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  • Title: Relation between serum sodium levels and prognosis in outpatients with chronic heart failure: neutral effect of treatment with beta-blockers and angiotensin-converting enzyme inhibitors: data from the Italian Network on Congestive Heart Failure (IN-CHF database).
    Author: Baldasseroni S, Urso R, Orso F, Bianchini BP, Carbonieri E, Cirò A, Gonzini L, Leonardi G, Marchionni N, Maggioni AP, IN-CHF Investigators.
    Journal: J Cardiovasc Med (Hagerstown); 2011 Oct; 12(10):723-31. PubMed ID: 21873881.
    Abstract:
    INTRODUCTION: The predictive role of hyponatremia has been tested in acute and chronic heart failure. Sodium level is inversely related with renin-angiotensin-aldersterone system (RAAS) and sympathetic nervous activity but important issues remain unresolved. Our aim was to define the level of hyponatremia able to predict 1-year outcomes and investigate the relation between sodium levels and mortality and the effect of beta-blockers and angiotensin-converting enzyme (ACE) inhibitors on this relation. METHODS: We analyzed 4670 patients enrolled in the IN-CHF Italian Registry. We controlled the predictivity of hyponatremia, testing it either as a continuous variable and dividing the study sample into three severity groups: group 1 (≥136  mEq/l; n = 4207), group 2 (131-135  mEq/l; n = 389) and group 3 (≤130  mEq/l; n = 74). The linearity of the relationship between sodium levels and mortality was also tested. RESULTS: Mild-to-moderate and severe hyponatremia (groups 2 and 3) independently predicted the 1-year mortality. The relation between sodium concentration and death was not linear and a decrease of 1  mEq/l of sodium increased death rate only for values of sodium 142.9  mEq/l or less. This relationship was not modified by beta-blocker and ACE inhibitor therapies. CONCLUSION: Our data confirm the negative prognostic value of hyponatremia, even of moderate degree, independently of the use of recommended treatments for heart failure.
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