TY - JOUR
T1 - Plasma sodium and mortality risk in patients with myocardial infarction and a low LVEF
AU - Schou, Morten
AU - Valeur, Nana
AU - Torp-Pedersen, Christian
AU - Gustafsson, Finn
AU - Køber, Lars
N1 - © 2011 The Authors. European Journal of Clinical Investigation © 2011 Stichting European Society for Clinical Investigation Journal Foundation.
PY - 2011/11
Y1 - 2011/11
N2 - Background Hyponatremia is a known prognostic factor for mortality in patients with heart failure but has not been extensively studied in patients with myocardial infarction (MI). This study was, therefore, designed to evaluate whether plasma sodium and hyponatremia (<135mM) are associated with mortality risk in patients with MI. Materials and methods In retrospective analyses using data from the Trandolapril Cardiac Evaluation (TRACE) study - a randomized, double-blind, placebo-controlled trial of trandolapril in 1749 patients with MI and left ventricular ejection fraction (LVEF) ≤35%- associations between plasma sodium or hyponatremia and more than 15-year mortality risk were evaluated in multivariate Cox proportional hazard models including traditional clinical confounders before and after additional adjustment for renal function, use of diuretics or both. Results During the extended follow-up time, 1462 patients died. Both hyponatremia [Hazard ratio: 1·30 (95% CI: 1·13-1·50), P<0·001] and plasma sodium [Hazard Ratio pro mM increase in P-Na: 0·98 (95% CI: 0·96-0·99), P=0·004] were associated with mortality risk, and the adjusted parameter estimates were not affected by additional adjustment for renal function, use of diuretics or both. Conclusions Hyponatremia and plasma concentrations of sodium are associated with long-term mortality risk in patients with MI complicated by left ventricular systolic dysfunction. Importantly, these associations are independent of renal function and use of diuretics. Whether the associations between plasma sodium or hyponatremia and long-term mortality risk reflect a causation or merely the severity of the underlying cardiac disease remains to be clarified.
AB - Background Hyponatremia is a known prognostic factor for mortality in patients with heart failure but has not been extensively studied in patients with myocardial infarction (MI). This study was, therefore, designed to evaluate whether plasma sodium and hyponatremia (<135mM) are associated with mortality risk in patients with MI. Materials and methods In retrospective analyses using data from the Trandolapril Cardiac Evaluation (TRACE) study - a randomized, double-blind, placebo-controlled trial of trandolapril in 1749 patients with MI and left ventricular ejection fraction (LVEF) ≤35%- associations between plasma sodium or hyponatremia and more than 15-year mortality risk were evaluated in multivariate Cox proportional hazard models including traditional clinical confounders before and after additional adjustment for renal function, use of diuretics or both. Results During the extended follow-up time, 1462 patients died. Both hyponatremia [Hazard ratio: 1·30 (95% CI: 1·13-1·50), P<0·001] and plasma sodium [Hazard Ratio pro mM increase in P-Na: 0·98 (95% CI: 0·96-0·99), P=0·004] were associated with mortality risk, and the adjusted parameter estimates were not affected by additional adjustment for renal function, use of diuretics or both. Conclusions Hyponatremia and plasma concentrations of sodium are associated with long-term mortality risk in patients with MI complicated by left ventricular systolic dysfunction. Importantly, these associations are independent of renal function and use of diuretics. Whether the associations between plasma sodium or hyponatremia and long-term mortality risk reflect a causation or merely the severity of the underlying cardiac disease remains to be clarified.
U2 - 10.1111/j.1365-2362.2011.02532.x
DO - 10.1111/j.1365-2362.2011.02532.x
M3 - Journal article
SN - 0014-2972
VL - 41
SP - 1237
EP - 1244
JO - Zeitschrift fur klinische Medizin
JF - Zeitschrift fur klinische Medizin
IS - 11
ER -