Hyponatremia, Natriuretic Peptides, and Outcomes in Acutely Decompensated Heart Failure Results From the International Collaborative of NT-proBNP Study

被引:46
作者
Mohammed, Asim A. [1 ,2 ]
van Kimmenade, Roland R. J. [3 ]
Richards, Mark [4 ]
Bayes-Genis, Antoni [5 ]
Pinto, Yigal [6 ]
Moore, Stephanie A. [1 ,2 ]
Januzzi, James L., Jr. [1 ,2 ]
机构
[1] Massachusetts Gen Hosp, Div Cardiol, Boston, MA 02114 USA
[2] Massachusetts Gen Hosp, Dept Med, Boston, MA 02114 USA
[3] Maastricht Univ, Med Ctr, Dept Cardiol, Maastricht, Netherlands
[4] Christchurch Sch Med & Hlth Sci, Dept Med, Christchurch, New Zealand
[5] Hosp Badalona Germans Trias & Pujol, Dept Cardiol, Badalona, Spain
[6] Univ Amsterdam, Dept Cardiol, NL-1012 WX Amsterdam, Netherlands
关键词
heart failure; hyponatremia; natriuretic peptides; CONVERTING-ENZYME-INHIBITION; SERUM SODIUM CONCENTRATION; WORSENING RENAL-FUNCTION; EMERGENCY-DEPARTMENT; PROGNOSTIC IMPORTANCE; SYSTOLIC FUNCTION; TOLVAPTAN; DYSPNEA; TRIAL; PREDICTION;
D O I
10.1161/CIRCHEARTFAILURE.109.915280
中图分类号
R5 [内科学];
学科分类号
100201 [内科学];
摘要
Background-Hyponatremia is a well-known predictor of mortality in patients with acutely decompensated heart failure. Associations between hyponatremia and other prognostic variables in acutely decompensated heart failure, such as amino-terminal pro-B type natriuretic peptide remain unclear. Methods and Results-Six hundred twenty-eight patients presenting to the emergency department with acutely decompensated heart failure were studied. All were hospitalized. Serum sodium (Na) concentration at presentation was examined as a function of mortality at 1 year, alone and relative to other predictors of death. Hyponatremia (Na <= 135 mmol/L) was diagnosed in 24% (n=149) patients. Compared with those without hyponatremia, those affected were less likely to be male or to have hypertension or coronary artery disease but were more likely to have severe symptoms, to be anemic, and to have higher amino-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations (all P <= 0.05). When examined as a function of Na deciles (ranging from Na <132 mmol/L to Na <= 142 mmol/L), a U-shaped association was found between Na level and 1-year mortality. In multivariate Cox proportional hazards analysis, hyponatremia was an independent predictor of 1-year mortality (hazards ratio=1.72; 95% CI=1.22 to 2.37; P=0.001) as was an NT-proBNP concentration above the median value of 4690 pg/mL (hazards ratio=1.49; 95% CI=1.10 to 2.00; P=0.009). Those with hyponatremia and more elevated NT-proBNP were more likely to develop worsening renal function during their hospitalization and had highest rates of 1-year death. Notably, however, hyponatremia predicted only 1-year mortality in those with an elevated NT-proBNP. Conclusion-Hyponatremia is associated with adverse outcome in patients with acutely decompensated heart failure; however, the prognostic value of low Na is mainly evident in those with more pronounced elevation of NT-proBNP concentrations. (Circ Heart Fail. 2010;3:354-361.)
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收藏
页码:354 / U42
页数:14
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