Department of Medicine, St. Luke's-Roosevelt Hospital Center, New York, New York.
Division of Cardiology, University of Alabama at Birmingham, Birmingham, Alabama.
Am J Cardiol. 2014 Jun 1;113(11):1834-8. doi: 10.1016/j.amjcard.2014.03.017. Epub 2014 Mar 18.
Hyponatremia in heart failure (HF) is an established predictor of adverse outcomes in hospitalized patients with reduced ejection fraction (EF). However, there is a paucity of data in ambulatory patients with HF with preserved ejection fraction (HFpEF). We examined the prevalence, risk factors, and long-term outcomes of hyponatremia (serum sodium ≤135 mEq/L) in ambulatory HFpEF and HF with reduced EF (HFrEF) in a national cohort of 8,862 veterans treated in Veterans Affairs clinics. Multivariable logistic regression models were used to identify factors associated with hyponatremia, and multivariable Cox proportional hazard models were used for analysis of outcomes. The cohort consisted of 6,185 patients with HFrEF and 2,704 patients with HFpEF with a 2-year follow-up. Hyponatremia was present in 13.8% and 12.9% patients in HFrEF and HFpEF, respectively. Hyponatremia was independently associated with younger age, diabetes, lower systolic blood pressure, anemia, body mass index <30 kg/m(2), and spironolactone use, whereas African-American race and statins were inversely associated. In multivariate analysis, hyponatremia remained a significant predictor of all-cause mortality in both HFrEF (hazards ratio [HR] 1.26, 95% confidence interval [CI] 1.11 to 1.44, p <0.001) and HFpEF (HR 1.40, 95% CI 1.12 to 1.75, p = 0.004) and a significant predictor of all-cause hospitalization in patients with HFrEF (HR 1.18, 95% CI 1.07 to 1.31, p = 0.001) but not in HFpEF (HR 1.08, 95% CI 0.92 to 1.27, p = 0.33). In conclusion, hyponatremia is prevalent at a similar frequency of over 10% in ambulatory patients with HFpEF and HFrEF. Hyponatremia is an independent prognostic marker of mortality across the spectrum of patients with HFpEF and HFrEF. In contrast, it is an independent predictor for hospitalization in patients with HFrEF but not in patients with HFpEF.
心力衰竭（HF）中的低钠血症是射血分数降低（EF）的住院患者不良结局的既定预测因素。然而，射血分数保留的心力衰竭（HFpEF）的门诊患者的数据很少。我们在退伍军人事务诊所治疗的 8862 名退伍军人的全国队列中检查了门诊 HFpEF 和射血分数降低的心力衰竭（HFrEF）患者低钠血症（血清钠≤135 mEq/L）的患病率，危险因素和长期结局。多变量逻辑回归模型用于确定与低钠血症相关的因素，多变量 Cox 比例风险模型用于分析结局。该队列包括 6185 名 HFrEF 患者和 2704 名 HFpEF 患者，随访 2 年。HFrEF 和 HFpEF 患者中分别有 13.8％和 12.9％的患者存在低钠血症。低钠血症与年龄较小，糖尿病，较低的收缩压，贫血，体重指数<30 kg/m2和螺内酯的使用有关，而非洲裔美国人种族和他汀类药物则呈负相关。在多变量分析中，低钠血症仍然是 HFrEF 中全因死亡率的重要预测指标（危险比[HR] 1.26，95％置信区间[CI] 1.11 至 1.44，p <0.001）和 HFpEF（HR 1.40，95％CI 1.12 至 1.75，p = 0.004），并且是 HFrEF 患者全因住院的重要预测指标（HR 1.18，95％CI 1.07 至 1.31，p = 0.001），但不是 HFpEF（HR 1.08，95％CI 0.92 至 1.27，p = 0.33）。总之，在 HFpEF 和 HFrEF 的门诊患者中，低钠血症的患病率相似，均超过 10％。低钠血症是 HFpEF 和 HFrEF 患者全谱死亡率的独立预后标志物。相比之下，它是 HFrEF 患者住院的独立预测指标，但不是 HFpEF 患者的独立预测指标。
