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Jensen CJ, Nielsen JK, Talbott MM, O'Connell D, Patel VS, Armstrong PA, Rafique Z, Tia LM, Paul KK, Jehle DV. Effects of Serum Potassium on Mortality in Patients With ST-Elevation Myocardial Infarction. Cureus 2024; 16:e61126. [PMID: 38919213 PMCID: PMC11197046 DOI: 10.7759/cureus.61126] [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: 05/14/2024] [Indexed: 06/27/2024] Open
Abstract
INTRODUCTION Disturbances in potassium levels can induce ventricular arrhythmias and heighten mortality in patients with ST-elevation myocardial infarction (STEMI). This study evaluates the influence of sK levels on seven-day mortality and incidence of ventricular arrhythmias in STEMI patients to further improve clinical guidelines and outcomes. METHODS This retrospective, propensity-matched study analyzed approximately 250,000 acute STEMI patients from 55 major academic medical centers/healthcare organizations (HCOs) in the US Collaborative Network of the TriNetX database. The sK levels recorded on the day of STEMI diagnosis were categorized into four cohorts: sK ≤ 3.4 (hypokalemia), 3.5 ≤ sK ≤ 4.5 (normal-control), 4.6 ≤ sK ≤ 5.0 (high-normal), and sK ≥ 5.1 (hyperkalemia). Patient cohorts were propensity-matched using linear and logistic regression for demographics. Outcomes of seven-day mortality, ventricular tachycardia (VT), and ventricular fibrillation (VF) were compared between these cohorts and the control group. RESULTS The analysis showed hypokalemia was linked to significantly higher seven-day mortality (7.2% vs. 4.3%; RR 1.69; p<0.001), and increased rates of VT and VF. Similarly, hyperkalemia was associated with elevated mortality (12.7% vs. 4.6%; RR 2.76; p<0.001), VT, and VF rates. High-normal sK levels showed increased mortality (7.4% vs. 4.7%; RR 1.58; p<0.001), but unchanged VT or VF rates compared to the normal sK group. CONCLUSION This comprehensive study highlights the correlation of sK levels with death in STEMI patients, revealing a nearly doubled risk of mortality with hypokalemia and almost triples with hyperkalemia. More notably, the mortality for STEMIs is higher for high-normal vs normal sK values. Additionally, hypokalemia and hyperkalemia were found to significantly elevate VT and VF risks.
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Affiliation(s)
- Colton J Jensen
- Department of Emergency Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Jonathan K Nielsen
- Department of Emergency Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Matthew M Talbott
- Department of Emergency Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Danielle O'Connell
- Department of Emergency Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Vivek S Patel
- Department of Emergency Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Peyton A Armstrong
- Department of Emergency Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Zubaid Rafique
- Department of Emergency Medicine, Baylor College of Medicine, Houston, USA
| | - Lillian M Tia
- Department of Emergency Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Krishna K Paul
- Department of Emergency Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Dietrich V Jehle
- Department of Emergency Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
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Wongtanasarasin W, Meelarp N. Replacing Potassium in the Emergency Department May Not Decrease the Hospital Mortality in Mild Hypokalemia: A Propensity Score Matching Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1912. [PMID: 38003961 PMCID: PMC10672891 DOI: 10.3390/medicina59111912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023]
Abstract
Background: Hypokalemia is associated with considerable morbidity and mortality, highlighting the timely correction of potassium levels as a critical medical consideration. However, the management of mild hypokalemia remains a subject of ongoing debate. This study explores the relationship between potassium replacement in the emergency department (ED) and hospital mortality in patients with mild hypokalemia. Methods: This retrospective cohort study was conducted at a tertiary care hospital, including patients who presented to the ED with mild hypokalemia, defined as potassium levels between 3.0 and 3.4 mmol/L, between 2020 and 2021. Patients diagnosed with acute coronary syndrome, diabetic ketoacidosis, hyperglycemic hyperosmolar state, and major cardiac arrhythmias were excluded. The patient cohort was then divided into two groups, based on whether they received potassium replacement in the ED. A propensity score analysis was employed to account for potential pretreatment confounding factors, including age, gender, time on ED arrival, insurance, comorbidities, serum potassium and creatinine levels, and ED length of stay. Subsequently, a multivariable logistic regression analysis, incorporating hospital length of stay and acute comorbidities, was performed post-matching to further adjust for predictive factors. The primary outcome was all-cause hospital mortality. Results: This study included a total of 1931 patients, of which 724 were matched for analysis (362 with potassium replacement and 362 without). The average age was 53.9 years, and most were male (58.5%). After adjusting for confounding factors using propensity score analysis, there was no significant difference in hospital mortality between the potassium replacement and control groups (adjusted odds ratio 0.81, 95% CI 0.36-1.79, p = 0.60). Conclusions: This study's findings indicate that replacing potassium in the ED may not lower the risk of hospital mortality in patients with mild hypokalemia. Consequently, the customary practice of potassium replacement in hospitalized patients may lack justification, and deferring the replacement until after patients leave the ED could be considered.
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Affiliation(s)
- Wachira Wongtanasarasin
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
- Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA 95817, USA
| | - Nattikarn Meelarp
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
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Electrolyte Imbalance Among Patients With and With No ST-Elevation Myocardial Infarction: A Cohort Study. Crit Care Nurs Q 2023; 46:136-144. [PMID: 36823740 DOI: 10.1097/cnq.0000000000000446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Electrolytes imbalances are highly prevalent and have shown a high impact on mortality in patients with acute myocardial infarction. These electrolytes imbalance have prognostic value in predicting mortality in patients with acute myocardial infarction. The purpose of this study was to assess the prognostic value of electrolyte imbalances in predicting 1-month mortality among patients with myocardial infarction with and with no ST-elevation. This cohort study was conducted in a referral hospital in the West Bank, Palestine. All patients with confirmed medical diagnosis of acute myocardial infarction and admitted to the medical coronary care unit in the hospital were eligible participants. A convenience sample of 186 participants was obtained. These participants were followed up for 1 month to assess their survival (alive or dead). Demographic and clinical data were recorded by reviewing their health records. The derived data were analyzed using SPSS version 19. About 36% of all patients were found to be hyponatremic, 15% of them have hypokalemia, and 9% of patients had hypocalcemia. There was a significant difference between STEMI and non-STEMI in sodium (t = 4.7, P < .001). A multivariate logistic regression analysis was performed to predict 1-month mortality for patients with myocardial infarction with and with no ST-elevation. The predictors that were found to be significant are sodium (odds ratio [OR] = 0.789, P = .010), calcium (OR = 0.221, P = .014), diastolic blood pressure (OR = 0.933, P = .047), and blood urea nitrogen (OR = 0.821, P = .005). Electrolyte imbalance was highly prevalent among patients with acute myocardial infarction. Hyponatremia and hypocalcemia were present and associated significantly with predicting 1-month mortality. Health care providers should take into consideration the electrolytes of patients with acute myocardial infarction from the first moment of admission and correct them early to maximize the clinical outcomes and survival for patients.
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Rafaqat S, Rafaqat S, Khurshid H, Rafaqat S. Electrolyte’s imbalance role in atrial fibrillation: Pharmacological management. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2022. [DOI: 10.1186/s42444-022-00065-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractThe contribution of the perpetuation of atrial fibrillation is caused by electrical remodeling in which calcium, sodium and potassium channels could refer to changes in the ion channel protein expression, development of fibrosis, gene transcription and ion channel redistribution. Calcium and magnesium could influence the risk of atrial fibrillation which is the leading cause of cardiac death, heart failure and ischemic stroke. The elevated serum concentration of calcium had a higher range of in-patient’s mortality, increased total cost of hospitalization and increased length of hospital stay as compared to those without hypercalcemia in atrial fibrillation patients. Moreover, chloride channels could affect homeostasis, atrial myocardial metabolism which may participate in the development of atrial fibrillation. Up to a 50% risk of incidence of AF are higher in which left ventricular hypertrophy, sudden cardiovascular death and overall mortality relate to a low serum magnesium level. Additionally, magnesium prevents the occurrence of AF after cardiac surgery, whereas greater levels of serum phosphorus in the large population-based study and the related calcium–phosphorus products were linked with a greater incidence of AF. Numerous clinical studies had shown the high preoperative risk of AF that is linked with lower serum potassium levels. The conventional risk factor of increased risk of new onset of AF events could independently link with high dietary sodium intake which enhances the fibrosis and inflammation in the atrium but the mechanism remains unknown. Many drugs were used to maintain the electrolyte imbalance in AF patients.
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Cheng L, Kang S, Lin L, Wang H. The Association Between High CHA 2DS 2-VASc Scores and Short and Long-Term Mortality for Coronary Care Unit Patients. Clin Appl Thromb Hemost 2022; 28:10760296221117969. [PMID: 35942685 PMCID: PMC9373173 DOI: 10.1177/10760296221117969] [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] [Indexed: 11/17/2022] Open
Abstract
Background The CHA2DS2-VASc score has been associated with the
prognosis of cardiovascular diseases. This study aimed to explore the
association between the CHA2DS2-VASc score and
all-cause mortality in coronary care unit (CCU) patients. Methods The study was based on the Medical Information Mart for Intensive Care
(MIMIC) III database. CCU patients were divided into two groups according to
CHA2DS2-VASc score: 0-3 (low risk),4-9
(intermediate and high risk). The primary outcome was 30-day mortality, and
the secondary endpoints included in-hospital, 1-year, and 5-year mortality.
Propensity score matching (PSM) and sensitivity analyzes for the confounders
were also performed. The restricted cubic splines flexibility model was used
to demonstrate the relation between red blood cell volume distribution width
(RDW), blood urea nitrogen (BUN), platelet, white blood cell (WBC),
hemoglobin, phosphorus, glucose, potassium, sodium and 30-day mortality in
the 0-3 score versus the 4-9 score groups after PSM. Results Among 4491 eligible patients, 988 patients with low
CHA2DS2-VASc scores and 988 patients with
intermediate and high CHA2DS2-VASc scores had similar
propensity scores and were included in the analyzes. In the survival
analysis, the patients with intermediate and high
CHA2DS2-VASc scores were associated with higher
30-day mortality [hazard ratio (HR): 1.11; 95% confidence interval (CI),
1.02–1.20, P = .014], 1-year mortality [HR: 1.13; 95%CI,
1.06–1.19, P < .001], and 5-year mortality [HR: 1.13;
95%CI, 1.07–1.18, P < .001]. The interaction for 30-day
mortality among subgroups was not significant between the 0-3 score versus
the 4-9 score groups. The restricted cubic splines for 30-day mortality
demonstrated an L-shaped trajectory for platelets and hemoglobin, a J-shaped
trajectory for WBC, glucose and potassium, and a U-shaped trajectory for
sodium, respectively (all nonlinear P <.001). Conclusions A high CHA2DS2-VASc score was an independent risk for
30-day, 1-year, and 5-year mortality for CCU patients.
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Affiliation(s)
- Long Cheng
- Department of Cardiovascular Medicine, Shanghai Pudong New Area Gongli Hospital, Shanghai, P.R. China
| | - Sheng Kang
- Department of Cardiovascular Medicine, East Hospital, 66324Tongji University School of Medicine, Shanghai, China
| | - Li Lin
- Department of Cardiovascular Medicine, East Hospital, 66324Tongji University School of Medicine, Shanghai, China
| | - Hairong Wang
- Department of Cardiovascular Medicine, Shanghai Pudong New Area Gongli Hospital, Shanghai, P.R. China
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Yang J, Chi L, Li S. High-Accuracy Determination of Potassium and Selenium in Human Serum by Two-Step Isotope Dilution ICPMS. JOURNAL OF ANALYTICAL METHODS IN CHEMISTRY 2021; 2021:5533631. [PMID: 34782852 PMCID: PMC8590592 DOI: 10.1155/2021/5533631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 09/02/2021] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
A high-accuracy measurement technique for determining potassium and selenium in human serum was developed by using two-step Isotope Dilution Inductively Coupled Plasma-Mass Spectrometry (ICPMS) in this research. A more accessible method of the quadrupole ICPMS was employed in this research to achieve an equally high accuracy which had been achieved by a much more expensive method, namely, high-resolution sector field ICPMS (SF-ICPMS), with a comparatively easy and simple operation. In addition, we have evaluated the uncertainty of this method. The results showed that the determination limits of potassium and selenium in serum were 0.8 mg/kg and 2.7 μg/kg, respectively, and the precision for both measurements was lower than 0.2% and 0.7%. The measurement, when employed to measure potassium and selenium in standard materials NIST956D, NIST909C, and GBW09152, had caused a maximum deviation of less than 0.9%, within the stated uncertainty range of standard materials. The RELA international inter-laboratory comparisons of potassium in serum in 2018 conducted by our laboratory also yielded a satisfactory result.
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Affiliation(s)
- Jian Yang
- Institute of Disaster Prevention, Langfang 065201, China
- Key Laboratory of Building Collapse Mechanism and Disaster Prevention, China Earthquake Administration, Sanhe 065201, China
| | - Lixia Chi
- Institute of Disaster Prevention, Langfang 065201, China
- Key Laboratory of Building Collapse Mechanism and Disaster Prevention, China Earthquake Administration, Sanhe 065201, China
| | - Shengmin Li
- Beijing Institute of Medical Device Testing, Beijing Key Laboratory of Medical Device Testing and Safety Evaluation, Beijing 101111, China
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Filipovic K, Bellmann B, Sultan A, LÜker J, Plenge T, Steven D. Hydrochlorothiazide therapy: impact on early recurrence of atrial fibrillation after catheter ablation? Minerva Cardiol Angiol 2020; 69:102-108. [PMID: 32989962 DOI: 10.23736/s2724-5683.20.05170-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hypokalemia has been linked to electrocardiogram changes and afterdepolarization-mediated arrhythmias. However, the association between hypokalemia and atrial fibrillation (AF) has not been well studied. Hydrochlorothiazide (HCT) diuretic therapy was shown to be associated with hypokalemia in multiple studies. We aimed to determine whether HCT therapy is associated with early recurrence of AF after radiofrequency (RF) catheter ablation during a 3-month follow-up. METHODS We performed a retrospective registry analysis of our internal AF ablation registry, containing 807 consecutive patients that underwent RF ablation for symptomatic AF. Propensity score matching was used to match 156 patients on HCT therapy with 156 controls. Furthermore, we performed propensity score matching between the first and the fourth quartile of baseline serum potassium (K) concentrations in the initial population (N.=807). RESULTS We observed a small but statistically significant difference in baseline mean potassium levels between the HCT group and the control group (4.03 mmol/L vs. 4.19 mmol/L respectively, P=0.001). There was no difference in short term recurrence of atrial fibrillation in the HCT group compared to the propensity score matched control group (41.0% [N.=64] vs. 45.5% [N.=71], P=0.424). In the comparison between the first and the fourth quartile of baseline serum potassium values, no difference in AF recurrence (38.2% [N.=63] vs. 37.0% [N.=61], P=0.820) during a 3-month follow-up after ablation was observed between both groups. CONCLUSIONS Patients on HCT therapy showed no difference in short term recurrence of AF after ablation compared to propensity matched controls.
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Affiliation(s)
- Karlo Filipovic
- Department of Electrophysiology, University Hospital of Cologne, Cologne, Germany -
| | - Barbara Bellmann
- Department of Electrophysiology, University Hospital of Cologne, Cologne, Germany
| | - Arian Sultan
- Department of Electrophysiology, University Hospital of Cologne, Cologne, Germany
| | - Jakob LÜker
- Department of Electrophysiology, University Hospital of Cologne, Cologne, Germany
| | - Tobias Plenge
- Department of Electrophysiology, University Hospital of Cologne, Cologne, Germany
| | - Daniel Steven
- Department of Electrophysiology, University Hospital of Cologne, Cologne, Germany
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Xi H, Yu RH, Wang N, Chen XZ, Zhang WC, Hong T. Serum potassium levels and mortality of patients with acute myocardial infarction: A systematic review and meta-analysis of cohort studies. Eur J Prev Cardiol 2020; 26:145-156. [PMID: 31060369 DOI: 10.1177/2047487318780466] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The evidence of current epidemiological studies investigating the association between serum potassium levels and mortality of acute myocardial infarction (AMI) patients is controversial and inadequate. DESIGN Systematic review and meta-analysis. METHODS Two researchers independently searched the PubMed, EMBASE and Web of Science databases to identify observational studies published prior to 31 October 2017. Similarly, two researchers separately extracted data and any differences were resolved by discussion. Pooled relative risks and 95% confidence intervals (CIs) were computed with an inverse variance-weighted random-effects model. Heterogeneity among studies was assessed with the I2 statistic. RESULTS Seven cohort studies were included for analysis. Compared with the reference group (3.5 to <4.0 mEq/L), the pooled relative risks of mortality were 1.15 (95% CI = 1.00-1.32), 1.09 (95% CI = 0.97-1.24), 1.42 (95% CI = 1.19-1.70) and 1.85 (95% CI = 1.39-2.47) for AMI patients with a potassium level of<3.5, 4.0 to <4.5, 4.5 to <5.0, and ≥5.0 mEq/L, respectively. For admission and post-admission potassium, although J-shaped associations were also indicated, non-significant results were observed for AMI patients with potassium levels of <3.5 mEq/L when compared with the reference group. Notably, in subgroup analyses of study characteristics, stratified by study quality, geographic location, type of outcome, number of cases, type of AMI, and adjustment for potential confounders, the findings were broadly consistent across strata. CONCLUSIONS These findings indicate that both lower (<3.5 mEq/L) and higher (≥4.5 mEq/L) serum potassium levels are associated with an increased risk of mortality of patients with AMI.
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Affiliation(s)
- Hui Xi
- 1 Department of Cardiology, Peking University International Hospital, Beijing, China
| | - Rong-Hui Yu
- 2 Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ning Wang
- 1 Department of Cardiology, Peking University International Hospital, Beijing, China
| | - Xue-Zhi Chen
- 1 Department of Cardiology, Peking University International Hospital, Beijing, China
| | - Wen-Chao Zhang
- 1 Department of Cardiology, Peking University International Hospital, Beijing, China
| | - Tao Hong
- 3 Department of Cardiology, Peking University First Hospital, Beijing, China
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Abensur Vuillaume L, Ferreira JP, Asseray N, Trombert-Paviot B, Montassier E, Legrand M, Girerd N, Boivin JM, Chouihed T, Rossignol P. Hypokalemia is frequent and has prognostic implications in stable patients attending the emergency department. PLoS One 2020; 15:e0236934. [PMID: 32750075 PMCID: PMC7402484 DOI: 10.1371/journal.pone.0236934] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 07/16/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Potassium disturbances are associated with adverse prognosis in patients with chronic conditions. Its prognostic implications in stable patients attending the emergency department (ED) is poorly described. AIMS This study aimed to assess the prevalence of dyskalemia, describe its predisposing factors and prognostic associations in a population presenting the ED without unstable medical illness. METHODS Post-hoc analysis of a prospective, cross-sectional, multicenter study in the ED of 11 French academic hospitals over a period of 8 weeks. All adults presenting to the ED during this period were included, except instances of self-drug poisoning, inability to complete self-medication questionnaire, presence of an unstable medical illness and decline to participate in the study. All-cause hospitalization or deaths were assessed. RESULTS A total of 1242 patients were included. The mean age was 57.2±22.3 years, 51% were female. The distribution according to potassium concentrations was: hypokalemia<4mmol/L(n = 620, 49.9%), normokalemia 4-5mmol/L(n = 549, 44.2%) and hyperkalemia >5mmol/L(n = 73, 0,6%). The proportion of patients with a kalemia<3.5mmol/L was 8% (n = 101). Renal insufficiency (OR [95% CI] = 3.56[1.94-6.52], p-value <0.001) and hemoglobin <12g/dl (OR [95% CI] = 2.62[1.50-4.60], p-value = 0.001) were associated with hyperkalemia. Female sex (OR [95% CI] = 1.31[1.03-1.66], p-value = 0.029), age <45years (OR [95% CI] = 1.69 [1.20-2.37], p-value = 0.002) and the use of thiazide diuretics (OR [95% CI] = 2.04 [1.28-3.32], p-value = 0.003), were associated with hypokalemia<4mmol/l. Two patients died in the ED and 629 (52.7%) were hospitalized. Hypokalemia <3.5mmol/L was independently associated with increased odds of hospitalization or death (OR [95% CI] = 1.47 [1.00-2.15], p-value = 0.048). CONCLUSIONS Hypokalemia is frequently found in the ED and was associated with worse outcomes in a low-risk ED population.
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Affiliation(s)
- Laure Abensur Vuillaume
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques- Plurithématique 1433, and Inserm U1116, CHRU, Nancy, France
- Emergency Departement, Regional Hospital Metz-Thionville, Metz, France
- F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France
| | - João Pedro Ferreira
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques- Plurithématique 1433, and Inserm U1116, CHRU, Nancy, France
- F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France
| | - Nathalie Asseray
- Infectious Diseases Department, Nantes University Hospital and CIC 1413, INSERM, Nantes, France
| | - Béatrice Trombert-Paviot
- Department of Public Health and Medical Informatics, University Hospital of Saint Etienne and Host Research Team SNA-EPIS, PRES Lyon, Jean Monnet University, Lyon, France
| | - Emmanuel Montassier
- F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France
- Department of Emergency Medicine, Nantes University Hospital; MiHAR lab, Université de Nantes, Nantes, France
| | - Matthieu Legrand
- APHP, Department of Anaesthesiology, Critical Care Medicine and Burn Unit, Saint Louis University Hospital, INSERM UMR-S942, INI-CRCT network and Univ Paris Diderot, Paris, France
| | - Nicolas Girerd
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques- Plurithématique 1433, and Inserm U1116, CHRU, Nancy, France
- F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France
| | - Jean-Marc Boivin
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques- Plurithématique 1433, and Inserm U1116, CHRU, Nancy, France
- F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France
| | - Tahar Chouihed
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques- Plurithématique 1433, and Inserm U1116, CHRU, Nancy, France
- F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France
- Emergency Departement, University Regional Hospital, Nancy, France
| | - Patrick Rossignol
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques- Plurithématique 1433, and Inserm U1116, CHRU, Nancy, France
- F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France
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Ravn Jacobsen M, Jabbari R, Glinge C, Kjær Stampe N, Butt JH, Blanche P, Lønborg J, Wendelboe Nielsen O, Køber L, Torp‐Pedersen C, Pedersen F, Tfelt‐Hansen J, Engstrøm T. Potassium Disturbances and Risk of Ventricular Fibrillation Among Patients With ST-Segment-Elevation Myocardial Infarction. J Am Heart Assoc 2020; 9:e014160. [PMID: 32067598 PMCID: PMC7070188 DOI: 10.1161/jaha.119.014160] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Potassium disturbances per se increase the risk of ventricular fibrillation (VF). Whether potassium disturbances in the acute phase of ST-segment-elevation myocardial infarction (STEMI) are associated with VF before primary percutaneous coronary intervention (PPCI) is uncertain. Methods and Results All consecutive STEMI patients were identified in the Eastern Danish Heart Registry from 1999 to 2016. Comorbidities and medication use were assessed from Danish nationwide registries. Potassium levels were collected immediately before PPCI start. Multivariate logistic models were performed to determine the association between potassium and VF. The main analysis included 8624 STEMI patients of whom 822 (9.5%) had VF before PPCI. Compared with 6693 (77.6%) patients with normokalemia (3.5-5.0 mmol/L), 1797 (20.8%) patients with hypokalemia (<3.5 mmol/L) were often women with fewer comorbidities, whereas 134 (1.6%) patients with hyperkalemia (>5.0 mmol/L) were older with more comorbidities. After adjustment, patients with hypokalemia and hyperkalemia had a higher risk of VF before PPCI (odds ratio 1.90, 95% CI 1.57-2.30, P<0.001) and (odds ratio 3.36, 95% CI 1.95-5.77, P<0.001) compared with normokalemia, respectively. Since the association may reflect a post-resuscitation phenomenon, a sensitivity analysis was performed including 7929 STEMI patients without VF before PPCI of whom 127 (1.6%) had VF during PPCI. Compared with normokalemia, patients with hypokalemia had a significant association with VF during PPCI (odds ratio 1.68, 95% CI 1.01-2.77, P=0.045) after adjustment. Conclusions Hypokalemia and hyperkalemia are associated with increased risk of VF before PPCI during STEMI. For hypokalemia, the association may be independent of the measurement of potassium before or after VF.
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Affiliation(s)
- Mia Ravn Jacobsen
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Reza Jabbari
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Charlotte Glinge
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Niels Kjær Stampe
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Jawad Haider Butt
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Paul Blanche
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
- Department of BiostatisticsUniversity of CopenhagenDenmark
| | - Jacob Lønborg
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Olav Wendelboe Nielsen
- Department of CardiologyBispebjerg and Frederiksberg University HospitalCopenhagenDenmark
| | - Lars Køber
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | | | - Frants Pedersen
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Jacob Tfelt‐Hansen
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
- Department of Forensic MedicineFaculty of Medical ScienceUniversity of CopenhagenDenmark
| | - Thomas Engstrøm
- Department of Cardiology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
- Department of CardiologyUniversity of LundSweden
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Association of hypokalemia with an increased risk for medically treated arrhythmias. PLoS One 2019; 14:e0217432. [PMID: 31206521 PMCID: PMC6576768 DOI: 10.1371/journal.pone.0217432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 05/10/2019] [Indexed: 02/08/2023] Open
Abstract
Background Potassium replenishment protocols are often employed across broad patient populations to prevent cardiac arrhythmias. Tailoring potassium thresholds to specific patient populations would reduce unnecessary tasks and cost. The objective of this retrospective cohort study was to determine the threshold at which hypokalemia increases the risk for medically treated arrhythmias in cardiac versus medical and surgical intensive care units. Methods Patients captured in the publicly available Philips eICU database were assessed for initiation of either intravenous amiodarone, adenosine, ibutilide, isoproterenol, or lidocaine as a surrogate for a clinically significant arrhythmia. A landmark time-to-event analysis was conducted to investigate the association of serum potassium values and time-marked administration of an antiarrhythmic drug. Analysis was adjusted for comorbidities, the use of vasopressor agents, diuretics, as well as age, gender and severity of illness. Results Among 20,665 admissions to cardiac intensive care units, 1,371 (6.6%) were treated with either amiodarone, adenosine, ibutilide, isoproterenol, or lidocaine. For potassium values of ≥3.0<3.5mEq/L, antiarrhythmic treatment occurred at an increased rate compared to a baseline of ≥4.0≤5.0mEq/L (HR 1.23, 95% CI 1.01–1.51; P = 0.04). For admissions to medical and surgical intensive care units, 2,100 of 69,714 patients (3.0%) were treated with either amiodarone, adenosine, ibutilide, isoproterenol, or lidocaine. Potassium values of ≥3.0<3.5mEq/L were also associated with an increased hazard of treatment (HR 1.26, 95% CI 1.09–1.45; P = 0.002). In both cohorts, worsening hypokalemia was associated with an increased risk of antiarrhythmic drug treatment. In neither cohort were there statistically significant differences for serum potassium values of ≥3.5<4.0 and a baseline of ≥4.0≤5.0mEq/L. The proportion of patients initiated on vasopressors or inotropes was over four-fold higher in those treated with one of the antiarrhythmic drugs in both cohorts. Conclusions Serum potassium levels <3.5mEq/L were associated with an increased hazard for treatment with specific antiarrhythmic drugs in a large cohort of patients admitted to both a cardiac as well as medical and surgical intensive care units. Potassium thresholds may be individualized further based on risk of relevant outcomes.
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Association of Abnormal Serum Potassium Levels with Arrhythmias and Cardiovascular Mortality: a Systematic Review and Meta-Analysis of Observational Studies. Cardiovasc Drugs Ther 2019; 32:197-212. [PMID: 29679302 DOI: 10.1007/s10557-018-6783-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To provide the first systematic review and meta-analysis of observational studies on the association of abnormal serum potassium and cardiovascular outcomes. METHODS Medline and ISI Web of Knowledge were systematically searched from inception until November 24, 2017. Data synthesis of relevant studies was performed using random effects model meta-analyses. RESULTS Meta-analyses included 310,825 participants from 24 studies. In the older general population, low serum potassium was associated with a 1.6-fold increased risk of supraventricular arrhythmias (risk ratio [95% confidence interval] 1.62 [1.02-2.55]). Contrarily, high serum potassium was associated with increased cardiovascular mortality (CVM) (1.38 [1.14-1.66]). In patients with acute myocardial infarction, the risk of ventricular arrhythmias was increased for high serum potassium (2.33 [1.60-3.38]). A U-shaped association was observed with a composite cardiovascular outcome in hypertensive patients (2.6-fold increased risk with hypokalemia and 1.7-fold increased risk with hyperkalemia), with CVM in dialysis patients (1.1-fold increased risk with hypokalemia and 1.4-fold increased risk with hyperkalemia) and with CVM in heart failure patients (albeit not statistically significant). Further, only hyperkalemia was associated with an increased risk of a composite cardiovascular outcome in both dialysis (1.12 [1.03-1.23]) and chronic kidney disease (1.34 [1.06-1.71]) patients. CONCLUSIONS Controlled clinical trials are needed to determine which populations may profit from more frequent potassium-monitoring and subsequent interventions, e.g., change or withdrawal of potassium-influencing drugs, in order to restore normal values and prevent cardiovascular outcomes. REGISTRATION DETAILS Registration in PROSPERO (Centre for Reviews and Dissemination University of York, York, UK): CRD42016048897 ( https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=48897 ).
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Ozen Y, Ozbay MB, Ertem AG, Yayla Ç. Serum Electrolyte Levels and Ventricular Arrhythmia. Angiology 2018; 70:87-88. [PMID: 30114942 DOI: 10.1177/0003319718794573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yasin Ozen
- 1 Türkiye Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Mustafa Bilal Ozbay
- 1 Türkiye Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Ahmet Goktuğ Ertem
- 1 Türkiye Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Çağri Yayla
- 1 Türkiye Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
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14
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Colombo MG, Kirchberger I, Amann U, Dinser L, Meisinger C. Association of serum potassium concentration with mortality and ventricular arrhythmias in patients with acute myocardial infarction: A systematic review and meta-analysis. Eur J Prev Cardiol 2018; 25:576-595. [DOI: 10.1177/2047487318759694] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Challenging clinical practice guidelines that recommend serum potassium concentration between 4.0–5.0 mEq/L or ≥4.5 mEq/L in patients with acute myocardial infarction, recent studies found increased mortality risks in patients with a serum potassium concentration of ≥4.5 mEq/L. Studies investigating consequences of hypokalemia after acute myocardial infarction revealed conflicting results. Therefore, the aim of this systematic review and meta-analysis was to combine evidence from previous studies on the association of serum potassium concentration with both short and long-term mortality as well as the occurrence of ventricular arrhythmias. Design Systematic review and meta-analysis. Methods A structured search of MEDLINE and EMBASE databases yielded 23 articles published between 1990 and January 2017 that met the inclusion criteria. Study selection, data extraction and quality assessment were carried out by three reviewers. Random effects models were used to pool estimates across the included studies and sensitivity analyses were performed when possible. Results Twelve studies were included in the meta-analysis. Both pooled results from six studies investigating short-term mortality and from five studies examining long-term mortality revealed significantly increased risks in patients with serum potassium concentrations of <3.5 mEq/L, 4.5–<5.0 mEq/L and ≥5.0 mEq/L after acute myocardial infarction. In addition, a serum potassium concentration of <3.5 mEq/L was significantly associated with the occurrence of ventricular arrhythmias. Conclusions Mortality, both short and long term, and the occurrence of ventricular arrhythmias in patients with acute myocardial infarction seem to be negatively associated with hypokalemic serum potassium concentration. There is evidence for adverse consequences of serum potassium concentrations of ≥4.5 mEq/L. Due to the heterogeneity among existing studies, further research is necessary to confirm the need to change clinical practice guidelines.
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Affiliation(s)
- Miriam Giovanna Colombo
- MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Germany
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Germany
| | - Inge Kirchberger
- MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Germany
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Germany
- Chair of Epidemiology, UNIKA-T, Ludwig-Maximilians-Universität München, Germany
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERcv), Spain
| | - Ute Amann
- MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Germany
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Germany
- Chair of Epidemiology, UNIKA-T, Ludwig-Maximilians-Universität München, Germany
| | - Lisa Dinser
- MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Germany
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Germany
| | - Christa Meisinger
- MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Germany
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Germany
- Chair of Epidemiology, UNIKA-T, Ludwig-Maximilians-Universität München, Germany
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Tongyoo S, Viarasilpa T, Permpikul C. Serum potassium levels and outcomes in critically ill patients in the medical intensive care unit. J Int Med Res 2018; 46:1254-1262. [PMID: 29332427 PMCID: PMC5972260 DOI: 10.1177/0300060517744427] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective To compare the outcomes of patients with and without a mean serum potassium (K+) level within the recommended range (3.5-4.5 mEq/L). Methods This prospective cohort study involved patients admitted to the medical intensive care unit (ICU) of Siriraj Hospital from May 2012 to February 2013. The patients' baseline characteristics, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, serum K+ level, and hospital outcomes were recorded. Patients with a mean K+ level of 3.5 to 4.5 mEq/L and with all individual K+ values of 3.0 to 5.0 mEq/L were allocated to the normal K+ group. The remaining patients were allocated to the abnormal K+ group. Results In total, 160 patients were included. Their mean age was 59.3±18.3 years, and their mean APACHE II score was 21.8±14.0. The normal K+ group comprised 74 (46.3%) patients. The abnormal K+ group had a significantly higher mean APACHE II score, proportion of coronary artery disease, and rate of vasopressor treatment. An abnormal serum K+ level was associated with significantly higher ICU mortality and incidence of ventricular fibrillation. Conclusion Critically ill patients with abnormal K+ levels had a higher incidence of ventricular arrhythmia and ICU mortality than patients with normal K+ levels.
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Affiliation(s)
- Surat Tongyoo
- Division of Critical Care, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tanuwong Viarasilpa
- Division of Critical Care, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chairat Permpikul
- Division of Critical Care, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Admission serum potassium concentration and long-term mortality in patients with acute myocardial infarction: results from the MONICA/KORA myocardial infarction registry. BMC Cardiovasc Disord 2017; 17:198. [PMID: 28738785 PMCID: PMC5525217 DOI: 10.1186/s12872-017-0635-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 07/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Conflicting with clinical practice guidelines, recent studies demonstrated that serum potassium concentrations (SPC) of ≥4.5 mEq/l were associated with increased mortality in patients with acute myocardial infarction (AMI). This study examined the association between SPC and long-term mortality following AMI in patients recruited from a population-based registry. METHODS Included in the study were 3347 patients with AMI aged 28-74 years consecutively hospitalized between 1 January 2000 and 31 December 2008 and followed up until 31 December 2011. Patients were categorized into five SPC groups (<3.5, 3.5 to <4.0, 4.0 to <4.5, 4.5 to <5.0, and ≥5.0 mEq/l). The outcome of the study was all-cause mortality. Cox regression models adjusted for risk factors, co-morbidities and in-hospital treatment were constructed. RESULTS In our study population, 249 patients (7.4%) had a low SPC (<3.5 mEq/l) and 134 (4.0%) patients had a high SPC (≥5.0 mEq/l). Patients with SPC of ≥5.0 mEq/l had the highest long-term mortality (29.9%) and in the adjusted model, their risk of dying was significantly increased (HR 1.46, 95% CI 1.03 to 2.07) compared to patients with SPC between 4.0 and <4.5 mEq/l. Analyses of increasing observation periods showed a trend towards a higher risk of dying in patients with SPC between 4.5 and <5.0 mEq/l. CONCLUSION An admission SPC of ≥5.0 mEq/l might be associated with an increased mortality risk in patients with AMI. Patients with an admission SPC between 4.5 and <5.0 mEq/l might have an increased mortality risk in the first few years following AMI.
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Ito S, Nagoshi T, Minai K, Kashiwagi Y, Sekiyama H, Yoshii A, Kimura H, Inoue Y, Ogawa K, Tanaka TD, Ogawa T, Kawai M, Yoshimura M. Possible increase in insulin resistance and concealed glucose-coupled potassium-lowering mechanisms during acute coronary syndrome documented by covariance structure analysis. PLoS One 2017; 12:e0176435. [PMID: 28430816 PMCID: PMC5400267 DOI: 10.1371/journal.pone.0176435] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 04/10/2017] [Indexed: 12/16/2022] Open
Abstract
Objective Although glucose-insulin-potassium (GIK) therapy ought to be beneficial for ischemic heart disease in general, variable outcomes in many clinical trials of GIK in acute coronary syndrome (ACS) had a controversial impact. This study was designed to examine whether “insulin resistance” is involved in ACS and to clarify other potential intrinsic compensatory mechanisms for GIK tolerance through highly statistical procedure. Methods and results We compared the degree of insulin resistance during ACS attack and remission phase after treatment in individual patients (n = 104). During ACS, homeostasis model assessment of insulin resistance (HOMA-IR) values were significantly increased (P<0.001), while serum potassium levels were transiently decreased (degree of which was indicated by ΔK) (P<0.001). This finding provides a renewed paradox, as ΔK, a surrogate marker of intrinsic GIK cascade activation, probably reflects the validated glucose metabolism during ischemic attack. Indeed, multiple regression analysis revealed that plasma glucose level during ACS was positively correlated with ΔK (P = 0.026), whereas HOMA-IR had no impact on ΔK. This positive correlation between ΔK and glucose was confirmed by covariance structure analysis with a strong impact (β: 0.398, P = 0.015). Intriguingly, a higher incidence of myocardial infarction relative to unstable angina pectoris, as well as a longer hospitalization period were observed in patients with larger ΔK, indicating that ΔK also reflects disease severity of ACS. Conclusions Insulin resistance most likely increases during ACS; however, ΔK was positively correlated with plasma glucose level, which overwhelmed insulin resistance condition. The present study with covariance structure analysis suggests that there are potential endogenous glucose-coupled potassium lowering mechanisms, other than insulin, regulating glucose metabolism during ACS.
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Affiliation(s)
- Satoshi Ito
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JAPAN
| | - Tomohisa Nagoshi
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JAPAN
- * E-mail:
| | - Kosuke Minai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JAPAN
| | - Yusuke Kashiwagi
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JAPAN
| | - Hiroshi Sekiyama
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JAPAN
| | - Akira Yoshii
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JAPAN
| | - Haruka Kimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JAPAN
| | - Yasunori Inoue
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JAPAN
| | - Kazuo Ogawa
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JAPAN
| | - Toshikazu D. Tanaka
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JAPAN
| | - Takayuki Ogawa
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JAPAN
| | - Makoto Kawai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JAPAN
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JAPAN
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Udensi UK, Tchounwou PB. Potassium Homeostasis, Oxidative Stress, and Human Disease. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PHYSIOLOGY 2017; 4:111-122. [PMID: 29218312 PMCID: PMC5716641 DOI: 10.4103/ijcep.ijcep_43_17] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Potassium is the most abundant cation in the intracellular fluid and it plays a vital role in the maintenance of normal cell functions. Thus, potassium homeostasis across the cell membrane, is very critical because a tilt in this balance can result in different diseases that could be life threatening. Both Oxidative stress (OS) and potassium imbalance can cause life threatening health conditions. OS and abnormalities in potassium channel have been reported in neurodegenerative diseases. This review highlights the major factors involved in potassium homeostasis (dietary, hormonal, genetic, and physiologic influences), and discusses the major diseases and abnormalities associated with potassium imbalance including hypokalemia, hyperkalemia, hypertension, chronic kidney disease, and Gordon's syndrome, Bartter syndrome, and Gitelman syndrome.
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Affiliation(s)
- Udensi K. Udensi
- Molecular Toxicology Research laboratory, NIH RCMI-Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, Jackson, Mississippi, MS 39217, USA
- Department of Pathology & Laboratory Medicine, Veterans Affairs Puget Sound Health Care System, 1660 S Columbian Way (S-113), Seattle, WA 98108, USA
| | - Paul B. Tchounwou
- Molecular Toxicology Research laboratory, NIH RCMI-Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, Jackson, Mississippi, MS 39217, USA
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Patel RB, Tannenbaum S, Viana-Tejedor A, Guo J, Im K, Morrow DA, Scirica BM. Serum potassium levels, cardiac arrhythmias, and mortality following non-ST-elevation myocardial infarction or unstable angina: insights from MERLIN-TIMI 36. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 6:18-25. [PMID: 26714972 DOI: 10.1177/2048872615624241] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND In acute coronary syndrome (ACS), potassium levels <3.5 mEq/L are associated with ventricular arrhythmias. Current guidelines therefore recommend a potassium target >4.0 mEq/L in ACS. Our study evaluated the association between potassium levels, cardiac arrhythmias, and cardiovascular death in patients with non-ST-segment elevation myocardial infarction or unstable angina. METHODS Potassium levels were measured in 6515 patients prior to randomization to receive either ranolazine or a placebo in the MERLIN-TIMI 36 trial. A seven-day continuous electrocardiographic assessment was obtained to determine the incidence of non-sustained ventricular tachycardia (NSVT) and ventricular pauses. The association between potassium levels and cardiovascular death was evaluated using a Cox proportional hazards regression model with multivariable adjustment. RESULTS NSVT lasting for at least eight consecutive beats occurred more frequently at potassium levels <3.5 mEq/L than at potassium levels ⩾5 mEq/L (10.1 vs. 4.5%, p=0.03 for trend), whereas the inverse pattern was observed for ventricular pauses >3 s, which occurred more frequently at potassium levels ⩾5 mEq/L than at potassium levels <3.5 mEq/L (5.9 vs. 2.0%, p=0.03 for trend). There was a U-shaped relationship between the potassium level at admission and both early and late risk of cardiovascular death. Compared with patients with potassium levels of 3.5 to <4 mEq/L, a potassium level <3.5 mEq/L was associated with an increased risk of cardiovascular death at day 14 (2.4 vs. 0.8%, HRadj 3.1, p=0.02) and at one year (6.4 vs. 3.0%, HRadj 2.2, p=0.01). The risk of cardiovascular death at one year was also significantly increased at potassium levels ⩾4.5 mEq/L and a similar trend was noted at potassium levels ⩾5 mEq/L. CONCLUSIONS The lowest risk of cardiovascular death was observed in patients with admission potassium levels between 3.5 and 4.5 mEq/L. Both lower and higher levels of potassium were associated with tachyarrhythmias and bradyarrhythmias, suggesting a potential mechanistic explanation for the increased risk of cardiovascular death at the extremes of potassium homeostasis.
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Affiliation(s)
- Ravi B Patel
- 1 TIMI Study Group, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, USA
| | - Sara Tannenbaum
- 1 TIMI Study Group, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, USA
| | | | - Jianping Guo
- 1 TIMI Study Group, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, USA
| | - KyungAh Im
- 1 TIMI Study Group, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, USA
| | - David A Morrow
- 1 TIMI Study Group, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, USA
| | - Benjamin M Scirica
- 1 TIMI Study Group, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, USA
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Abstract
OBJECTIVES IV potassium supplementation is commonly used in the pediatric cardiovascular ICU. However, concentrated IV potassium chloride doses can lead to life-threatening complications. We report results of a quality improvement project aimed at decreasing concentrated IV potassium chloride exposure. DESIGN Retrospective evaluation of a quality improvement project aimed at reducing IV potassium chloride exposure. SETTING Pediatric cardiac ICU. PATIENTS All patients admitted to pediatric cardiac ICUs in April 2013 to September 2013 (preprotocol) and October 2013 to April 2014 (postprotocol). INTERVENTIONS A quality improvement team developed a potassium protocol aimed at maintaining serum potassium levels 3.0-5.5 mEq/L, via algorithm focused on early enteral supplementation. All patients receiving IV diuretics who had a serum potassium level less than 4.5 mEq/L and urine output more than 0.5 mL/kg/hr had protocol initiated with potassium chloride-containing IV fluids or enteral potassium chloride. Concentrated IV potassium chloride infusions were limited to asymptomatic patients with serum potassium less than 2.0 mEq/L and high-risk patients at less than 3.0 mEq/L. Serum potassium levels were measured once daily, and protocolized adjustments were made based on this level and concurrent diuretic therapy. MEASUREMENTS AND MAIN RESULTS Serum potassium, potassium chloride supplementation, patient cost, fluid administration, and arrhythmia incidence were compared pre and post protocol. Four hundred forty-three admissions were included (234 pre protocol and 209 post protocol). No significant differences were found in demographics. There was no difference in mean morning serum potassium after protocol implementation (3.85 [0.77] mEq/L before protocol and 3.89 [0.75] mEq/L after protocol; p = 0.90). Concentrated IV potassium chloride administration was decreased by 86% (331 vs 47 doses). With protocol, there was decreased incidence in days with one measured episode of hyperkalemia (11 vs 4/1,000 patient-days; p = 0.02) and a trend toward decreased hypokalemia (433 vs 400/1,000 patient-days; p = 0.05). Arrhythmia incidence was similar (p = 0.59). CONCLUSIONS Protocolized potassium management in pediatric cardiac intensive care patients decreased concentrated IV potassium chloride exposure and incidence of hyperkalemia. Lower potassium treatment threshold for IV potassium chloride was not associated with increased arrhythmias.
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Shlomai G, Berkovitch A, Pinchevski-Kadir S, Bornstein G, Leibowitz A, Goldenberg I, Grossman E. The association between normal-range admission potassium levels in Israeli patients with acute coronary syndrome and early and late outcomes. Medicine (Baltimore) 2016; 95:e3778. [PMID: 27281080 PMCID: PMC4907658 DOI: 10.1097/md.0000000000003778] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Abnormal serum potassium levels are associated with an increased risk of ventricular arrhythmias and mortality in patients with acute myocardial infarction (AMI). The aim of the present study was to evaluate whether different levels of serum potassium, within the normal range, are associated with worse outcomes. The present study comprised 1277 patients with AMI and normal-range admission potassium levels (3.5-5.2 mEq/L), who were enrolled and prospectively followed up in the Acute Coronary Syndrome Israeli Survey between 2010 and 2013. Patients were divided into 4 quartiles based on admission potassium levels; "normal-low" (K ≥ 3.5 and K ≤ 3.9), "normal-moderate" (K > 3.9 and K ≤ 4.18), "normal-high" (K > 4.18 and K ≤ 4.45), and "normal-very high" (K > 4.45 and K ≤ 5.2). We analyzed the association between admission serum potassium levels and 7 days in-hospital complication rates, and 30-day and 1-year all-cause mortality rates. Patients with "normal-very high" potassium displayed increased frequency of baseline clinical risk factors and experienced a higher rate of acute kidney injury during hospitalization compared with the "normal-low" group (7.7% vs 2.4%; P = 0.002). However, the rate of in-hospital ventricular arrhythmias was similar across the range of admission potassium levels (overall P = 0.26), Multivariate analysis showed that compared with "low-normal" potassium values, patients with "normal-very high" potassium levels experienced increased risk for 30-days (adjusted hazard ratio 2.88, 95% confidence interval 1.05-7.87, P = 0.039) and 1-year all-cause mortality (adjusted hazard ratio 1.98, 95% confidence interval 1.05-3.75, P = 0.034). In patients admitted with AMI, admission serum potassium levels of 4.45 to 5.2 mEq/L are not associated with in-hospital ventricular arrhythmias, but are associated with increased short and long-term mortality.
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Affiliation(s)
- Gadi Shlomai
- Department of Internal Medicine D and Hypertension Unit
- The Dr Pinchas Borenstein Talpiot Medical Leadership Program 2013
| | - Anat Berkovitch
- Department of Internal Medicine D and Hypertension Unit
- Heart Institute and the Neufeld Cardiac Research Institute, Leviev Heart Center, the Chaim Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Gil Bornstein
- Department of Internal Medicine D and Hypertension Unit
| | | | - Ilan Goldenberg
- Heart Institute and the Neufeld Cardiac Research Institute, Leviev Heart Center, the Chaim Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ehud Grossman
- Department of Internal Medicine D and Hypertension Unit
- ∗Correspondence: Ehud Grossman, Dean, Sackler Faculty of Medicine, Tel-Aviv University, Head of Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel ()
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Uluganyan M, Ekmekçi A, Murat A, Avşar Ş, Ulutaş TK, Uyarel H, Bozbay M, Çiçek G, Karaca G, Eren M. Admission serum potassium level is associated with in-hospital and long-term mortality in ST-elevation myocardial infarction. Anatol J Cardiol 2016; 16:10-5. [PMID: 26467357 PMCID: PMC5336698 DOI: 10.5152/akd.2015.5706] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Current guidelines recommend a serum potassium (sK) level of 4.0-5.0 mmol/L in acute myocardial infarction patients. Recent trials have demonstrated an increased mortality rate with an sK level of>4.5 mmol/L. The aim of this study was to figure out the relation between admission sK level and in-hospital and long-term mortality and ventricular arrhythmias. METHODS Retrospectively, 611 patients with ST-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention were recruited. Admission sK levels were categorized accordingly: <3.5, 3.5-<4, 4-<4.5, 4.5-<5, and ≥5 mmol/L. RESULTS The lowest in-hospital and long-term mortality occurred in patients with sK levels of 3.5 to <4 mmol/L. The long-term mortality risk increased for admission sK levels of >4.5 mmol/L [odds ratio (OR), 1.58; 95% confidence interval (CI) 0.42-5.9 and OR, 2.27; 95% CI 0.44-11.5 for sK levels of 4.5-<5 mmol/L and ≥5 mmol/L, respectively]. At sK levels <3 mmol/L and ≥5 mmol/L, the incidence of ventricular arrhythmias was higher (p=0.019). CONCLUSION Admission sK level of >4.5 mmol/L was associated with increased long-term mortality in STEMI. A significant relation was found between sK level of <3 mmol/L and ≥5 mmol/L and ventricular arrhythmias.
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Affiliation(s)
- Mahmut Uluganyan
- Clinic of Cardiology, Kadirli Government Hospital; Osmaniye-Turkey.
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Peng Y, Huang FY, Liu W, Zhang C, Zhao ZG, Huang BT, Liao YB, Li Q, Chai H, Luo XL, Ren X, Chen C, Meng QT, Huang DJ, Wang H, Chen M. Relation between admission serum potassium levels and long-term mortality in acute coronary syndrome. Intern Emerg Med 2015; 10:927-35. [PMID: 25986480 DOI: 10.1007/s11739-015-1253-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 05/05/2015] [Indexed: 10/23/2022]
Abstract
Serum potassium homeostasis play an important role in myocardial function, but the impact of serum potassium levels on long-term mortality has not been well evaluated. In the current study, we investigated patients with acute coronary syndrome (ACS) and analyzed the relationship between admission serum potassium levels and long-term mortality. Between July 2008 and September 2012, 2369 patients with ACS that was confirmed by coronary angiography were enrolled in this study and completed the follow-up. The serum potassium level was evaluated within first 24 h after admission. The primary outcome in this study was all-cause mortality. Patients were categorized into five groups to determine the relation between admission serum potassium levels and long-term mortality: < 3.5, 3.5 to < 4.0, 4.0 to < 4.5, 4.5 to < 5.0, and > 5 mEq/L. There was a U-shaped relationship between admission serum potassium levels and long-term mortality that persisted after multivariable adjustment. The mortality risk was lowest in the group of patients with potassium levels of 3.5 to < 4.0 mEq/L, whereas mortality was higher in patients with potassium levels > 4.5 [hazard ratio (HR) 1.62, 95 % confidence interval (CI) 0.90 to 2.93 and HR 1.55, 95 % CI 0.54 to 4.49, for patients with potassium levels of 4.5 to < 5.0 mEq/L and ≥ 5.0 mEq/L, respectively] or < 3.5 mEq/L (HR 2.14, 95 % CI 1.28 to 3.59). There was a U-shaped relationship between admission serum potassium levels and long-term mortality for ACS patients; in particular, among the examined patients, the lowest mortality was observed in those with admission serum potassium levels of between 3.5 and < 4.5 mEq/L compared with those who had higher or lower potassium levels.
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Affiliation(s)
- Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Fang-yang Huang
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Wei Liu
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Chen Zhang
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Zhen-gang Zhao
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Bao-tao Huang
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Yan-biao Liao
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Qiao Li
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Hua Chai
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Xiao-lin Luo
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Xin Ren
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Chi Chen
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Qing-tao Meng
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - De-jia Huang
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China
| | - Hua Wang
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China.
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China.
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Conway R, Creagh D, Byrne DG, O'Riordan D, Silke B. Serum potassium levels as an outcome determinant in acute medical admissions. Clin Med (Lond) 2015; 15:239-43. [PMID: 26031972 PMCID: PMC4953106 DOI: 10.7861/clinmedicine.15-3-239] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The relationship between serum potassium levels and mortality in acute medical admissions is uncertain. In particular, the relevance of minor abnormalities in potassium level or variations within the normal range remains to be determined. We performed a retrospective cohort study of all emergency medical admissions to St James's Hospital (Dublin, Ireland) between 2002 and 2012. We used a stepwise logistic regression model to predict in-hospital mortality, adjusting risk estimates for major predictor variables. There were 67,585 admissions in 37,828 patients over 11 years. After removing long-stay patients, 60,864 admissions in 35,168 patients were included in the study. Hypokalaemia was present in 14.5% and hyperkalaemia in 4.9%. In-hospital mortality was 3.9, 5.0, and 18.1% in the normokalaemic, hypokalaemic and hyperkalaemic groups respectively. Hypokalaemic patients had a univariate odds ratio (OR) of 1.29 for in-hospital mortality (95% confidence interval (CI) 1.16-1.43; p<0.001). Hyperkalaemic patients had a univariate OR for in-hospital mortality of 5.2 (95% CI 4.7-5.7; p<0.001). The ORs for an in-hospital death for potassium between 4.3 and 4.7 mmol/l, and 4.7 and 5.2 mmol/l, were 1.73 (95% CI 1.51-1.99) and 2.97 (95% CI 2.53-3.50) respectively. Hyperkalaemia and hypokalaemia are associated with increased mortality.
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Affiliation(s)
- Richard Conway
- Department of Internal Medicine, St James's Hospital, Dublin, Ireland
| | - Donnacha Creagh
- Information Management Systems, St James's Hospital, Dublin, Ireland
| | - Declan G Byrne
- Department of Internal Medicine, St James's Hospital, Dublin, Ireland
| | - Deirdre O'Riordan
- consultant physician, Department of Internal Medicine, St James's Hospital, Dublin, Ireland
| | - Bernard Silke
- Department of Internal Medicine, St James's Hospital, Dublin, Ireland
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Lai YH, Leu HB, Yeh WT, Chang HY, Pan WH. Low-normal serum potassium is associated with an increased risk of cardiovascular and all-cause death in community-based elderly. J Formos Med Assoc 2015; 114:517-25. [PMID: 26009484 DOI: 10.1016/j.jfma.2015.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 12/23/2014] [Accepted: 01/06/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/PURPOSE Several studies have already reported that serum potassium (SK) correlated inversely with adverse events among patients with preexisting cardiovascular disease and impaired renal function; less is known about the prognostic value of SK at the normal range in community-based elderly individuals. This study aimed to examine whether low normal SK value was associated with cardiovascular and all-cause mortalities in elderly people. METHODS A prospective study was conducted using two independent elderly Taiwanese community cohorts that included 2065 individuals with relatively normal SK values (2.8-5.6 mmol/L). The participants were grouped as follows: low (2.8-3.4 mmol/L), low-normal SK (3.5-3.8 mmol/L), normal (3.9-4.4 mmol/L), and high-normal SK (4.5-5.6 mmol/L). Proportional hazards model was applied to compare the association between SK concentration groups and mortality. RESULTS The relationship between baseline SK and all-cause and cardiovascular mortality was U-shaped, with the lowest mortality rates observed in patients with SK levels of 3.9-4.4 mmol/L. The low-normal SK group had significantly higher risks of all-cause (hazard ratio, 1.3; 95% confidence interval, 1.0-1.6) and cardiovascular mortality (hazard ratio, 1.6; 95% confidence interval, 1.1-2.3) than the normal SK group. The high-normal SK group had higher but nonsignificant risk compared to the normal group. CONCLUSION Our findings suggest that low-normal SK may be used as a marker of poor survival for elderly outpatient cares.
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Affiliation(s)
- Ying-Ho Lai
- Department of Biochemical Science and Technology, College of Life Science, National Taiwan University, Number 1, Section 4, Roosevelt Road, Taipei, Taiwan
| | - Hsin-Bang Leu
- Healthcare and Management Center, Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Number 201, Section 2, Shih-Pai Road, Taipei, Taiwan
| | - Wen-Ting Yeh
- Institute of Biomedical Sciences, Academia Sinica, Number 128, Section 2, Academia Road, Taipei, Taiwan
| | - Hsing-Yi Chang
- Division of Preventive Medicine and Health Services Research, Institute of Population Health Sciences, National Health Research Institutes, Number 35, Keyan Road, Miaoli, Taiwan
| | - Wen-Harn Pan
- Institute of Biomedical Sciences, Academia Sinica, Number 128, Section 2, Academia Road, Taipei, Taiwan.
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Abstract
Acute emotional or physical stress can trigger a catecholamine-mediated myocardial stunning known as takotstubo cardiomyopathy (TCM). Although TCM is generally reversible, it can be associated with significant morbidity, including secondarily to cardiac arrhythmia. Lethal arrhythmias such as heart block, ventricular tachycardia, and ventricular fibrillation have been described. Repolarization abnormalities associated with TCM can lead to characteristic T-wave abnormalities and QT prolongation that place patients at increased risk for ventricular arrhythmia, including torsades de pointes. This article focuses on the arrhythmic complications associated with TCM and explores the underlying etiology of these arrhythmias.
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Affiliation(s)
- Kathleen Hayes Brown
- Clinical Cardiac Electrophysiology Service, Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Richard G Trohman
- Clinical Cardiac Electrophysiology Service, Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Christopher Madias
- Clinical Cardiac Electrophysiology Service, Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA.
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Potassium concentration on admission is an independent risk factor for target lesion revascularization in acute myocardial infarction. ScientificWorldJournal 2014; 2014:946803. [PMID: 24523655 PMCID: PMC3913530 DOI: 10.1155/2014/946803] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 10/22/2013] [Indexed: 01/10/2023] Open
Abstract
Background. Acute myocardial infarction (AMI) is accompanied by excessive production of catecholamines, which is characterized by a hypokalemic dip.
A polymorphism of the adrenergic receptor has also been reported to be associated with target lesion revascularization (TLR) after coronary intervention.
Subjects and Methods. We enrolled 276 consecutive patients with AMI within 24 hours of symptom onset, who underwent emergency coronary intervention
using bare metal stents and had examinations over a 5–10-month follow-up period. The patients were divided into tertiles based on their serum potassium level on admission
(low K, <3.9; mid K, ≥3.9, <4.3; and high K, ≥4.3). Results. Sixty-four TLRs were observed in the study.
Increased potassium concentration was associated significantly with TLR. Patients in the high K group were about two and a half times more likely to have a TLR after AMI compared to
those in the low K group. Multiple logistic analysis showed that potassium level on admission was an independent risk factor for TLR (odds ratio 1.69; confidence interval 1.04 to 2.74; P = 0.036). Conclusions. These findings indicated that increased potassium levels on admission might predict TLRs in AMI patients treated with bare metal stents.
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Krijthe BP, Heeringa J, Kors JA, Hofman A, Franco OH, Witteman JCM, Stricker BH. Serum potassium levels and the risk of atrial fibrillation: the Rotterdam Study. Int J Cardiol 2013; 168:5411-5. [PMID: 24012173 DOI: 10.1016/j.ijcard.2013.08.048] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 08/06/2013] [Accepted: 08/18/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atrial fibrillation is the most common sustained arrhythmia in the elderly. Serum potassium is associated with ventricular arrhythmias and cardiac arrest. Little is known about the association of serum potassium with atrial fibrillation. The objective of this study was to investigate the association of serum potassium and the risk of atrial fibrillation in a population based setting. METHODS The study was performed within the prospective population-based Rotterdam Study. The study population consisted of 4059 participants without atrial fibrillation at baseline for whom baseline levels of serum potassium were measured. Atrial fibrillation was ascertained from centre visit ECG assessments as well as medical records. RESULTS During a mean follow up of 11.8 years (SD=5.2 yr), 474 participants developed atrial fibrillation. Participants with hypokalemia (<3.5 mmol/l) had a higher risk of atrial fibrillation (HR: 1.63, 95%CI: 1.03-2.56) than those with normokalemia (3.5-5.0 mmol/l). This association was independent of age, sex, serum magnesium, and other potential confounders. Especially in participants with a history of myocardial infarction, those with hypokalemia had a higher risk of atrial fibrillation than those with normokalemia (HR: 3.81, 95%-CI: 1.51-9.61). CONCLUSIONS In this study low serum levels of potassium were associated with a higher risk of atrial fibrillation.
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Affiliation(s)
- Bouwe P Krijthe
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Netherlands Consortium for Healthy Aging (NCHA), The Netherlands
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Sekiyama H, Nagoshi T, Komukai K, Matsushima M, Katoh D, Ogawa K, Minai K, Ogawa T, Yoshimura M. Transient decrease in serum potassium level during ischemic attack of acute coronary syndrome: paradoxical contribution of plasma glucose level and glycohemoglobin. Cardiovasc Diabetol 2013; 12:4. [PMID: 23289667 PMCID: PMC3561250 DOI: 10.1186/1475-2840-12-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 12/30/2012] [Indexed: 11/26/2022] Open
Abstract
Background Although a decrease in serum potassium level has been suggested to be a fairly common observation in acute coronary syndrome (ACS), there have so far been no definitive reports directly demonstrating the transient potassium decrease (the potassium dip) during ischemic attack of ACS compared to stable phase in individual patients. To understand the pathophysiological significance of the potassium dip, we examined the changes in serum potassium level throughout ischemic attack and evaluated the clinical factors affecting it. Methods The degree of the potassium dip during ischemic attack (as indicated by ΔK, ΔK = K at discharge − K on admission) was examined in 311 consecutive patients with ACS who required urgent hospitalization in our institution. Results Serum potassium level during ischemic attack was significantly decreased compared to that during stable phase (P < 0.001). Multiple regression analysis revealed that plasma glucose level during attack was the sole factor which was positively correlated with ΔK (P < 0.01), while HbA1c level was negatively correlated (P < 0.05). The medication profiles and renal function had no impact on ΔK. A longer hospitalization period, higher incidence of myocardial infarction and higher peak creatine kinase level were observed in patients with a larger ΔK. Conclusions We have clearly demonstrated that there is a transient decrease in serum potassium level during ischemic attack of ACS compared to stable phase. The degree of the potassium dip was tightly correlated with glucose level, which overwhelmed the diabetic condition, and it also indicates the disease severity. The present study therefore promotes awareness of the significance of monitoring potassium level in parallel with glucose level in patients with ACS.
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Affiliation(s)
- Hiroshi Sekiyama
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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Al-Quthami AH, Udelson JE. What Is the “Goal” Serum Potassium Level in Acute Myocardial Infarction? Am J Kidney Dis 2012; 60:517-20. [DOI: 10.1053/j.ajkd.2012.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 05/21/2012] [Indexed: 11/11/2022]
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Su J, Fu X, Tian Y, Ma Y, Chen H, Wang Y, Wang X, Liu H. Additional predictive value of serum potassium to Thrombolysis In Myocardial Infarction risk score for early malignant ventricular arrhythmias in patients with acute myocardial infarction. Am J Emerg Med 2011; 30:1089-94. [PMID: 22035586 DOI: 10.1016/j.ajem.2011.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Revised: 07/02/2011] [Accepted: 07/15/2011] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the additional predictive value of serum potassium (SK) to Thrombolysis In Myocardial Infarction (TIMI) risk score for malignant ventricular arrhythmias (MVA) in patients within 24 hours of acute myocardial infarction (AMI). METHODS This was a 6-year retrospective study. The receiver operating characteristic curve was used to evaluate the predictive value of SK and TIMI risk score for MVA attack. In addition, SK-modified TIMI risk score was created by incorporating SK information into the usual score; the accuracy of new score was compared with that of the usual TIMI risk score by comparing the area under the receiver operating characteristic curves (AUC). RESULTS Among the 468 patients enrolled, the incidence of MVA 24 hours after AMI was 9.4%, and it was higher in the hypokalemia group compared with that of the normokalemic group (27.3% vs 7.5%, P < .001; odds ratio, 4.594; 95% confidence interval [CI], 2.159-9.774). A significant predictive value of SK was indicated by AUC of 0.787 (95% CI, 0.747-0.823, P < .01). Serum potassium remained a predictor of MVA after being adjusted by the variables in TIMI risk score. The AUC of TIMI risk score in relation to MVA was 0.586 (95% CI, 0.54-0.631; P = .0676). The incorporation of SK into TIMI risk score improved its predictive value for MVA attack (AUC = 0.66; 95% CI, 0.568-0.753; P < .001), with significant difference between AUC of the new score and that of the original risk score (Z = 2.474, P = .013). CONCLUSIONS Serum potassium on admission to the emergency department may be used as a valuable predictor and could add predictive information to some extent to TIMI risk score for MVA attack during 24-hour post-AMI.
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Affiliation(s)
- Jianling Su
- Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050000, China
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Madias C, Fitzgibbons TP, Alsheikh-Ali AA, Bouchard JL, Kalsmith B, Garlitski AC, Tighe DA, Estes NM, Aurigemma GP, Link MS. Acquired long QT syndrome from stress cardiomyopathy is associated with ventricular arrhythmias and torsades de pointes. Heart Rhythm 2011; 8:555-61. [DOI: 10.1016/j.hrthm.2010.12.012] [Citation(s) in RCA: 144] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 12/07/2010] [Indexed: 11/30/2022]
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Clausen T. Hormonal and pharmacological modification of plasma potassium homeostasis. Fundam Clin Pharmacol 2010; 24:595-605. [DOI: 10.1111/j.1472-8206.2010.00859.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Roos M, Ndrepepa G, Baumann M, Pan CR, Heemann U, Lutz J, Keta D, Schulz S, Byrne RA, Mehilli J, Schömig A, Kastrati A. Serum potassium levels on admission and infarct size in patients with acute myocardial infarction. Clin Chim Acta 2009; 409:46-51. [DOI: 10.1016/j.cca.2009.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Revised: 08/20/2009] [Accepted: 08/20/2009] [Indexed: 12/08/2022]
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Relation of baseline serum potassium levels to angiographic findings in patients with known or suspected coronary artery disease. Am J Hypertens 2009; 22:754-62. [PMID: 19373212 DOI: 10.1038/ajh.2009.65] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND In experimental animal studies, potassium has been demonstrated to protect against the development of atherosclerosis through a variety of mechanisms. Data regarding the role of potassium in the development of human atherosclerosis are sparse. The objective of this study was to determine the association between plasma potassium levels and angiographically defined coronary artery disease (CAD). METHODS In a cohort of 389 male patients undergoing coronary angiography for a variety of clinical indications, the association between baseline serum potassium levels and the extent of angiographically defined atherosclerosis was analyzed. Adjustments were made for clinical and laboratory variables (including inflammatory markers) known to be associated with atherosclerosis. RESULTS By multivariate logistic regression analysis, baseline serum potassium levels were an independent predictor of the presence of multivessel disease (odds ratio (OR) 1.31, 95% confidence interval (CI) 1.01-1.69; P < 0.05). In addition, in the non-myocardial infarction subpopulation of patients, serum potassium was also an independent predictor of the presence of multivessel disease by multivariate logistic regression analysis (OR 1.34, 95% CI, 1.02-1.76; P < 0.05). In the myocardial infarction (MI) subpopulation, serum potassium was not a predictor of multivessel disease, possibly due to the confounding effect of hypokalemia known to be present during MI. CONCLUSIONS These data demonstrate that a simple baseline serum potassium level is independently associated with the presence of multivessel disease, even in the context of clinical CAD risk factors and other established inflammatory markers.
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Abstract
Potassium (K) concentration plays a significant role in cell metabolism and membrane excitability. The imbalance of serum potassium is important because it can lead to life-threatening events. Potassium balance may be lost both through the neurohormonal mechanisms involved in cardiovascular diseases and through the drugs used in the treatment of this illness. Avoiding both hypo- and hyperkalemia is beneficial in several cardiovascular diseases, especially heart failure. Electrolyte abnormalities are frequently seen complications in subjects with heart failure. Malignant ventricular arrhythmias and sudden cardiac death are particularly feared complications in K+ instability.
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Affiliation(s)
- Ihsan Dursun
- Ondokuz Mayis University Medical School, Department of Cardiology, Samsun, Turkey.
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Bundgaard H, Kjeldsen K, Suarez Krabbe K, van Hall G, Simonsen L, Qvist J, Hansen CM, Moller K, Fonsmark L, Lav Madsen P, Klarlund Pedersen B. Endotoxemia stimulates skeletal muscle Na+-K+-ATPase and raises blood lactate under aerobic conditions in humans. Am J Physiol Heart Circ Physiol 2003; 284:H1028-34. [PMID: 12446281 DOI: 10.1152/ajpheart.00639.2002] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We assessed the hypothesis that the epinephrine surge present during sepsis accelerates aerobic glycolysis and lactate production by increasing activity of skeletal muscle Na(+)-K(+)-ATPase. Healthy volunteers received an intravenous bolus of endotoxin or placebo in a randomized order on two different days. Endotoxemia induced a response resembling sepsis. Endotoxemia increased plasma epinephrine to a maximum at t = 2 h of 0.7 +/- 0.1 vs. 0.3 +/- 0.1 nmol/l (P < 0.05, n = 6-7). Endotoxemia reduced plasma K(+) reaching a nadir at t = 5 h of 3.3 +/- 0.1 vs. 3.8 +/- 0.1 mmol/l (P < 0.01, n = 6-7), followed by an increase to placebo level at t = 7-8 h. During the declining plasma K(+), a relative accumulation of K(+) was seen reaching a maximum at t = 6 h of 8.7 +/- 3.8 mmol/leg (P < 0.05). Plasma lactate increased to a maximum at t = 1 h of 2.5 +/- 0.5 vs. 0.9 +/- 0.1 mmol/l (P < 0.05, n = 8) in association with increased release of lactate from the legs. These changes were not associated with hypoperfusion or hypoxia. During the first 24 h after endotoxin infusion, renal K(+) excretion was 27 +/- 7 mmol, i.e., 58% higher than after placebo. Combination of the well-known stimulatory effect of catecholamines on skeletal muscle Na(+)-K(+)-ATPase activity, with the present confirmation of an expected Na(+)-K(+)- ATPase-induced decline in plasma K(+), suggests that the increased lactate release was due to increased Na(+)-K(+)-ATPase activity, supporting our hypothesis. Thus increased lactate levels in acutely and severely ill patients should not be managed only from the point of view that it reflects hypoxia.
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Affiliation(s)
- Henning Bundgaard
- Department of Medicine, University of Copenhagen, 2100 Copenhagen, Denmark.
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Foo K, Sekhri N, Deaner A, Knight C, Suliman A, Ranjadayalan K, Timmis AD. Effect of diabetes on serum potassium concentrations in acute coronary syndromes. Heart 2003; 89:31-5. [PMID: 12482786 PMCID: PMC1767495 DOI: 10.1136/heart.89.1.31] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To compare serum potassium concentrations in diabetic and non-diabetic patients in the early phase of acute coronary syndromes. BACKGROUND Acute phase hypokalaemia occurs in response to adrenergic activation, which stimulates membrane bound sodium-potassium-ATPase and drives potassium into the cells. It is not known whether the hypokalaemia is attenuated in patients with diabetes because of the high prevalence of sympathetic nerve dysfunction. METHODS Prospective cohort study of 2428 patients presenting with acute coronary syndromes. Patients were stratified by duration of chest pain, diabetic status, and pretreatment with beta blockers. RESULTS The mean (SD) serum potassium concentration was significantly higher in diabetic than in non-diabetic patients (4.3 (0.5) v 4.1 (0.5) mmol/l, p < 0.0001). Multivariate analysis identified diabetes as an independent predictor of a serum potassium concentration in the upper half of the distribution (odds ratio 1.66, 95% confidence interval 1.38 to 2.00). In patients presenting within 6 hours of symptom onset, there was a progressive increase in plasma potassium concentrations from 4.08 (0.46) mmol/l in patients presenting within 2 hours, to 4.20 (0.47) mmol/l in patients presenting between 2-4 hours, to 4.24 (0.52) mmol/l in patients presenting between 4-6 hours (p = 0.0007). This pattern of increasing serum potassium concentration with duration of chest pain was attenuated in patients with diabetes, particularly those with unstable angina. Similar attenuation occurred in patients pretreated with beta blockers. CONCLUSION In acute coronary syndromes, patients with diabetes have significantly higher serum potassium concentrations and do not exhibit the early dip seen in non-diabetics. This may reflect sympathetic nerve dysfunction that commonly complicates diabetes.
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Affiliation(s)
- K Foo
- Department of Cardiology, Newham HealthCare NHS Trust, London, UK
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