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Prognostic importance of sodium level trajectory in acute heart failure

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Abstract

Low sodium levels are strongly associated with poor prognosis in acute heart failure (AHF); however, the prognostic impact of the sodium level trajectory overtime has not been determined. A secondary analysis of the AQUAMARINE study in which patients with AHF and renal impairment were randomized to receive either tolvaptan or conventional treatment was performed. Sodium levels were evaluated at the baseline and at 6, 12, 24, and 48 h. We defined ‘sodium dipping’ as sodium level falling below the baseline level at any time point. The primary endpoint was the combined event of all-cause death and heart failure rehospitalization during follow-up. The analysis included 184 patients with a median follow-up of 21.1 months. Sodium levels more steeply increased during the 48 h in patients without events as compared to sodium levels in patients with events (P = 0.018 in linear-mixed effect model). The sodium dipping group (n = 100; 54.3%) demonstrated significantly less urine output, less body weight reduction, and poorer diuretic response within 48 h 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 (HR 1.97; 95% CI 1.06–3.38; P = 0.033). The trajectory of sodium levels during the acute phase is associated with the prognosis of patients with AHF independently of the baseline sodium level.

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Author information

Authors and Affiliations

  1. Department of Cardiology, Kameda Medical Center, 929 Higashi-Cho, Kamogawa, Chiba, Japan

    Yuya Matsue, Kenji Yoshioka & Makoto Suzuki

  2. Department of Cardiology, School of Medicine, Tokai University, Kanagawa, Japan

    Sho Torii

  3. Department of Cardiology, Tomishiro Central Hospital, Okinawa, Japan

    Satoshi Yamaguchi

  4. Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan

    Seiji Fukamizu

  5. Department of Cardiology, Ome Municipal General Hospital, Tokyo, Japan

    Yuichi Ono

  6. Department of Cardiology, Yokohama Minami Kyosai Hospital, Kanagawa, Japan

    Hiroyuki Fujii

  7. Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan

    Takeshi Kitai

  8. Department of Cardiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan

    Toshihiko Nishioka

  9. Division of Cardiovascular Medicine, Ohashi Medical Center, Toho University, Tokyo, Japan

    Kaoru Sugi

  10. Department of Cardiology, Hiratsuka Kyosai Hospital, Kanagawa, Japan

    Yuko Onishi

  11. Department of Cardiology, Tokyo Yamate Medical Center, Tokyo, Japan

    Makoto Noda

  12. Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan

    Nobuyuki Kagiyama

  13. Department of Cardiology, National Disaster Medical Center, Tokyo, Japan

    Yasuhiro Satoh

  14. Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Kazuki Yoshida

  15. Division of Cardiology, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA

    Steven R. Goldsmith

Authors
  1. Yuya Matsue
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  2. Kenji Yoshioka
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  3. Makoto Suzuki
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  4. Sho Torii
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  5. Satoshi Yamaguchi
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  6. Seiji Fukamizu
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  7. Yuichi Ono
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  8. Hiroyuki Fujii
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  12. Yuko Onishi
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  13. Makoto Noda
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  14. Nobuyuki Kagiyama
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  15. Yasuhiro Satoh
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  16. Kazuki Yoshida
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  17. Steven R. Goldsmith
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Corresponding author

Correspondence to Yuya Matsue.

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Funding/support

The AQUAMARINE study was funded by a Japan Heart Foundation Multicenter Study Grant.

Conflict of interest

Dr. Yuya Matsue is supported by Japan Society for the Promotion of Science (JSPS) Overseas Research Fellowships, and received an honorarium from Otsuka Pharmaceutical Co. Dr. Makoto Suzuki received lectures honoraria from Bayer, Otsuka Pharmaceutical Co., Biotronik Japan Co., Daiichi-Snakyo, Medtronic Japan Co., Ltd., St. Jude Medical Japan, and Fukuda Denshi. Dr. Yuichi Ono received lectures honoraria from Medtronic Japan Co., Ltd. Dr. Kazuki Yoshida receives tuition support jointly from the Japan Student Services Organization and Harvard T.H. Chan School of Public Health (partially supported by training grants from Pfizer, Takeda, Bayer, and PhRMA). Dr. Kaoru Sugi received scholarship fund from Daiichi-Sankyo Pharmaceutical and lectures honoraria from Bayer. Dr. Steven R. Goldsmith received consulting fees, speaking fees, and research support from Otsuka USA and Otsuka-Japan. The other authors have nothing to disclose related to this paper.

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Matsue, Y., Yoshioka, K., Suzuki, M. et al. Prognostic importance of sodium level trajectory in acute heart failure. Heart Vessels 32, 1498–1505 (2017). https://doi.org/10.1007/s00380-017-1020-5

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  • DOI: https://doi.org/10.1007/s00380-017-1020-5

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