Hyponatremia Is a Powerful Predictor of Poor Prognosis in Left Ventricular Assist Device Patients.
Hyponatremia Is a Powerful Predictor of Poor Prognosis in Left Ventricular Assist Device Patients.
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DOI：
10.1097/mat.0000000000001691
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发表时间：
2022-12-01
期刊：
影响因子：
4.2
通讯作者：
Rich, Jonathan D.
中科院分区：
文献类型：
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作者：
Tibrewala, Anjan;Wehbe, Ramsey M.;Wu, Tingqing;Harap, Rebecca;Ghafourian, Kambiz;Wilcox, Jane E.;Okwuosa, Ike S.;Vorovich, Esther E.;Ahmad, Faraz S.;Yancy, Clyde;Pawale, Amit;Anderson, Allen S.;Pham, Duc T.;Rich, Jonathan D.
血清钠是心力衰竭（HF）患者的既定预后标志物，与发病率和死亡率风险增加相关。我们试图研究血清钠在左心室辅助装置（LVAD）患者中的预后价值，以及低钠血症是否反映了HF恶化或替代机制。我们确定了2008年至2019年期间接受LVAD植入的HF患者。低钠血症定义为植入后3个月时Na ≤134 mEq/L。我们评估了LVAD植入前后低钠血症的差异。我们还评估了低钠血症与全因死亡率和复发性HF住院的关系。有342名合格的LVAD患者在3个月时具有钠值。其中，LVAD植入后血清钠水平较术前显著改善（137.2 vs. 134.7 mEq/L，P < 0.0001）。有和无低钠血症的患者在超声心动图和血流动力学测量方面没有显著差异。在多变量分析中，当考虑到年龄、性别、合并症、袢利尿剂使用和B型利钠肽水平时，低钠血症与全因死亡风险显著增加相关（HR 3.69，95% CI，1.93-7.05，P < 0.001）。低钠血症也与复发性HF住院显著相关（HR 2.11，95% CI，1.02-4.37，P = 0.04）。LVAD患者的低钠血症与全因死亡率和复发性HF住院的风险显著升高相关。低钠血症可能是持续神经激素激活的标志物，比其他实验室值、超声心动图参数和血流动力学测量更敏感。
Serum sodium is an established prognostic marker in heart failure (HF) patients and is associated with an increased risk of morbidity and mortality. We sought to study the prognostic value of serum sodium in left ventricular assist device (LVAD) patients and whether hyponatremia reflects worsening HF or an alternative mechanism. We identified HF patients that underwent LVAD implantation between 2008 and 2019. Hyponatremia was defined as Na ≤134 mEq/L at 3 months after implantation. We assessed for differences in hyponatremia before and after LVAD implantation. We also evaluated the association of hyponatremia with all-cause mortality and recurrent HF hospitalizations. There were 342 eligible LVAD patients with a sodium value at 3 months. Among them, there was a significant improvement in serum sodium after LVAD implantation compared to preoperatively (137.2 vs. 134.7 mEq/L, P < 0.0001). Patients with and without hyponatremia had no significant differences in echocardiographic and hemodynamic measurements. In a multivariate analysis, hyponatremia was associated with a markedly increased risk of all-cause mortality (HR 3.69, 95% CI, 1.93–7.05, P < 0.001) when accounting for age, gender, co-morbidities, use of loop diuretics, and B-type natriuretic peptide levels. Hyponatremia was also significantly associated with recurrent HF hospitalizations (HR 2.11, 95% CI, 1.02–4.37, P = 0.04). Hyponatremia in LVAD patients is associated with significantly higher risk of all-cause mortality and recurrent HF hospitalizations. Hyponatremia may be a marker of ongoing neurohormonal activation that is more sensitive than other lab values, echocardiography parameters, and hemodynamic measurements.