Fu Shizhe, Wang Kairu, Ma Xueping, Shi Bo, Ye Congyan, Yan Rui, Yan Ru, Jia Shaobin, Cong Guangzhi, Gitangaza Israel, Rehman Abdul
Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China.
School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, China.
BMC Cardiovasc Disord. 2025 Mar 10;25(1):168. doi: 10.1186/s12872-025-04564-4.
Transcatheter aortic valve replacement (TAVR) has emerged as a major therapeutic option for treating aortic stenosis. Hyponatremia is a common electrolyte disorder closely associated with adverse cardiovascular outcomes. However, large-scale studies investigating the impact of hypotonic hyponatremia on outcomes among TAVR patients are lacking.
We queried patients who underwent TAVR with concomitant hypo-osmolar hyponatremia (defined as a serum sodium concentration < 135 mEq/L with a serum osmolality < 280 mOsm/kg) using the National Inpatient Sample (2016-2021). Multivariate regression analysis and 1:1 propensity score matching (PSM) were performed to assess the associations between hypo-osmolar hyponatremia and in-hospital mortality and major adverse events (including acute kidney injury [AKI], acute myocardial infarction [AMI], and cardiogenic shock [CS]). Furthermore, sensitivity analysis was performed to assess the robustness of the findings.
Among the total weighted national estimate of 370,680 patients who underwent TAVR, 13,865 (3.7%) had concomitant hypo-osmolar hyponatremia. These patients had a significantly increased risk of in-hospital mortality (aOR: 1.37; 95% CI: 1.08-1.74) and a greater likelihood of developing AKI (aOR: 3.39; 95% CI: 3.07-3.74), AMI (aOR: 3.20; 95% CI: 2.77-3.70), and CS (aOR: 2.96; 95% CI: 2.52-3.47). After PSM and sensitivity analysis, these associations remained significant.
In TAVR patients, hypo-osmolar hyponatremia is associated with increased in-hospital mortality and adverse events, including AKI, AMI, and CS.
经导管主动脉瓣置换术（TAVR）已成为治疗主动脉瓣狭窄的主要治疗选择。低钠血症是一种常见的电解质紊乱，与不良心血管结局密切相关。然而，缺乏关于低渗性低钠血症对TAVR患者结局影响的大规模研究。
我们使用国家住院样本（2016 - 2021年）查询了接受TAVR并伴有低渗性低钠血症（定义为血清钠浓度<135 mEq/L且血清渗透压<280 mOsm/kg）的患者。进行多因素回归分析和1:1倾向评分匹配（PSM）以评估低渗性低钠血症与住院死亡率和主要不良事件（包括急性肾损伤[AKI]、急性心肌梗死[AMI]和心源性休克[CS]）之间的关联。此外，进行敏感性分析以评估研究结果的稳健性。
在全国总计加权估计的370,680例接受TAVR的患者中，13,865例（3.7%）伴有低渗性低钠血症。这些患者的住院死亡率风险显著增加（调整后比值比：1.37；95%置信区间：1.08 - 1.74），发生AKI（调整后比值比：3.39；95%置信区间：3.07 - 3.74）、AMI（调整后比值比：3.20；95%置信区间：2.77 - 3.70）和CS（调整后比值比：2.96；95%置信区间：2.52 - 3.47）的可能性更大。经过PSM和敏感性分析后，这些关联仍然显著。
在TAVR患者中，低渗性低钠血症与住院死亡率增加以及包括AKI、AMI和CS在内的不良事件相关。
