Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
J Card Fail. 2012 Aug;18(8):620-5. doi: 10.1016/j.cardfail.2012.06.415.
Although hyponatremia during hospitalization for acute decompensated heart failure (ADHF) has been reported to correlate with poor prognosis, few studies have examined the effect of progression of hyponatremia on cardiac prognosis in ADHF patients who were normonatremic at admission.
Consecutive ADHF patients (n = 662) categorized as New York Heart Association Class III or IV were investigated retrospectively. Of these patients, 634 who survived to discharge were examined and 531 were normonatremic (serum sodium concentration [Na] ≥ 135 and ≤ 145 mmol/L) at admission. The 531 patients were divided into 2 groups: the non-developed group, who remained normonatremic at discharge (n = 455), and the developed group, who had progressed to hyponatremia (Na < 135 mmol/L) at discharge (n = 76). The cardiac event-free rate after 12 months was significantly lower in the developed group than in the non-developed group (22% vs. 71%; P < .0001). Although their baseline levels of brain natriuretic peptide and left ventricular ejection fraction were similar before discharge, the patients in the developed group exhibited higher fractional excretion of sodium and received higher doses of diuretics than did those in the non-developed group.
Our data suggest that progression to hyponatremia during hospitalization is a robust predictor of poor cardiac prognosis in ADHF patients who were normonatremic at admission.
尽管住院期间急性失代偿性心力衰竭（ADHF）患者发生低钠血症与预后不良相关，但很少有研究探讨入院时血钠正常的 ADHF 患者中低钠血症进展对心脏预后的影响。
回顾性调查了连续的 ADHF 患者（n=662），这些患者纽约心脏协会（NYHA）心功能分级为 III 级或 IV 级。其中，634 例存活至出院的患者被纳入研究，531 例入院时血钠正常（血清钠浓度[Na]≥135mmol/L 且≤145mmol/L）。531 例患者被分为 2 组：未发生组（n=455），出院时仍保持血钠正常；发生组（n=76），出院时进展为低钠血症（Na＜135mmol/L）。发生组 12 个月后心脏无事件生存率明显低于未发生组（22% vs. 71%；P＜0.0001）。尽管出院前两组患者的脑利钠肽和左心室射血分数基线水平相似，但发生组的患者钠排泄分数更高，利尿剂剂量也更高。
我们的数据表明，入院时血钠正常的 ADHF 患者住院期间发生低钠血症是预后不良的一个强有力的预测因素。
