Abstract 13030: Prognostic Value of Serum Sodium Concentrations for Cardiovascular Events in Patients with Heart Failure with Normal Left Ventricular Ejection Fraction
BACKGROUND Precise mechanisms and pathogenesis underlying heart failure with normal left ventricular ejection fraction (HFNEF) remain unclear. Lower levels of serum sodium (sNa) concentration have been shown as a significant predictor of adverse cardiovascular (CV) outcome in heart failure (HF) with systolic dysfunction. However, the relationship between sNa concentrations and CV event is unknown in HFNEF patients.
METHODS We assessed cardiac function by using echocardiography evaluating the ratio of early transmitral flow velocity to tissue Doppler early diastolic mitral annular velocity(E/e’) and measured sNa concentrations at the stable condition in symptomatic patients with HFNEF (n=310, New York heart association class: NYHA-II=243, -III/IV=67). HFNEF patients were prospectively followed until April 2012 or the occurrence of CV events (CV death, non-fatal myocardial infarction or ischemic stroke, unstable angina pectoris, hospitalization for HF, or coronary revascularization).
RESULTS During a mean follow-up of 26 months, 59 patients developed CV events. Levels of sNa concentration were significantly lower in patients with CV events than those without CV events (138.9±14.3 vs. 140.2±7.0 mEq/mL, P=0.001). Kaplan-Meier analysis demonstrated significantly higher probability of CV events in the lower sNa group (<138 mEq/ml) than in the higher sNa group (log rank test P<0.01). By univariate Cox hazard analysis, seven variables were identified as significant predictors; sNa concentrations, NYHA class, atrial fibrillation (AF), B-type natriuretic peptide (BNP), left ventricular ejection fraction, E/e’, and diuretic use. Multivariate Cox hazard analysis including these predictors and estimated glomerular filtration rate revealed that sNa concentrations [hazard ratio (HR) 0.92, 95% confidence interval (CI) 0.86-0.99, P=0.037], BNP/20 (HR 1.021, 95% CI 1.009-1.033, P<0.001), E/e’ (HR 1.09, 95% CI 1.03-1.14, P=0.02), and AF (HR 2.03, 95% CI 1.16-3.56, p=0.01) were independent predictors for CV events.
CONCLUSION Serum sodium concentrations were independently correlated with the occurrence of future CV events in patients with HFNEF. sNa levels could provide us the useful clinical information in managing HFNEF patients.
- © 2012 by American Heart Association, Inc.