Department of Academic Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, UK.
Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow, UK.
Eur J Heart Fail. 2018 Oct;20(10):1426-1435. doi: 10.1002/ejhf.1247. Epub 2018 Jun 26.
Low serum chloride is common in patients with chronic heart failure (CHF) and is associated with worse outcomes. We investigated the clinical and prognostic associations, including cause of death associations, of low serum chloride in patients referred to a secondary care clinic with suspected heart failure.
Patients with echocardiogram and serum chloride were evaluated (n = 5613). CHF was defined as signs and symptoms of the disease and either left ventricular systolic dysfunction (LVSD) worse than mild [heart failure with reduced ejection fraction (HFrEF)] or LVSD mild or better and raised amino-terminal pro-B-type natriuretic peptide (NT-proBNP) levels (>125 ng/L) [heart failure with preserved ejection fraction (HFpEF)]. Hypochloraemia was defined as greater than two standard deviations below the mean in the local normal distribution (<96 mmol/L). Of the 5613 patients referred, 908 patients did not have CHF, 1988 had HFrEF, and 2717 had HFpEF. Compared to patients in the fourth quartile (median chloride 106 mmol/L), patients in the first quartile (median chloride 96 mmol/L) had more severe symptoms (38% New York Heart Association class III or IV vs. 25%, P < 0.001) and were more likely to take loop diuretics (79% vs. 55%, P < 0.001). The annual mortality rate for patients with CHF was 11%. Hypochloraemia was associated with an increased risk of death independent of NT-proBNP. Patients in the first quartile had a two-fold increased risk of death compared to patients in the fourth quartile (P < 0.001). Sudden death was a common mode of death amongst patients with hypochloraemia.
Hypochloraemia is strongly related to an adverse prognosis and may be a therapeutic target in patients with CHF.
血清氯水平低在慢性心力衰竭（CHF）患者中很常见，与预后较差有关。我们研究了低血清氯在疑似心力衰竭的二级护理诊所就诊的患者中的临床和预后相关性，包括死亡原因相关性。
评估了接受超声心动图和血清氯检查的患者（n=5613）。CHF 的定义为疾病的体征和症状，以及左心室收缩功能障碍（LVSD）差于轻度[射血分数降低的心力衰竭（HFrEF）]或 LVSD 轻度或更好且氨基末端 pro-B 型利钠肽（NT-proBNP）水平升高（>125ng/L）[射血分数保留的心力衰竭（HFpEF）]。低氯血症定义为在当地正常分布中大于平均值两个标准差以下（<96mmol/L）。在 5613 名就诊患者中，908 名患者没有 CHF，1988 名患者有 HFrEF，2717 名患者有 HFpEF。与第四四分位（中位数氯 106mmol/L）的患者相比，第一四分位（中位数氯 96mmol/L）的患者症状更严重（38%纽约心脏协会[NYHA]心功能分级 III 或 IV 级 vs. 25%，P<0.001），更有可能服用袢利尿剂（79% vs. 55%，P<0.001）。有 CHF 的患者的年死亡率为 11%。低氯血症与 NT-proBNP 无关，与死亡风险增加独立相关。与第四四分位的患者相比，第一四分位的患者死亡风险增加一倍（P<0.001）。低氯血症患者的常见死亡模式是猝死。
低氯血症与不良预后密切相关，可能是 CHF 患者的治疗靶点。
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