title: Low-Normal Serum Sodium and Heart Failure-Related Events in Patients With Heart Failure With Preserved Left Ventricular Ejection Fraction.
abstract: BACKGROUND
  Hyponatremia has been shown to be a prognostic factor in heart failure (HF) with preserved ejection fraction (HFpEF). Serum sodium (sNa) cut-off, however, is not defined in HFpEF. Therefore, we investigated the relationship between sNa and HF-related events (cardiovascular death and hospitalization for HF decompensation) in HFpEF patients.
  
  
  RESULTS
  We assessed cardiac function using echocardiography and measured sNa in HFpEF patients with New York Heart Association class II (n=321) or III (n=84) in a compensated condition after implementing medical therapy for HF. During a mean follow-up of 27 months, 73 patients developed HF-related events. On multivariate Cox hazard analysis including established predictors in HF, sNa level as a continuous variable was identified as an independent predictor for HF-related events in HFpEF (per 1.0 mmol/L: HR, 0.93; 95% CI: 0.87-0.98; P<0.01). Kaplan-Meier analysis demonstrated significantly higher probability of HF-related events in the lower sNa group (sNa <140 mmol/L) than in the higher sNa group (sNa ≥140 mmol/L; P<0.001, log-rank test). Further, the low-normal sNa group (135 mmol/L<sNa<140 mmol/L) was significantly associated with HF-related events compared with the higher sNa group (P<0.001, log-rank test).
  
  
  CONCLUSIONS
  sNa as a continuous variable was independently correlated with future HF-related events in HFpEF. Low-normal sNa could provide important prognostic information for practical risk stratification in HFpEF.
authors.affiliation: Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kusaka
authors.forename: Seigo
authors.initials: S
authors.lastname: Sugiyama
authors.forename: Eiichiro
authors.initials: E
authors.lastname: Yamamoto
authors.forename: Eiichi
authors.initials: E
authors.lastname: Akiyama
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Matsuzawa
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Hirata
authors.forename: Koichiro
authors.initials: K
authors.lastname: Fujisue
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kurokawa
authors.forename: Junichi
authors.initials: J
authors.lastname: Matsubara
authors.forename: Koichi
authors.initials: K
authors.lastname: Sugamura
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Maeda
authors.forename: Hideaki
authors.initials: H
authors.lastname: Jinnouchi
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Matsui
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007010:Hyponatremia / Q000097:blood / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012964:Sodium / Q000097:blood*; D013318:Stroke Volume; D015996:Survival Rate
chemical_list: D012964:Sodium