Abstract 17381: Hyponatremia as a Predictor for Adverse Events in Patients With Heart Failure Receiving Cardiac Resynchroniation Therapy
INTRODUCTION: Hyponatremia portends a poor prognosis in patients with heart failure. The aim of this study was to evaluate prognostic implication of hyponatremia on adverse events in heart failure patients receiving cardiac resynchronization therapy (CRT). Additionally, the impact of improvement of hyponatremia after CRT implant is evaluated.
METHODS: In this retrospective analysis, we included patients in whom a CRT device was implanted between April 2004 and April 2011 at our institution and had baseline sodium within 72 hours of implant. The patients were followed up for 3 years post-implant for blood chemistry and subsequent adverse clinical events, i.e. hospitalization for heart failure, left ventricular assist device or heart transplant and cardiac death. Hyponatremia was defined as a serum sodium level <135 mmol/L.
RESULTS: In all 319 patients were included (age 69± 12 years, females 20%). 149 adverse events were noted in this period. In a multivariate model, hyponatremia [HR 1.52, 95%CI (1.06-2.17), p=0.021], Creatinine greater than 2 mg/dl [HR 1.75, 95%CI (1.2-2.5) p=0.004] and need for diuretics [HR 2.14, 95%CI (1.05-4.38), p=0.036] were associated with occurrence of adverse events. 62% of patients with hyponatremia at baseline had adverse events as compared to 42% of those with normal sodium concentration (p=0.002). Kaplan Meier curve showed that hyponatremic patients fared worse (Figure A). Also, patients in whom hyponatremia resolved after CRT implantation had less frequent adverse events as compared to patients who had normal pre-CRT sodium but developed hyponatremia later (Figure B).
CONCLUSIONS: Baseline hyponatremia is associated with a worse prognosis after CRT implantation. Post-CRT improvement of hyponatremia is associated with improved clinical outcomes.
- © 2013 by American Heart Association, Inc.