Abstract 17899: Prognostic Value of Persistent Hyponatremia in Patients With Chronic Heart Failure: A Prospective Comparative Study With Cardiac I-123 Metaiodobenzylguanidine Imaging
Backgrounds: Hyponatremia is associated with not only mortality, but also excessive neurohumoral drive including sympathetic overactivation in patients (pts) with chronic heart failure (CHF). However, the prognostic significance of persistent hyponatremia (per-hypoNa) remains to be unclear in CHF pts. Cardiac metaiodobenzylguanidine (MIBG) imaging, which is useful for the estimation of cardiac sympathetic nerve activity, provides prognostic information in CHF pts. We sought to investigate whether per-hypoNa would provide the additional prognostic information to MIBG imaging in CHF pts.
Methods: We studied 103 CHF outpatients with LVEF <40% in our prospective cohort study. The cardiac MIBG heart-to-mediastinum ratio (H/M) washout rate (WR) were calculated from the chest anterior view images obtained at 20 and 200 min after isotope injection. We also measured serum sodium concentration at entry and every 6month for the initial 3 years. Per-hypoNa was defined that hyponatremia (<137mEq/L) was observed for more than 6 months.
Results: During a follow up period of 8.0±4.0 years, 41 pts died. At multivariate Cox analysis, per-hypoNa (p=0.01) and abnormal WR (p=0.007) were significantly independently associated with the mortality, although H/M showed the significant association with the mortality at the univariate analysis. Pts with per-hypoNa had a significantly higher risk of mortality than pts without per-hypoNa (67% vs 35%, p=0.03). Pts with both per-hypoNa and abnormal WR had a significantly greater risk of mortality than pts with either per-hypoNa or abnormal WR (80% vs 48% p=0.01, adjusted HR 2.8[1.2-6.5]). Furthermore, pts with either per-hypoNa or abnormal WR also had a significantly greater risk of mortality than pts with neither per-hypoNa nor abnormal WR (48% vs 22% p=0.009, adjusted HR 2.6 [1.2-5.4]).
Conclusion: The combination of persistent hyponatremia and cardiac MIBG imaging could provide the improved prediction of mortality in CHF pts.
Author Disclosures: M. Seo: None. T. Yamada: None. T. Morita: None. Y. Furukawa: None. S. Tamaki: None. Y. Iwasaki: None. M. Kawasaki: None. A. Kikuchi: None. T. Kondo: None. M. Ishimi: None. H. Hakui: None. T. Ozaki: None. Y. Sato: None. I. Ikeda: None. E. Fukuhara: None. M. Fukunami: None.
- © 2015 by American Heart Association, Inc.