Prognostic value of hyponatremia in hospitalized patients with worsening heart failure - insights from the outcomes of a prospective trial of intravenous milrinone for exacerbations of chronic heart failure (OPTIME - CHF)

Klein, Liviu; Gattis, Wendy A.; Leimberger, Jeffrey D.; Piña, Ileana L.; O’Connor, Christopher M.; Gheorghiade, Mihai

doi:10.1016/s1071-9164(03)00145-3

Cited by 109 publications

(175 citation statements)

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“…The significance of serum sodium concentration in hospitalised patients with acute heart failure was evaluated in an analysis of the recent Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) study [77]. Multivariate analysis demonstrated that serum sodium on admission was predictive of in-hospital and 60-day mortality (each 3 mmol/l decrease in sodium was associated with a HR of 1.18).…”

Section: Sodiummentioning

confidence: 99%

Biomarkers in heart failure: a clinical review

2008

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The diagnosis and management of heart failure remains challenging despite considerable clinical advances in recent decades. With greater understanding of the pathophysiology of this complex syndrome, a large number of candidate biomarkers have emerged and duly received scientific and clinical attention. These are frequently a measure of the degree of pathophysiological derangement or counter-regulatory processes occurring in heart failure and include biomarkers of neurohormonal activation, myocyte necrosis and myocardial remodelling amongst others. As such they may serve as an indicator of the presence, severity and possibly therapeutic response of the heart failure syndrome and may complement conventional clinical measurements and acumen. This may in turn lead to tangible clinical benefits and the targeting of intensified and often costly therapies to those most at risk. This article reviews and summarises the most extensively investigated biomarkers currently available, with an emphasis on clinical applicability and discusses the future evaluation of candidate biomarkers in patients with heart failure.

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Section: Sodiummentioning

confidence: 99%

Biomarkers in heart failure: a clinical review

2008

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“…Hyponatremia (conventionally defined as a serumsodium concentration [Na] B135 mmol/l) [6,7], is a common phenomenon in HF patients, with an incidence of 20-25% [8][9][10], and it is known to be associated with increased morbidity and mortality in these patients [11][12][13]. So far treatment strategies have been limited and burdened by side effects.…”

Section: Introductionmentioning

confidence: 99%

Significance of hyponatremia in heart failure

Bettari¹,

Fiuzat

Felker

et al. 2010

Heart Fail Rev

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Heart failure is one of the most common, costly, disabling and growing diseases (McMurray and Pfeffer in Lancet 365(9474):1877-1889, 2005). Hyponatremia, conventionally defined as a serum-sodium concentration equal or less than 135 mmol/l (American Heart Association in Heart disease and stroke statistics--2007 update. American Heart Association, Dallas, 2007; Stewart et al. in Eur J Heart Fail 4:361-371, 2002), is a common phenomenon in patients with heart failure, with an incidence of 20-25% (Krumholz et al. in Arch Intern Med 157:e99-e104, 1997; Rosamond et al. in Circulation 117(4):e25-e146, 2008; Adrogue and Madias in N Engl J Med 342:1581-1589, 2000) and seems to be of prognostic importance in patients with heart failure (Luca et al. in Am J Cardiol 96:19L-23L, 2005; Gheorghiade et al. in Eur Heart J 28:980-988, 2007; Gheorghiade et al. in Arch Intern Med 167:1998-2005, 2007). So far treatment strategies have been limited and burdened by side effects. The development of hyponatremia in the setting of heart failure is related to the arginine vasopressin (AVP) dysregulation. Thus, AVP receptor antagonists are a promising approach to treatment. However, several questions remain: whether there is a cause-and-effect mechanism, if the correction of hyponatremia improves outcomes, and defining the specific cut-off level of serum-sodium that should be used to define hyponatremia. In this review, we aim to summarize the literature on hyponatremia in patients with heart failure within several aspects: incidence in clinical trials and registries, prognostic value, underlying mechanisms, therapeutic options, and possible future perspectives.

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“…Treatment of heart failure with loop diuretics to get rid of the excess water can result in worsening of hyponatremia; even mild hyponatremia in patients with heart failure indicates a worse prognosis [154]. Vasopressin antagonists, which cause the loss of free water and conserve sodium, seem to be an ideal choice for such patients.…”

Section: Vasopressin Blockade In Heart Failurementioning

confidence: 99%

Potential of endothelin-1 and vasopressin antagonists for the treatment of congestive heart failure

Rehsia

Dhalla

2009

Heart Fail Rev

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It is now becoming clear that two major systems namely the sympathetic nervous system and the renin-angiotensin system are activated in response to ischemic injury; these result in the elevation of plasma catecholamines and angiotensin II during the development of myocardial infarction as well as congestive heart failure. Although plasma levels of several other hormones including aldosterone, endothelin, vasopressin, natriuretic peptides, growth factors and inflammatory cytokines are also increased in heart failure, their relationship with changes in catecholamine and/or angiotensin levels as well as their significance for the induction of congestive heart failure are poorly understood. In this article we have examined the evidence regarding the role of endothelin and vasopressin in the pathogenesis of cardiac hypertrophy and congestive heart failure in addition to evaluating the significance of their antagonism by using their receptor blockade for treatment of congestive heart failure. Endothelin appears to maintain blood pressure by its vasoconstricting action whereas vasopressin primarily produces similar effect by retention of body fluid. Myocardium is also known to express both ET-A and ET-B receptors in addition to V1 and V2 receptors for vasopressin, which have been shown to induce cardiac remodeling. Out of various ET-1 receptor antagonists, which are available, a non-selective endothelin receptor antagonist, bosentan, as well as an ET-A receptor antagonist, BQ-123, seem most promising for the treatment of congestive heart failure. Likewise, vasopressin antagonists such as a non-selective antagonist, conivaptan, as well as V2 selective antagonist, tolvaptan, may prove highly valuable for the therapy of this condition. Since most of the existing interventions are helpful in treating patients with congestive heart failure only partially, there appears to be a real challenge for developing some combination therapy for the treatment of congestive heart failure.

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Prognostic value of hyponatremia in hospitalized patients with worsening heart failure - insights from the outcomes of a prospective trial of intravenous milrinone for exacerbations of chronic heart failure (OPTIME - CHF)

Cited by 109 publications

References 0 publications

Biomarkers in heart failure: a clinical review

Biomarkers in heart failure: a clinical review

Significance of hyponatremia in heart failure

Potential of endothelin-1 and vasopressin antagonists for the treatment of congestive heart failure

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