The prognostic impact of pre-implantation hyponatremia on morbidity and mortality among patients with left ventricular dysfunction and implantable cardioverter-defibrillators
| Autor: | Jeffrey Kluger, Danette Guertin, Craig I Coleman, Anupam Kumar, Christopher A. Clyne, Sanjeev P. Bhavnani, Ravi K. Yarlagadda |
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| Rok vydání: | 2013 |
| Předmět: |
Male
medicine.medical_specialty Acute decompensated heart failure medicine.medical_treatment Comorbidity Ventricular tachycardia Risk Assessment Sudden cardiac death Prosthesis Implantation Ventricular Dysfunction Left Physiology (medical) Internal medicine Preoperative Care medicine Humans Aged Heart Failure Ejection fraction business.industry Incidence nutritional and metabolic diseases Prognosis medicine.disease Implantable cardioverter-defibrillator Survival Analysis Defibrillators Implantable Connecticut Treatment Outcome Heart failure Ventricular fibrillation Cardiology Female Cardiology and Cardiovascular Medicine Hyponatremia business |
| Zdroj: | Europace. 16:47-54 |
| ISSN: | 1532-2092 1099-5129 |
| DOI: | 10.1093/europace/eut211 |
| Popis: | Aims Hyponatremia is commonly observed among patients with left ventricular (LV) dysfunction and is a marker for adverse outcomes. We aimed to determine the prognostic significance of pre-implant hyponatremia on the outcomes of death, acute decompensated heart failure (ADHF) and appropriate implantable cardioverter-defibrillator (ICD) therapy for ventricular arrhythmias among patients with ICDs. Methods and results The study population consisted of patients with an ejection fraction ≤40% undergoing ICD implantation ( n = 911) for the primary or secondary prevention of sudden cardiac death from 1997 to 2007. The predictive value of the severity of pre-implantation hyponatremia stratified into mild hyponatremia ( n = 268, sodium 134–136 mmol/L), moderate hyponatremia ( n = 105, sodium 131–133 mmol/L), and severe hyponatremia ( n = 31, sodium ≤130 mmol/L) on the risk of death, ADHF, and appropriate ICD therapy for ventricular arrhythmias as compared with patients a normal serum sodium ( n = 507, sodium ≥ 137 mmol/L), was calculated using multivariable Cox proportional hazards analyses. During a mean follow-up of 775 ± 750 days as the severity of hyponatremia (from a normal sodium to severe hyponatremia) increased an incremental incidence of death (25% to 61%, P < 0.001) and ADHF (11% to 26%, P = 0.004) was observed with a reduced incidence of ICD therapy for ventricular tachycardia/ventricular fibrillation (37–29%, P = 0.037). Compared with the normal sodium cohort, patients with severe hyponatremia demonstrated an increased risk of death [adjusted hazard ratio (AHR) 2.69 (95% confidence interval, CI 1.57–4.59), P = 0.004] and ADHF [AHR 2.98 (95% CI 1.41–6.30), P = 0.004], with a lower probability of appropriate ICD therapy [AHR 0.68 (95% CI 0.27–0.88), P = 0.031]. Conclusion Hyponatremia is commonly observed among ICD recipients with LV dysfunction. Patients with an increasing severity of hyponatremia are at increased risk of death and HF related morbidity with a reduced incidence of appropriate ICD therapy particularly among patients with severe hyponatremia. |
| Databáze: | OpenAIRE |
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