (p=1.0). The mortality rate was higher in patients who had a history of cirrhosis and cancer, but was lower in patients with a history of coronary artery disease (p=0.0002, p<0.0001 and p=0.04, respectively). Conclusion . Severe hyponatraemia was more prevalent in women, serum sodium levels were higher in conscious patients, and the mortality rate was higher in patients who had a history of cirrhosis and cancer. We found that the mean serum sodium levels did not help in distinguishing between the deceased and discharged patients.
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Affiliation(s)
- Refika Sendag
- Mersin City Education Research Hospital Emergency Service, Mersin University Medical Faculty, Mersin, Turkey
| | - Seyran Bozkurt Babus
- Department of Emergency Medicine, Mersin University Medical Faculty, Mersin, Turkey
| | - Ataman Köse
- Department of Emergency Medicine, Mersin University Medical Faculty, Mersin, Turkey
| | - Gülhan Orekici Temel
- Department of Biostatistics and Medical Informatics, Mersin University Medical Faculty, Mersin, Turkey
| | - Kenan Turgutalp
- Department of Nephrology, Mersin University Medical Faculty, Mersin, Turkey
| | - Sevcan Tenekeci
- Department of Obstetrics and Gynaecology, Mersin University Medical Faculty, Mersin, Turkey
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Cohen A, Li T, Maybaum S, Fridman D, Gordon M, Shi D, Nelson M, Stevens GR. Pulmonary Congestion on Lung Ultrasound Predicts Increased Risk of 30-Day Readmission in Heart Failure Patients. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023. [PMID: 36840718 DOI: 10.1002/jum.16202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/03/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Heart failure exacerbations are a common cause of hospitalizations with a high readmission rate. There are few validated predictors of readmission after treatment for acute decompensated heart failure (ADHF). Lung ultrasound (LUS) is sensitive and specific in the assessment of pulmonary congestion; however, it is not frequently utilized to assess for congestion before discharge. This study assessed the association between number of B-lines, on LUS, at patient discharge and risk of 30-day readmission in patients hospitalized for acute decompensated heart failure (ADHF). METHODS This was a single-center prospective study of adults admitted to a quaternary care center with a diagnosis of ADHF. At the time of discharge, the patient received an 8-zone LUS exam to evaluate for the presence of B-lines. A zone was considered positive if ≥3 B-lines was present. We assessed the risk of 30-day readmission associated with the number of lung zones positive for B-lines using a log-binomial regression model. RESULTS Based on data from 200 patients, the risk of 30-day readmission in patients with 2-3 positive lung zones was 1.25 times higher (95% CI: 1.08-1.45), and in patients with 4-8 positive lung zones was 1.50 times higher (95% CI: 1.23-1.82, compared with patients with 0-1 positive zones, after adjusting for discharge blood urea nitrogen, creatinine, and hemoglobin. CONCLUSION Among patients admitted with ADHF, the presence of B-lines at discharge was associated with a significantly increased risk of 30-day readmission, with greater number of lung zones positive for B-lines corresponding to higher risk.
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Affiliation(s)
- Allison Cohen
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, USA
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Timmy Li
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, USA
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Simon Maybaum
- Department of Cardiology, North Shore University Hospital, Manhasset, New York, USA
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - David Fridman
- Department of Cardiology, North Shore University Hospital, Manhasset, New York, USA
| | - Miles Gordon
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, USA
- Department of Emergency Medicine, Columbia University, Manhattan, New York, USA
| | - Dorothy Shi
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, USA
- Department of Emergency Medicine, South Shore University Hospital, Bay Shore, New York, USA
| | - Mathew Nelson
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, USA
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Gerin R Stevens
- Department of Cardiology, North Shore University Hospital, Manhasset, New York, USA
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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Ishikawa SE, Funayama H. Hyponatremia Associated with Congestive Heart Failure: Involvement of Vasopressin and Efficacy of Vasopressin Receptor Antagonists. J Clin Med 2023; 12:jcm12041482. [PMID: 36836016 PMCID: PMC9967582 DOI: 10.3390/jcm12041482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 02/04/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Hyponatremia is frequently found in patients with congestive heart failure. A reduction in effective circulatory blood volume in a volume-expanded patient with decreased cardiac output is linked to a baroreceptor-mediated non-osmotic release of arginine vasopressin (AVP). The increased production of AVP and salt and water retention in the proximal and distal tubules of the kidney by humoral, hemodynamic, and neural mechanisms increase circulatory blood volume and contribute to hyponatremia. Recent studies have indicated that hyponatremia predicts the short-term and long-term prognosis of heart failure by increasing cardiac death and rehospitalization. In addition, the early development of hyponatremia in acute myocardial infarction also predicts the long-term prognosis of worsening heart failure. AVP V2 receptor antagonism may relieve water retention, but it is unknown whether the V2 receptor inhibitor, tolvaptan, improves the long-term prognosis of congestive heart failure. The newly identified natriuretic factor in renal salt wasting has the potential of improving clinical outcomes when combined with a distal diuretic.
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Affiliation(s)
- San-e Ishikawa
- Department of Medicine, Jichi Medical University, Shimotsuke 329-0498, Tochigi, Japan
- Correspondence:
| | - Hiroshi Funayama
- Department of Cardiology, Jichi Medical University, Shimotsuke 329-0498, Tochigi, Japan
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32
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Association of hyponatremia with clinical outcomes in patients admitted with acute pulmonary embolism. J Thromb Thrombolysis 2023; 55:737-741. [PMID: 36745322 DOI: 10.1007/s11239-023-02783-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hyponatremia is associated with negative prognosis in several conditions like Congestive heart failure and acute MI (Myocardial Infarction), but its impact on the outcomes in patients with pulmonary embolism (PE) is not well studied. We aimed to study the association of hyponatremia in patients hospitalized with PE. METHODS A retrospective cohort study was designed using data obtained from the 2016 to 2019 combined National Inpatient Sample (NIS) database. Adult patients admitted with PE were identified and stratified based on the presence of hyponatremia. Primary outcomes assessed were, mortality, length of stay (LOS), and Total Hospitalization Charges (THC). Secondary outcomes included a diagnosis of Acute Kidney Injury (AKI), Acute Respiratory Failure (ARF), sepsis, Acute Cerebrovascular accident (CVA), arrhythmias and acute MI. Multivariate linear and logistic regressions were used to adjust for confounders. RESULTS There was a total of 750,655 adult hospitalizations for PE and among them 41,595 (5.5%) had a secondary diagnosis of hyponatremia. Hyponatremia was associated with an increased odds of mortality, 6.31% vs 2.91% (AOR:1.77, p = 0.000, 95% CI: 1.61-1.92), increased LOS, 6.79 days vs 4.20 days (adjusted difference of 2.20 days, p = 0.000, 95% CI: 2.04-2.37), as well as an increase in THC, 75,458.95 USD vs 46,708.27 USD (adjusted difference of 24,341.37 USD, p < 0.001, 95% CI: 21,484.58-27,198.16). Similarly, the presence of hyponatremia was associated with increased odds of several secondary outcomes measured. CONCLUSION Hyponatremia is associated with an increased odds of death and attendant increase in LOS and THC. The odds of several secondary adverse clinical outcomes were also increased.
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33
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Wettersten N, Duff S, Horiuchi Y, van Veldhuisen DJ, Mueller C, Filippatos G, Nowak R, Hogan C, Kontos MC, Cannon CM, Müeller GA, Birkhahn R, Taub P, Vilke GM, McDonald K, Mahon N, Nuñez J, Briguori C, Passino C, Maisel A, Murray PT, Ix JH. Implications of worsening renal function before hospitalization for acute heart failure. ESC Heart Fail 2023; 10:532-541. [PMID: 36325747 PMCID: PMC9871662 DOI: 10.1002/ehf2.14221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/13/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022] Open
Abstract
AIMS Kidney function changes dynamically during AHF treatment, but risk factors for and consequences of worsening renal function (WRF) at hospital admission are uncertain. We aimed to determine the significance of WRF at admission for acute heart failure (AHF). METHODS AND RESULTS We evaluated a subgroup of 406 patients from The Acute Kidney Injury Neutrophil gelatinase-associated lipocalin Evaluation of Symptomatic heart failure Study (AKINESIS) who had serum creatinine measurements available within 3 months before and at the time of admission. Admission WRF was primarily defined as a 0.3 mg/dL or 50% creatinine increase from preadmission. Alternative definitions evaluated were a ≥0.5 mg/dL creatinine increase, ≥25% glomerular filtration rate decrease, and an overall change in creatinine. Predictors of admission WRF were evaluated. Outcomes evaluated were length of hospitalization, a composite of adverse in-hospital events, and the composite of death or HF readmission at 30, 90, and 365 days. Biomarkers' prognostic ability for these outcomes were evaluated in patients with admission WRF. One-hundred six patients (26%) had admission WRF. These patients had features of more severe AHF with lower blood pressure, higher BUN, and lower serum sodium concentrations at admission. Higher BNP (odds ratio [OR] per doubling 1.16-1.28, 95% confidence interval [CI] 1.00-1.55) and lower diastolic blood pressure (OR 0.97-0.98, 95% CI 0.96-0.99) were associated with a higher odds for the three definitions of admission WRF. The primary WRF definition was not associated with a longer hospitalization, but alternative WRF definitions were (1.3 to 1.6 days longer, 95% CI 1.0-2.2). WRF across definitions was not associated with a higher odds of adverse in-hospital events or a higher risk of death or HF readmission. In the subset of patients with WRF, biomarkers were not prognostic for any outcome. CONCLUSIONS Admission WRF is common in AHF patients and is associated with an increased length of hospitalization, but not adverse in-hospital events, death, or HF readmission. Among those with admission WRF, biomarkers did not risk stratify for adverse events.
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Affiliation(s)
- Nicholas Wettersten
- Division of Cardiovascular MedicineSan Diego Veterans Affairs Medical CenterSan DiegoCaliforniaUSA
- Division of Cardiovascular MedicineUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Stephen Duff
- School of MedicineUniversity College DublinDublinIreland
| | - Yu Horiuchi
- Division of CardiologyMitsui Memorial HospitalTokyoJapan
| | - Dirk J. van Veldhuisen
- Department of Cardiology, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Christian Mueller
- Department of Cardiology, University Hospital BaselUniversity of BaselBaselSwitzerland
| | - Gerasimos Filippatos
- Department of Cardiology, Athens University Hospital AttikonUniversity of AthensAthensGreece
| | - Richard Nowak
- Department of Emergency MedicineHenry Ford Hospital SystemDetroitMichiganUSA
| | - Christopher Hogan
- Division of Emergency Medicine and Acute Care Surgical Services, VCU Medical CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Michael C. Kontos
- Division of Cardiology, VCU Medical CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Chad M. Cannon
- Department of Emergency MedicineUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Gerhard A. Müeller
- Department of Nephrology and Rheumatology, University Medical Center GöttingenUniversity of GöttingenGöttingenGermany
| | - Robert Birkhahn
- Department of Emergency MedicineNew York MethodistBrooklynNew YorkUSA
| | - Pam Taub
- Division of Cardiovascular MedicineUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Gary M. Vilke
- Department of Emergency MedicineUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Kenneth McDonald
- Department of Cardiology, Mater Misericordiae University HospitalUniversity College DublinDublinIreland
- Department of CardiologySt. Vincent's University HospitalDublinIreland
| | - Niall Mahon
- Department of CardiologySt. Vincent's University HospitalDublinIreland
| | - Julio Nuñez
- Department of Cardiology, Hospital Clínico Universitario Valencia, INCLIVAUniversity of ValenciaValenciaSpain
- CIBER in Cardiovascular DiseasesMadridSpain
| | - Carlo Briguori
- Department of Cardiology, Interventional CardiologyMediterranea CardiocentroNaplesItaly
| | - Claudio Passino
- Department of Cardiology and Cardiovascular MedicineFondazione Gabriele MonasterioPisaItaly
| | - Alan Maisel
- Division of Cardiovascular MedicineUniversity of California, San DiegoLa JollaCaliforniaUSA
| | | | - Joachim H. Ix
- Division of Nephrology‐Hypertension, Department of MedicineUniversity of California San DiegoLa JollaCaliforniaUSA
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Ontaneda AM, Coss-Bu JA, Kennedy C, Akcan-Arikan A, Fernandez E, Lasa JJ, Price JF, Shekerdemian LS. Post-operative dysnatremia is associated with adverse early outcomes after surgery for congenital heart disease. Pediatr Res 2023:10.1038/s41390-023-02495-4. [PMID: 36707662 DOI: 10.1038/s41390-023-02495-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 12/17/2022] [Accepted: 01/15/2023] [Indexed: 01/28/2023]
Abstract
BACKGROUND Dysnatremia is a common disorder in critically ill surgical children. The study's aim is to determine the prevalence of dysnatremia and its association with outcomes after surgery for congenital heart disease (CHD). METHODS This is a single-center retrospective cohort study of children <18 years of age undergoing surgery for CHD between January 2012 and December 2014. Multivariable logistic regression analysis was used to evaluate the relationship between dysnatremia and outcomes during the perioperative period. A total of 1345 encounters met the inclusion criteria. RESULTS The prevalence of pre- and post-operative dysnatremia were 10.2% and 47.1%, respectively. Hyponatremia occurred in 19.1%, hypernatremia in 25.6%. Hypernatremia at 24, 48, and 72 h post-operative was associated with increased hospital mortality (odds ratios (OR) [95% confidence intervals (CI)] 3.08 [1.16-8.17], p = 0.024; 4.35 [1.58-12], p = 0.0045; 4.14 [1.32-12.97], p = 0.0148, respectively. Hypernatremia was associated with adverse neurological events 3.39 [1.12-10.23], p = 0.0302 at 48 h post-operative. Hyponatremia was not associated with any adverse outcome in our secondary analysis. CONCLUSIONS Post-operative dysnatremia is a common finding in this heterogeneous cohort of pediatric cardiac-surgical patients. Hypernatremia was more prevalent than hyponatremia and was associated with adverse early post-operative outcomes. IMPACT Our study has shown that dysnatremia was highly prevalent in children after congenital heart surgery with hypernatremia associated with adverse outcomes including mortality. It is important to understand fluid and sodium regulation in the post-operative period in children with congenital heart disease to better address fluid overload and associated electrolyte imbalances and acute kidney injury. While clinicians are generally very aware of the importance of hyponatremia in critically ill children, similar attention should be given to hypernatremia in this population.
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Affiliation(s)
- Andrea M Ontaneda
- Division of Critical Care, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.
| | - Jorge A Coss-Bu
- Division of Critical Care, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Curtis Kennedy
- Division of Critical Care, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Ayse Akcan-Arikan
- Division of Critical Care, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.,Division of Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Ernesto Fernandez
- Division of Critical Care, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Javier J Lasa
- Division of Critical Care, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Jack F Price
- Division of Critical Care, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Lara S Shekerdemian
- Division of Critical Care, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
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35
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Rao J, Ma Y, Long J, Tu Y, Guo Z. The combined impact of hyponatremia and hematocrit on the risk for 90-day readmission and death in patients with heart failure: dilutional hyponatremia versus depletional hyponatremia. Ann Saudi Med 2023; 43:17-24. [PMID: 36739500 PMCID: PMC9899337 DOI: 10.5144/0256-4947.2023.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hyponatremia is common in hospitalized patients with heart failure (HF) and predicts a poor prognosis after discharge. In general, hyponatremia can be divided into two types: dilutional or depletional. OBJECTIVE Assess the impact of hyponatremia type on short-term outcomes. DESIGN Retrospective cohort SETTINGS: Single center in China PATIENTS AND METHODS: We sorted patients by hyponatremia into two types: dilutional hyponatremia (DiH, with hematocrit <35%) and depletional hyponatremia (DeH, with hematocrit ≥35%). The Kaplan-Meier method and Cox regression analysis were used to identify the impact of hyponatremia types on the risk for 90-day readmission and death. MAIN OUTCOME MEASURES 90-day readmission and death combined. SAMPLE SIZE 1770 patients. RESULTS Hyponatremia was present in 324/1770 patients with 182 cases classified as DiH versus 142 as DeH. Kaplan-Meier analyses showed a higher incidence of poor short-term outcomes in hyponatremia compared with normonatremia (log-rank P<.001), and the risk was higher in DiH than DeH although the difference was not statistically significant (log-rank P=.656). Multivariate Cox regression analyses showed that only DiH was independently associated with short-term outcomes (HR=1.34, 95%CI: 1.02-1.77, P=.038), but not DeH (HR=1.32, 95%CI: 0.97-1.80, P=.081). Analysis of the secondary endpoints showed that DiH increased the risk of readmission but not death (HR=1.36, P=.035 for readmission; HR=1.13, P=.831 for all-cause death). CONCLUSIONS Low hematocrit, rather than high hematocrit, with hyponatremia was associated with a risk of 90-day readmission in patients with HF. LIMITATIONS Single center, nonrandomized. CONFLICT OF INTEREST None.
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Affiliation(s)
- Jiahuan Rao
- From the Department of Cardiology, Huiqiao Medical Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yusheng Ma
- From the Department of Cardiology, Huiqiao Medical Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jieni Long
- From the Department of Cardiology, Huiqiao Medical Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yan Tu
- From the Department of Cardiology, Huiqiao Medical Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhigang Guo
- From the Department of Cardiology, Huiqiao Medical Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
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36
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Anwar F, Omar Asar T, Al-Abassi FA, Kumar V, Alhayyani S. Natural sea salt in diet ameliorates better protection compared to table salt in the doxorubicin-induced cardiac remodeling. JOURNAL OF TAIBAH UNIVERSITY FOR SCIENCE 2022. [DOI: 10.1080/16583655.2022.2154491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Firoz Anwar
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Turky Omar Asar
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Biology, College of Science and Arts at Alkamil, University of Jeddah, Jeddah, Saudi Arabia
| | - Fahad A. Al-Abassi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Vikas Kumar
- Natural Product Drug Discovery Laboratory, Department of Pharmaceutical Sciences, Faculty of Health Sciences, Sam Higginbottom Institute of Agriculture, Technology & Sciences, Allahabad, Uttar Pradesh, India
| | - Sultan Alhayyani
- Department of Chemistry, College of Sciences & Arts, King Abdulaziz University, Rabigh, Saudi Arabia
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Tibrewala A, Wehbe RM, Wu T, Harap R, Ghafourian K, Wilcox JE, Okwuosa IS, Vorovich EE, Ahmad FS, Yancy C, Pawale A, Anderson AS, Pham DT, Rich JD. Hyponatremia Is a Powerful Predictor of Poor Prognosis in Left Ventricular Assist Device Patients. ASAIO J 2022; 68:1475-1482. [PMID: 35696712 PMCID: PMC9908070 DOI: 10.1097/mat.0000000000001691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Serum sodium is an established prognostic marker in heart failure (HF) patients and is associated with an increased risk of morbidity and mortality. We sought to study the prognostic value of serum sodium in left ventricular assist device (LVAD) patients and whether hyponatremia reflects worsening HF or an alternative mechanism. We identified HF patients that underwent LVAD implantation between 2008 and 2019. Hyponatremia was defined as Na ≤134 mEq/L at 3 months after implantation. We assessed for differences in hyponatremia before and after LVAD implantation. We also evaluated the association of hyponatremia with all-cause mortality and recurrent HF hospitalizations. There were 342 eligible LVAD patients with a sodium value at 3 months. Among them, there was a significant improvement in serum sodium after LVAD implantation compared to preoperatively (137.2 vs. 134.7 mEq/L, P < 0.0001). Patients with and without hyponatremia had no significant differences in echocardiographic and hemodynamic measurements. In a multivariate analysis, hyponatremia was associated with a markedly increased risk of all-cause mortality (HR 3.69, 95% CI, 1.93-7.05, P < 0.001) when accounting for age, gender, co-morbidities, use of loop diuretics, and B-type natriuretic peptide levels. Hyponatremia was also significantly associated with recurrent HF hospitalizations (HR 2.11, 95% CI, 1.02-4.37, P = 0.04). Hyponatremia in LVAD patients is associated with significantly higher risk of all-cause mortality and recurrent HF hospitalizations. Hyponatremia may be a marker of ongoing neurohormonal activation that is more sensitive than other lab values, echocardiography parameters, and hemodynamic measurements.
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Affiliation(s)
- Anjan Tibrewala
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Ramsey M. Wehbe
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Tingqing Wu
- Clinical Trials Unit, Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
| | - Rebecca Harap
- Department of Surgery, Division of Cardiac Surgery, Northwestern University, Chicago, Illinois
| | - Kambiz Ghafourian
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Jane E. Wilcox
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Ike S. Okwuosa
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Esther E. Vorovich
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Faraz S. Ahmad
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Clyde Yancy
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Amit Pawale
- Department of Surgery, Division of Cardiac Surgery, Northwestern University, Chicago, Illinois
| | - Allen S. Anderson
- Department of Medicine, Division of Cardiology, University of Texas at San Antonio, San Antonio, Texas
| | - Duc T. Pham
- Department of Surgery, Division of Cardiac Surgery, Northwestern University, Chicago, Illinois
| | - Jonathan D. Rich
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
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38
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Peng S, Peng J, Yang L, Ke W. Relationship between serum sodium levels and all-cause mortality in congestive heart failure patients: A retrospective cohort study based on the Mimic-III database.. [DOI: 10.21203/rs.3.rs-1919991/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
BACKGROUND: The relationship between serum sodium levels and mortality in congestive heart failure (CHF) patients has not been well studied previously. Serum sodium levels are linked to an increased risk of all-cause death in CHF patients over the short, medium, and long term. Serum sodium levels are strongly linked to an increased risk of death from congestive heart failure and could be a new risk factor for cardiovascular disease. The goal of this study is to look into the relationship between serum sodium levels and all-cause mortality in people with CHF after controlling for other factors.METHODS: The publicly accessible Mimic III database was the source of data for our study. We use the ICU Admission Scoring System to collect demographic data, laboratory findings, comorbidities, vital signs, and scoring information for each patient. Cox proportional risk analysis, smooth curve fitting, and the Kaplan-Meier survival curve were used to assess the relationship between baseline sodium levels and all-cause mortality in CHF patients.RESULTS: The segmentation regression model discovered a turning point value of serum sodium levels (137.5mmol/L) between serum sodium levels and all-cause mortality. According to the results of the fully adjusted Cox proportional hazard model, lower serum sodium levels (<137.5mmol/L) were associated with an increased risk of 30-day, 90-day, 365-day, and 4-year all-cause deaths. The HRs and 95th confidence intervals were 0.96 (0.94, 0.99) , 0.96 (0.94, 0.99), 0.96 (0.94, 0.98) , and 0.96 (0.95, 0.98), respectively; The higher Serum sodium levels(≥137.5mmol/L) were related to associate multiplied risk of 30-day, 90-day, 365-day, and 4-year all-cause deaths; the HRs and 95th confidence intervals were 1.02 (1.00, 1.05), 1.02 (1.00, 1.04), 1.02 (1.00, 1.03) , and 1.02 (1.00, 1.03), respectively.CONCLUSION: Serum sodium levels were u-shaped about all-cause mortality. In individuals with CHF, serum sodium levels are linked to an elevated risk of short-, medium-, and long-term all-cause mortality.
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Affiliation(s)
- Shixuan Peng
- The First People's Hospital of Xiangtan City, the University of South China
| | | | | | - Weiqi Ke
- The First Affiliated Hospital of Shantou University Medical College
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39
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Tanemoto M, Suenaga S. Hyponatremia reflects mortality risks other than myocardial damage in acute coronary syndrome. Intern Emerg Med 2022; 17:1235-1237. [PMID: 35066859 DOI: 10.1007/s11739-021-02915-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/16/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Masayuki Tanemoto
- Division of Nephrology, Department of Internal Medicine, International University of Health and Welfare School of Medicine, 13-1 Higashi-Kaigan-Cho, Atami, Shizuoka, 413-0012, Japan.
- Dialysis Unit, Shin-Kuki General Hospital, Saitama, Japan.
| | - Shingo Suenaga
- Cardiovascular Center, Shin-Kuki General Hospital, Saitama, Japan
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40
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Lamba HK, Parikh UM, Vincent J, Civitello AB, Nair A, Bhardwaj A, Senussi MH, Loor G, Shafii AE, Liao KK, Chatterjee S. Preoperative hyponatremia and survival after left ventricular assist device implantation. Artif Organs 2022; 46:1923-1931. [PMID: 35524483 DOI: 10.1111/aor.14280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/19/2022] [Accepted: 04/29/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hyponatremia is associated with adverse outcomes in heart failure and after cardiac surgery. We hypothesized that hyponatremia is associated with poorer short-term and longer-term survival in patients after continuous-flow left ventricular assist device (CF-LVAD) placement. METHODS We reviewed a single-center database of patients who received a CF-LVAD during 2012-2017. Sodium (Na) values obtained within 14 days before CF-LVAD insertion were averaged; patients (n=332) were divided into hyponatremia (mean Na <135 mEq/L; n=160; 48.2%) and normonatremia groups (mean Na 135-145 mEq/L; n=172; 51.8%). Patients requiring preoperative dialysis or pump exchanged were excluded. We compared outcomes between preoperative hyponatremia and normonatremia groups. RESULTS The two groups' baseline characteristics were similar, although hyponatremia patients more often had preoperative mechanical circulatory support (44.4% vs 31.4%, p=0.002). Although hyponatremic and normonatremic patients did not differ in 30-day mortality (7.5% vs 6.5%, p=0.7), preoperative hyponatremia was associated with greater 5-year mortality (61% vs 44%, p=0.03). On binary logistic regression analysis, the strongest independent predictors of late mortality were hyponatremia (odds ratio [OR] 1.88, 95% CI [1.07-3.31], p=0.02), older age (OR 1.03, 95% CI [1.01-1.05], p=0.01), and elevated mean right atrial pressure/pulmonary capillary wedge pressure ratio (OR 4.69, 95% CI [1.76-12.47], p=0.002). CONCLUSIONS Hyponatremia was not associated with greater early mortality but was associated with poorer late survival. Optimal timing of LVAD implantation in relation to hyponatremia, and whether correcting hyponatremia perioperatively improves long-term survival, should be investigated.
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Affiliation(s)
- Harveen K Lamba
- Michael E. DeBakey Department of Surgery, Division of Cardiothoracic Transplantation and Circulatory Support, Baylor College of Medicine, Houston, Texas, USA
| | - Umang M Parikh
- Michael E. DeBakey Department of Surgery, Division of Cardiothoracic Transplantation and Circulatory Support, Baylor College of Medicine, Houston, Texas, USA
| | - Justin Vincent
- Michael E. DeBakey Department of Surgery, Division of Cardiothoracic Transplantation and Circulatory Support, Baylor College of Medicine, Houston, Texas, USA
| | - Andrew B Civitello
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.,Department of Cardiology, Texas Heart Institute, Houston, Texas, USA
| | - Ajith Nair
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.,Department of Cardiology, Texas Heart Institute, Houston, Texas, USA
| | - Anju Bhardwaj
- Center for Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas, Houston, Texas, USA
| | - Mourad H Senussi
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Gabriel Loor
- Michael E. DeBakey Department of Surgery, Division of Cardiothoracic Transplantation and Circulatory Support, Baylor College of Medicine, Houston, Texas, USA.,Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas, USA
| | - Alexis E Shafii
- Michael E. DeBakey Department of Surgery, Division of Cardiothoracic Transplantation and Circulatory Support, Baylor College of Medicine, Houston, Texas, USA.,Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas, USA
| | - Kenneth K Liao
- Michael E. DeBakey Department of Surgery, Division of Cardiothoracic Transplantation and Circulatory Support, Baylor College of Medicine, Houston, Texas, USA.,Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas, USA
| | - Subhasis Chatterjee
- Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas, USA.,Michael E. DeBakey Department of Surgery, Division of General Surgery, Baylor College Medicine, Houston, Texas, USA.,Michael E. DeBakey Department of Surgery, Division of Cardiothoracic Surgery, Baylor College Medicine, Houston, Texas, USA
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Umehara T, Kaneguchi A, Kawakami W, Katayama N, Kito N. Association of muscle mass and quality with hand grip strength in elderly patients with heart failure. Heart Vessels 2022; 37:1380-1386. [PMID: 35233647 DOI: 10.1007/s00380-022-02046-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/18/2022] [Indexed: 11/26/2022]
Abstract
In patients with heart failure, it is unknown whether the extracellular water (ECW)/intracellular water (ICW) ratio is associated with muscle strength, and thus, it is not well understood whether poor muscle quality contributes to muscular weakness. This study examined the relationship among hand grip strength, skeletal muscle mass index (SMI), and upper limb ECW/ICW ratio in patients with heart failure. This study followed a cross-sectional design. Demographic data, medical information, and hand grip strength were collected. The SMI and ECW/ICW ratio were measured using bio-impedance analysis (BIA). Hierarchical multiple regression analysis was conducted to identify factors associated with hand grip strength. 51 patients with heart failure were analyzed for this study (mean age 84.58 ± 7.18). Hierarchical multiple regression analysis identified SMI as well as upper limb ECW/ICW ratio as factors associated with hand grip strength, independent of age, sex, body mass index, and Life Space Assessment scores. Standardized partial regression coefficients representing the magnitude of involvement of each independent variable were 0.33 and - 0.16. The coefficient of determination adjusted for degrees of freedom (R2), representing the contribution rate of the regression equation, was 0.830. We revealed that loss of hand grip strength in patients with heart failure is associated with not only with a decrease in skeletal muscle mass, but also with a decline in muscle quality, characterized by an increased upper limb ECW/ICW ratio. BIA is a simple and useful method to measure the ECW/ICW ratio, and in turn, the muscle quality, in patients with heart failure.
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Affiliation(s)
- Takuya Umehara
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan.
| | - Akinori Kaneguchi
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
| | - Wataru Kawakami
- Department of Rehabilitation, Kure Kyosai Hospital, Nishichuo 2-3-28, Kure, Hiroshima, Japan
| | - Nobuhisa Katayama
- Department of Rehabilitation, Kure Kyosai Hospital, Nishichuo 2-3-28, Kure, Hiroshima, Japan
| | - Nobuhiro Kito
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
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Dridi H, Santulli G, Gambardella J, Jankauskas SS, Yuan Q, Yang J, Reiken S, Wang X, Wronska A, Liu X, Lacampagne A, Marks AR. IP3 receptor orchestrates maladaptive vascular responses in heart failure. J Clin Invest 2022; 132:e152859. [PMID: 35166236 PMCID: PMC8843748 DOI: 10.1172/jci152859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/21/2021] [Indexed: 12/02/2022] Open
Abstract
Patients with heart failure (HF) have augmented vascular tone, which increases cardiac workload, impairing ventricular output and promoting further myocardial dysfunction. The molecular mechanisms underlying the maladaptive vascular responses observed in HF are not fully understood. Vascular smooth muscle cells (VSMCs) control vasoconstriction via a Ca2+-dependent process, in which the type 1 inositol 1,4,5-trisphosphate receptor (IP3R1) on the sarcoplasmic reticulum (SR) plays a major role. To dissect the mechanistic contribution of intracellular Ca2+ release to the increased vascular tone observed in HF, we analyzed the remodeling of IP3R1 in aortic tissues from patients with HF and from controls. VSMC IP3R1 channels from patients with HF and HF mice were hyperphosphorylated by both serine and tyrosine kinases. VSMCs isolated from IP3R1VSMC-/- mice exhibited blunted Ca2+ responses to angiotensin II (ATII) and norepinephrine compared with control VSMCs. IP3R1VSMC-/- mice displayed significantly reduced responses to ATII, both in vivo and ex vivo. HF IP3R1VSMC-/- mice developed significantly less afterload compared with HF IP3R1fl/fl mice and exhibited significantly attenuated progression toward decompensated HF and reduced interstitial fibrosis. Ca2+-dependent phosphorylation of the MLC by MLCK activated VSMC contraction. MLC phosphorylation was markedly increased in VSMCs from patients with HF and HF mice but reduced in VSMCs from HF IP3R1VSMC-/- mice and HF WT mice treated with ML-7. Taken together, our data indicate that VSMC IP3R1 is a major effector of increased vascular tone, which contributes to increased cardiac afterload and decompensation in HF.
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MESH Headings
- Animals
- Calcium Signaling
- Heart Failure/genetics
- Heart Failure/metabolism
- Heart Failure/physiopathology
- Humans
- Inositol 1,4,5-Trisphosphate Receptors/genetics
- Inositol 1,4,5-Trisphosphate Receptors/metabolism
- Mice
- Mice, Knockout
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/physiopathology
- Myocytes, Smooth Muscle/metabolism
- Vasoconstriction
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Affiliation(s)
- Haikel Dridi
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Gaetano Santulli
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, New York, New York, USA
- Department of Molecular Pharmacology, Einstein-Sinai Diabetes Research Center (ES-DRC), Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Neuroimmunology and Inflammation, Albert Einstein College of Medicine, New York, New York, USA
| | - Jessica Gambardella
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, New York, New York, USA
- International Translational Research and Medical Education (ITME) Consortium, Department of Advanced Biomedical Science, “Federico II” University, Naples, Italy
| | - Stanislovas S. Jankauskas
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, New York, New York, USA
- Department of Molecular Pharmacology, Einstein-Sinai Diabetes Research Center (ES-DRC), Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Neuroimmunology and Inflammation, Albert Einstein College of Medicine, New York, New York, USA
| | - Qi Yuan
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Jingyi Yang
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Steven Reiken
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Xujun Wang
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, New York, New York, USA
- Department of Molecular Pharmacology, Einstein-Sinai Diabetes Research Center (ES-DRC), Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Neuroimmunology and Inflammation, Albert Einstein College of Medicine, New York, New York, USA
| | - Anetta Wronska
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Xiaoping Liu
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Alain Lacampagne
- PhyMedExp, University of Montpellier, CNRS, INSERM, CHRU Montpellier, Montpellier, France
| | - Andrew R. Marks
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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Seo M, Watanabe T, Yamada T, Yano M, Hayashi T, Nakagawa A, Nakagawa Y, Tamaki S, Yasumura Y, Sotomi Y, Hikoso S, Nakatani D, Fukunami M, Sakata Y. Prognostic significance of serum chloride level in heart failure patients with preserved ejection fraction. ESC Heart Fail 2022; 9:1444-1453. [PMID: 35137570 PMCID: PMC8934985 DOI: 10.1002/ehf2.13840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/06/2022] [Accepted: 01/26/2022] [Indexed: 11/16/2022] Open
Abstract
Aims The prognostic value of serum chloride level has been reported primarily in patients with heart failure with reduced ejection fraction, and hence, there is limited evidence in patients of heart failure with preserved ejection fraction (HFpEF). This study was conducted to clarify the relationship between serum chloride level and clinical outcomes in patients with HFpEF with acute decompensated heart failure (ADHF). Methods and results Patient data were extracted from The Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with Preserved Ejection Fraction (PURSUIT HFpEF) study, a prospective multicentre observational registry for ADHF‐HFpEF in Osaka. The data of 870 patients were analysed after excluding patients with in‐hospital death, missing follow‐up data, missing data of serum chloride level, or on chronic dialysis therapy. The primary endpoint of this study was all‐cause mortality. At discharge, right ventricular systolic dysfunction was significantly associated with the lowest tertile of serum chloride level after multivariable adjustment (P = 0.0257). During a mean follow‐up period of 1.8 ± 1.0 years, 186 patients died. Cox multivariable analysis showed that serum chloride level at discharge (P = 0.0017) was independently associated with all‐cause mortality after multivariable adjustment of major confounders, whereas serum sodium level was no longer significant (P = 0.6761). Kaplan–Meier survival curve analysis revealed a significantly increased risk of mortality stratified by the tertile of serum chloride level [29% vs. 19% vs. 16%, P = 0.0002; hazard ratio (HR): 2.09 (95% confidence interval, CI: 1.31 to 3.34), HR: 1.03 (95% CI: 0.65 to 1.64)]. Conclusions Serum chloride level was useful for the prediction of poor outcome in ADHF patients with preserved ejection fraction.
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Affiliation(s)
- Masahiro Seo
- Division of Cardiology, Osaka General Medical Center, 3-1-56 Mandaihigashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Tetsuya Watanabe
- Division of Cardiology, Osaka General Medical Center, 3-1-56 Mandaihigashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Takahisa Yamada
- Division of Cardiology, Osaka General Medical Center, 3-1-56 Mandaihigashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | | | - Akito Nakagawa
- Division of Cardiovascular Medicine, Amagasaki-Chuo Hospital, Amagasaki, Japan.,Department of Medical Informatics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yusuke Nakagawa
- Division of Cardiology, Kawanishi City Hospital, Kawanishi, Japan
| | - Shunsuke Tamaki
- Department of Cardiology, Rinku General Medical Center, Osaka, Japan
| | - Yoshio Yasumura
- Division of Cardiovascular Medicine, Amagasaki-Chuo Hospital, Amagasaki, Japan
| | - Yohei Sotomi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masatake Fukunami
- Division of Cardiology, Osaka General Medical Center, 3-1-56 Mandaihigashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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44
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Lisco G, Giagulli VA, Iovino M, Zupo R, Guastamacchia E, De Pergola G, Iacoviello M, Triggiani V. Endocrine system dysfunction and chronic heart failure: a clinical perspective. Endocrine 2022; 75:360-376. [PMID: 34713389 PMCID: PMC8553109 DOI: 10.1007/s12020-021-02912-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 10/13/2021] [Indexed: 11/01/2022]
Abstract
Chronic heart failure (CHF) leads to an excess of urgent ambulatory visits, recurrent hospital admissions, morbidity, and mortality regardless of medical and non-medical management of the disease. This excess of risk may be attributable, at least in part, to comorbid conditions influencing the development and progression of CHF. In this perspective, the authors examined and described the most common endocrine disorders observed in patients with CHF, particularly in individuals with reduced ejection fraction, aiming to qualify the risks, quantify the epidemiological burden and discuss about the potential role of endocrine treatment. Thyroid dysfunction is commonly observed in patients with CHF, and sometimes it could be the consequence of certain medications (e.g., amiodarone). Male and female hypogonadism may also coexist in this clinical context, contributing to deteriorating the prognosis of these patients. Furthermore, growth hormone deficiency may affect the development of adult myocardium and predispose to CHF. Limited recommendation suggests to screen endocrine disorders in CHF patients, but it could be interesting to evaluate possible endocrine dysfunction in this setting, especially when a high suspicion coexists. Data referring to long-term safety and effectiveness of endocrine treatments in patients with CHF are limited, and their impact on several "hard" endpoints (such as hospital admission, all-cause, and cardiovascular mortality) are still poorly understood.
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Affiliation(s)
- Giuseppe Lisco
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Vito Angelo Giagulli
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Michele Iovino
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Roberta Zupo
- National Institute of Gastroenterology, Saverio de Bellis, Research Hospital, Castellana Grotte, Bari, Italy
| | - Edoardo Guastamacchia
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Giovanni De Pergola
- National Institute of Gastroenterology, Saverio de Bellis, Research Hospital, Castellana Grotte, Bari, Italy
- Clinical Nutrition Unit, Medical Oncology, Department of Internal Medicine and Clinical Oncology, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Massimo Iacoviello
- Department of Medical and Surgical Sciences, Cardiology Department, University of Foggia, Foggia, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy.
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45
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Peng S, Peng J, Yang L, Ke W. Relationship between serum sodium levels and all-cause mortality in congestive heart failure patients: A retrospective cohort study based on the Mimic-III database. Front Cardiovasc Med 2022; 9:1082845. [PMID: 36712264 PMCID: PMC9880197 DOI: 10.3389/fcvm.2022.1082845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/29/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The relationship between serum sodium levels and mortality in congestive heart failure (CHF) patients has not been well-studied previously. The non-linear correlation between serum sodium levels and mortality in patients with heart failure is currently controversial, and the relationship between different serum sodium levels and mortality is disputed. The goal of this study is to look into the relationship between serum sodium levels and all-cause mortality in people with CHF after controlling for other factors. METHODS The publicly accessible Mimic III database was the source of data for our study. We use the ICU Admission Scoring System to collect demographic data, laboratory findings, comorbidities, vital signs, and scoring information for each patient. Cox proportional risk analysis, smooth curve fitting, and the Kaplan-Meier survival curve were used to assess the relationship between baseline sodium levels and all-cause mortality in CHF patients. RESULTS The segmentation regression model discovered a turning point value of serum sodium levels (137.5 mmol/L) between serum sodium levels and all-cause mortality. According to the results of the fully adjusted Cox proportional hazard model, lower serum sodium levels (<137.5 mmol/L) were associated with an increased risk of 30, 90, 365-day, and 4-year all-cause deaths. The HRs and 95th confidence intervals were 0.96 (0.94, 0.99), 0.96 (0.94, 0.99), 0.96 (0.94, 0.98), and 0.96 (0.95, 0.98), respectively; the higher serum sodium levels (≥137.5 mmol/L) were related to an associated multiplied risk of 30, 90, 365-day, and 4-year all-cause deaths; the HRs and 95th confidence intervals were 1.02 (1.00, 1.05), 1.02 (1.00, 1.04), 1.02 (1.00, 1.03), and 1.02 (1.00, 1.03), respectively. CONCLUSION Serum sodium levels were u-shaped about all-cause mortality. In individuals with CHF, serum sodium levels are linked to an elevated risk of short-, medium-, and long-term all-cause mortality.
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Affiliation(s)
- Shixuan Peng
- Department of Oncology, Graduate Collaborative Training Base of The First People's Hospital of Xiangtan City, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Jianxing Peng
- Department of Orthopaedics, Anxiang People's Hospital, Changde, Hunan, China
| | - Lianju Yang
- Department of Health Management Centre, Anxiang People's Hospital, Changde, Hunan, China
| | - Weiqi Ke
- Department of Anesthesiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- *Correspondence: Weiqi Ke ✉
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46
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de Oliveira AA, Vergara A, Wang X, Vederas JC, Oudit GY. Apelin pathway in cardiovascular, kidney, and metabolic diseases: Therapeutic role of apelin analogs and apelin receptor agonists. Peptides 2022; 147:170697. [PMID: 34801627 DOI: 10.1016/j.peptides.2021.170697] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 02/07/2023]
Abstract
The apelin/apelin receptor (ApelinR) signal transduction pathway exerts essential biological roles, particularly in the cardiovascular system. Disturbances in the apelin/ApelinR axis are linked to vascular, heart, kidney, and metabolic disorders. Therefore, the apelinergic system has surfaced as a critical therapeutic strategy for cardiovascular diseases (including pulmonary arterial hypertension), kidney disease, insulin resistance, hyponatremia, preeclampsia, and erectile dysfunction. However, apelin peptides are susceptible to rapid degradation through endogenous peptidases, limiting their use as therapeutic tools and translational potential. These proteases include angiotensin converting enzyme 2, neutral endopeptidase, and kallikrein thereby linking the apelin pathway with other peptide systems. In this context, apelin analogs with enhanced proteolytic stability and synthetic ApelinR agonists emerged as promising pharmacological alternatives. In this review, we focus on discussing the putative roles of the apelin pathway in various physiological systems from function to dysfunction, and emphasizing the therapeutic potential of newly generated metabolically stable apelin analogs and non-peptide ApelinR agonists.
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Affiliation(s)
- Amanda A de Oliveira
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Ander Vergara
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Xiaopu Wang
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Department of Physiology, University of Alberta, Edmonton, Alberta, Canada
| | - John C Vederas
- Department of Chemistry, University of Alberta, Edmonton, Alberta, Canada
| | - Gavin Y Oudit
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Department of Physiology, University of Alberta, Edmonton, Alberta, Canada.
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47
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Vicent L, Alvarez-Garcia J, Gonzalez-Juanatey JR, Rivera M, Segovia J, Worner F, Bover R, Pascual-Figal D, Vázquez R, Cinca J, Fernandez-Aviles F, Martinez-Sellés M. Prognostic impact of hyponatraemia and hypernatraemia at admission and discharge in heart failure patients with preserved, mid-range and reduced ejection fraction. Intern Med J 2021; 51:930-938. [PMID: 32237007 DOI: 10.1111/imj.14836] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/27/2020] [Accepted: 03/15/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hyponatraemia is common in patients with acute heart failure (HF). AIMS To determine the impact of sodium disturbances on mortality and readmissions in HF with reduced left ventricular ejection fraction (HFrEF), preserved ejection fraction (HFpEF) and mid-range ejection fraction (HFmrEF). METHODS This study was a prospective multicentre consecutive registry in 20 hospitals, including patients admitted due to acute HF in cardiology departments. Sodium <135 mmol/L was considered hyponatraemia, >145 mmol/L hypernatraemia and 135-145 mmol/L normal. RESULTS A total of 1309 patients was included. Mean age was 72.0 ± 11.9 years, and 810 (61.9%) were male. Mean serum sodium level was 138.6 ± 4.7 mmol/L at hospital admission and 138.1 ± 4.1 mmol/L at discharge. The evolution of sodium levels was: normal-at-admission/normal-at-discharge 941 (71.9%), abnormal-at-admission/normal-at-discharge 127 (9.7%), normal-at-admission/abnormal-at-discharge 155 (11.8%) and abnormal-at-admission/abnormal-at-discharge 86 (6.6%). Hyponatraemia at discharge was more common in HFrEF (109 (20.7%)) than in HFpEF (79 (13.9%)) and HFmrEF (27 (12%)), P = 0.003. The prevalence of hypernatraemia at discharge was similar in the three groups: HFrEF (10 (1.9%)), HFpEF (12 (2.1%)) and HFmrEF (4 (1.9%)), P = 0.96. In multivariate analysis, abnormal sodium concentrations at hospital admission (hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.15-1.76, P = 0.001) and discharge (HR 1.33, 95% CI 1.08-1.64, P = 0.007) were both independently associated with increased mortality and readmissions at 12 months. CONCLUSIONS Hyponatraemia and hypernatraemia at admission and discharge predict a poor outcome in patients with acute HF regardless of left ventricular ejection fraction. Hyponatraemia at discharge is more frequent in HFrEF than in the other groups.
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Affiliation(s)
- Lourdes Vicent
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Jesús Alvarez-Garcia
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, CIBERCV, Barcelona, Spain
| | - José Ramón Gonzalez-Juanatey
- Cardiology and Coronary Care Unit Department, Complexo Hospitalario Universitario de Santiago de Compostela, CIBERCV, A Coruña, Spain
| | - Miguel Rivera
- Cardiology Department, University Hospital La Fe, Valencia, Spain
| | - Javier Segovia
- Cardiology Department, Hospital Universitario Puerta de Hierro Majadahonda, CIBERCV, Madrid, Spain
| | - Fernando Worner
- Cardiology Department, Hospital Universitari Arnau de Vilanova, IRBLLEIDA, Lleida, Spain
| | - Ramón Bover
- Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Domingo Pascual-Figal
- Cardiology Department, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Spain
| | - Rafael Vázquez
- Cardiology Department, Puerta del Mar University Hospital, Cádiz, Spain
| | - Juan Cinca
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, CIBERCV, Barcelona, Spain
| | - Francisco Fernandez-Aviles
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain.,Universidad Complutense, Madrid, Spain
| | - Manuel Martinez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain.,Universidad Complutense, Madrid, Spain.,Universidad Europea, Madrid, Spain
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48
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Abstract
Coexisting dysfunction of heart and kidney, the cardiorenal syndrome, is a common condition and is associated with worsening of outcomes and complexities of diagnostic, preventive, and therapeutic approaches. The knowledge of the physiology of heart and kidney and their interaction with each other and with other organ systems has progressed significantly in recent years, resulting in a better understanding of the pathogenesis of cardiorenal syndrome. A robust knowledge of the pathophysiology and of the latest practical advancements about cardiorenal syndrome is necessary for cardiologists, nephrologists, and other practitioners who provide medical care to the patients with heart and kidney diseases.
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Affiliation(s)
- Parta Hatamizadeh
- Department of Medicine, Division of Nephrology, Hypertension & Renal Transplantation, University of Florida, 1600 SW Archer Road, CG-98, PO Box 100224, Gainesville, FL 32610, USA.
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49
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Suwanto D, Dewi IP, Fagi RA. Hyponatremia in heart failure: not just 135 to 145. J Basic Clin Physiol Pharmacol 2021; 33:381-388. [PMID: 34134181 DOI: 10.1515/jbcpp-2020-0399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 06/01/2021] [Indexed: 01/21/2023]
Abstract
One of the most frequent in-hospital electrolyte disturbances is hyponatremia. Hyponatremia in heart failure (HF) is mainly associated with hypervolemia resulting from activation of baroreceptor-mediated hormones, such as arginine vasopressin (AVP), renin-angiotensin-aldosterone system, and catecholamines. Various electrolyte imbalance can occur as heart failure progress. The goal of this review was to outline the current literature on hyponatremia in HF patients.
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Affiliation(s)
- Denny Suwanto
- Faculty of Medicine, Airlangga University, Surabaya, Indonesia.,Cardiology and Vascular Medicine Department, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Ivana Purnama Dewi
- Faculty of Medicine, Airlangga University, Surabaya, Indonesia.,Cardiology and Vascular Medicine Department, Dr. Soetomo General Hospital, Surabaya, Indonesia.,Faculty of Medicine, Duta Wacana Christian University, Yogyakarta, Indonesia
| | - Rosi Amrilla Fagi
- Faculty of Medicine, Airlangga University, Surabaya, Indonesia.,Cardiology and Vascular Medicine Department, Dr. Soetomo General Hospital, Surabaya, Indonesia
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50
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Hu W, Lv X, Li C, Xu Y, Qi Y, Zhang Z, Li M, Cai F, Liu D, Yue J, Ye M, Chen Q, Shi K. Disorders of sodium balance and its clinical implications in COVID-19 patients: a multicenter retrospective study. Intern Emerg Med 2021; 16:853-862. [PMID: 33064253 PMCID: PMC7563904 DOI: 10.1007/s11739-020-02515-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/24/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND The worldwide spread of SARS-CoV-2 has infected millions of people leading to over 0.3 million mortalities. The disruption of sodium homeostasis, tends to be a common occurrence in patients with COVID-19. METHODS AND RESULTS A total of 1,254 COVID-19 patients comprising 124 (9.9%) hyponatremic patients (under 135 mmol/L) and 30 (2.4%) hypernatremic patients (over 145 mmol/L) from three hospitals in Hubei, China, were enrolled in the study. The relationships between sodium balance disorders in COVID-19 patients, its clinical features, implications, and the underlying causes were presented. Hyponatremia patients were observed to be elderly, had more comorbidities, with severe pneumonic chest radiographic findings. They were also more likely to have a fever, nausea, higher leukocyte and neutrophils count, and a high sensitivity C-reactive protein (HS-CRP). Compared to normonatremia patients, renal insufficiency was common in both hyponatremia and hypernatremia patients. In addition, hyponatremia patients required extensive treatment with oxygen, antibiotics, and corticosteroids. The only significant differences between the hypernatremia and normonatremia patients were laboratory findings and clinical complications, and patients with hypernatremia were more likely to use traditional Chinese medicine for treatment compared to normonatremia patients. This study indicates that severity of the disease, the length of stay in the hospital of surviving patients, and mortality were higher among COVID-19 patients with sodium balance disorders. CONCLUSION Sodium balance disorder, particularly hyponatremia, is a common condition among hospitalized patients with COVID-19 in Hubei, China, and it is associated with a higher risk of severe illness and increased in-hospital mortality.
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Affiliation(s)
- Weihua Hu
- Department of Respiratory, First Hospital of Yangtze University, Clinical Medical College, Yangtze University, Jingzhou, 434000, Hubei, China
| | - Xinke Lv
- Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Chang Li
- Hubei No.3 People's Hospital of Jianghan University, Wuhan, 430033, Hubei, China
| | - Yang Xu
- Department of Orthopedics, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430015, Hubei, China
| | - Yiding Qi
- Department of Cardiology, Huadong Hospital Affiliated To Fudan University, Shanghai, 200040, China
| | - Zhuheng Zhang
- Wuhan University School of Basic Medical Sciences, Wuhan, 430071, Hubei, China
| | - Mingxuan Li
- Department of Cardiology, Huadong Hospital Affiliated To Fudan University, Shanghai, 200040, China
| | - Feina Cai
- Department of Cardiology, Huadong Hospital Affiliated To Fudan University, Shanghai, 200040, China
| | - Dan Liu
- Department of Respiratory, First Hospital of Yangtze University, Clinical Medical College, Yangtze University, Jingzhou, 434000, Hubei, China
| | - Jiang Yue
- Wuhan University School of Basic Medical Sciences, Wuhan, 430071, Hubei, China
| | - Maoqing Ye
- Department of Cardiology, Huadong Hospital Affiliated To Fudan University, Shanghai, 200040, China.
| | - Qijian Chen
- Department of Emergency, The fifth Hospital in Wuhan, Wuhan, 430050, Hubei, China.
| | - Kailei Shi
- Department of Cardiology, Huadong Hospital Affiliated To Fudan University, Shanghai, 200040, China.
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