Satoshi Honda1, Toshiyuki Nagai2, Kunihiro Nishimura3, Michikazu Nakai3, Yasuyuki Honda1, Hiroki Nakano1, Naotsugu Iwakami1, Yasuo Sugano1, Yasuhide Asaumi1, Takeshi Aiba1, Teruo Noguchi1, Kengo Kusano1, Hiroyuki Yokoyama1, Hisao Ogawa1, Satoshi Yasuda1, Toshihisa Anzai4. 1. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan. 2. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; National Heart and Lung Institute, Imperial College London, London, United Kingdom. Electronic address: t.nagai@imperial.ac.uk. 3. Preventive Medicine and Epidemiology Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan. 4. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Abstract
BACKGROUND: Lower urinary sodium concentration (UNa) may reflect impaired renal perfusion, higher neurohormonal activity and diuretic resistance. However, the prognostic impact of UNa in patients with acute heart failure (AHF) has not been fully elucidated. METHODS: We investigate the association between UNa and clinical outcomes in 669 patients admitted with AHF in our prospective registry. Patients were stratified into tertiles based on UNa in a spot urine sample on admission. RESULTS: Patients with lower UNa were more likely to have a history of prior heart failure admission, β-blockers and diuretics use, and had lower blood pressure and serum sodium level, and higher blood urea nitrogen, estimated glomerular filtration rate, blood glucose and troponin T levels on admission than those with higher UNa. Plasma renin activity, aldosterone, cortisol and dopamine levels were also significantly higher in patients with lower UNa (all p<0.001). Furthermore, patients with lower UNa had significantly less weight loss, lower net fluid loss/furosemide equivalent dose and higher incidence of worsening renal function during hospitalization than those with higher UNa (all p<0.01). During a median follow-up period of 560days, lower UNa was significantly associated with the composite of all-cause death and worsening heart failure (p<0.001). In multivariable Cox-proportional hazards model, UNa remained an independent determinant of long-term adverse events (HR, 1.24, 95% CI, 1.06-1.45, p=0.006). CONCLUSIONS: Lower UNa was associated with worse long-term clinical outcomes along with increased neurohormonal activities, impaired response to diuretics and higher incidence of worsening renal function in patients with AHF.
BACKGROUND: Lower urinary sodium concentration (UNa) may reflect impaired renal perfusion, higher neurohormonal activity and diuretic resistance. However, the prognostic impact of UNa in patients with acute heart failure (AHF) has not been fully elucidated. METHODS: We investigate the association between UNa and clinical outcomes in 669 patients admitted with AHF in our prospective registry. Patients were stratified into tertiles based on UNa in a spot urine sample on admission. RESULTS:Patients with lower UNa were more likely to have a history of prior heart failure admission, β-blockers and diuretics use, and had lower blood pressure and serum sodium level, and higher blood ureanitrogen, estimated glomerular filtration rate, blood glucose and troponin T levels on admission than those with higher UNa. Plasma renin activity, aldosterone, cortisol and dopamine levels were also significantly higher in patients with lower UNa (all p<0.001). Furthermore, patients with lower UNa had significantly less weight loss, lower net fluid loss/furosemide equivalent dose and higher incidence of worsening renal function during hospitalization than those with higher UNa (all p<0.01). During a median follow-up period of 560days, lower UNa was significantly associated with the composite of all-cause death and worsening heart failure (p<0.001). In multivariable Cox-proportional hazards model, UNa remained an independent determinant of long-term adverse events (HR, 1.24, 95% CI, 1.06-1.45, p=0.006). CONCLUSIONS: Lower UNa was associated with worse long-term clinical outcomes along with increased neurohormonal activities, impaired response to diuretics and higher incidence of worsening renal function in patients with AHF.
Authors: Veena S Rao; Juan B Ivey-Miranda; Zachary L Cox; Ralph Riello; Matthew Griffin; James Fleming; Richard Soucier; Prasama Sangkachand; Margaret O'Brien; Francine LoRusso; Julie D'Ambrosi; Keith Churchwell; Devin Mahoney; Lavanya Bellumkonda; Jennifer L Asher; Christopher Maulion; Jeffrey M Turner; F Perry Wilson; Sean P Collins; Jeffrey M Testani Journal: J Am Coll Cardiol Date: 2021-02-16 Impact factor: 24.094
Authors: Belén García-Magallón; Marta Cobo-Marcos; Aitor Dávila Martiarena; Esther Montero Hernández; Maria Luisa Martín Jiménez; Aránzazu Martín García; Daniel De Castro Campos; Paula Vela Martín; Fernando Hernández Terciado; Ramón Garrido González; Andrea Matutano Muñoz; Daniel Escribano García; Fernando Domínguez; Ana Sainz Herrero; Camino Gómez Peñalba; Pablo Garcia-Pavia; Javier Segovia Journal: Front Physiol Date: 2022-05-02 Impact factor: 4.566
Authors: Kevin Damman; Jozine M Ter Maaten; Jenifer E Coster; Jan A Krikken; Vincent M van Deursen; Hidde K Krijnen; Mischa Hofman; Wybe Nieuwland; Dirk J van Veldhuisen; Adriaan A Voors; Peter van der Meer Journal: Eur J Heart Fail Date: 2020-02-22 Impact factor: 15.534