Abstract 18891: Importance of Sodium Level Trajectory in Acute Heart Failure
Background: Hyponatremia is a common electrolyte disorder which is strongly associated with poor prognosis in acute heart failure (AHF); however, the prognostic impact of the sodium level trajectory has not been determined.
Methods: A secondary analysis of the AQUAMARINE study in which patients with AHF and renal impairment (eGFR < 60 mL/min/1.73 m2) were randomized to receive either tolvaptan or conventional treatment was performed. Sodium levels were evaluated at baseline, 6, 12, 24, and 48 hours after randomization. We defined ‘sodium dipping’ as sodium level falling below the baseline level at any timepoint. All patients were categorized into a dipping or non-dipping group. The primary endpoint was the combined event of all-cause death and heart failure rehospitalization.
Results: The analysis included 184 patients with a median follow-up of 21.1 months. Sodium levels more steeply increased during the 48 hours in patients without events as compared to sodium levels in patients with events (P=0.033). The sodium dipping group (n=100; 54.3%) demonstrated less urine output, less body weight reduction, and poorer diuretic response within 48 hours compared to the non-dipping group. The sodium dipping group was also significantly associated with a low combined-event-free survival after adjustment for other prognostic factors in adjusted Kaplan-Meier analysis (Log-rank: P<0.001) and Cox regression analysis (HR: 1.84; 95%CI: 1.01 - 3.36; P=0.032). The negative impact of sodium dipping on the prognosis was potentiated in patients with a low baseline sodium level (interaction: P = 0.023).
Conclusions: The trajectory of sodium levels during the acute phase is associated with the prognosis of patients with AHF independently from the sodium level itself.
Author Disclosures: K. Yoshioka: None. Y. Matsue: Honoraria; Modest; Otsuka Pharmaceutical Co. M. Suzuki: Honoraria; Modest; Otsuka Pharmaceutical Co., Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals, Medtronic Japan Co., Ltd., Boston Scientific Japan Co., Ltd., and Fukuda Denshi. S. Torii: None. S. Yamaguchi: None. S. Fukamizu: None. Y. Ono: None. H. Fujii: None. T. Kitai: None. T. Nishioka: None. K. Sugi: Honoraria; Modest; Bayer. Other; Modest; Daiichi-Sankyo Pharmaceutical. Y. Onishi: None. M. Noda: None. N. Kagiyama: None. Y. Satoh: None. K. Yoshida: Other; Modest; Japan Student Services Organization and Harvard T. H. Chan School of Public Health (partially supported by training grants from Pfizer, Takeda, Bayer, and PhRMA). S.R. Goldsmith: Other Research Support; Modest; Otsuka USA and Otsuka-Japan.
- © 2016 by American Heart Association, Inc.