Division of Cardiology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea.
Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Heart. 2018 Oct;104(20):1670-1677. doi: 10.1136/heartjnl-2017-312084. Epub 2017 Oct 27.
Hyponatraemia is a well-known predictor of clinical outcomes in heart failure (HF). However, the mechanism remains poorly understood. Previous reports suggest that hyponatraemia is related to right HF. We sought to evaluate the association between right ventricular (RV) dysfunction and hyponatraemia, and the impact of this relationship on the prognosis of patients with acute heart failure (AHF).
This is a nested case-control study of the Korean Acute Heart Failure registry. Among 2935 AHF patients enrolled prospectively and consecutively at four tertiary hospitals in Korea from 2011 to 2014, 116 patients with severe persistent hyponatraemia, defined as serum sodium level <130 mmol/L at admission and <135 mmol/L before discharge, were matched with 232 controls, based on propensity scores for hyponatraemia. RV function was assessed with fractional area change (FAC) by echocardiography.
RV dysfunction (FAC <35%) was more prevalent in patients with severe persistent hyponatraemia than in those without (81.0% vs 33.6%, p<0.001). Hyponatraemia was strongly associated with RV dysfunction (adjusted OR 8.00, 95% CI 4.50 to 14.22, p<0.001), but not with left ventricular dysfunction (adjusted OR 1.21, 95% CI 0.74 to 1.50, p=0.308). RV dysfunction was an independent predictor of all-cause mortality, after adjustment for hyponatraemia (adjusted HR 2.20, 95% CI 1.53 to 3.15, p<0.001), while hyponatraemia was not (adjusted HR 1.33, 95% CI 0.94 to 1.87, p=0.108).
In patients with AHF, hyponatraemia was more common with RV dysfunction. RV dysfunction, rather than hyponatraemia, was more significantly related with patients' prognosis. Thus, the utility of RV dysfunction instead of hyponatraemia per se should be considered in HF risk models.
Korean Acute Heart Failure registry NCT01389843; Results.
低钠血症是心力衰竭（HF）临床结局的一个众所周知的预测因子。然而，其机制仍知之甚少。先前的报告表明，低钠血症与右心 HF 有关。我们旨在评估右心室（RV）功能障碍与低钠血症之间的关系，以及这种关系对急性心力衰竭（AHF）患者预后的影响。
这是一项在韩国四个三级医院前瞻性连续纳入的韩国急性心力衰竭注册研究中的嵌套病例对照研究。2011 年至 2014 年期间，共有 2935 例 AHF 患者入组，其中 116 例严重持续性低钠血症患者（入院时血清钠水平<130mmol/L，出院前<135mmol/L）与 232 例对照根据低钠血症的倾向评分进行匹配。RV 功能通过超声心动图评估分数面积变化（FAC）。
与无低钠血症的患者相比，严重持续性低钠血症患者的 RV 功能障碍（FAC<35%）更为常见（81.0% vs 33.6%，p<0.001）。低钠血症与 RV 功能障碍密切相关（调整后的 OR 8.00，95%CI 4.50 至 14.22，p<0.001），但与左心室功能障碍无关（调整后的 OR 1.21，95%CI 0.74 至 1.50，p=0.308）。RV 功能障碍是全因死亡率的独立预测因素，调整低钠血症后（调整后的 HR 2.20，95%CI 1.53 至 3.15，p<0.001），而低钠血症不是（调整后的 HR 1.33，95%CI 0.94 至 1.87，p=0.108）。
在 AHF 患者中，RV 功能障碍时更常见低钠血症。与患者预后更显著相关的是 RV 功能障碍，而不是低钠血症。因此，在 HF 风险模型中应考虑 RV 功能障碍而不是低钠血症本身的效用。
韩国急性心力衰竭注册研究 NCT01389843；结果。
