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. 2008 Jun 15;177(12):1364-9.
doi: 10.1164/rccm.200712-1876OC. Epub 2008 Mar 20.

Hyponatremia predicts right heart failure and poor survival in pulmonary arterial hypertension

Paul R Forfia  1 , Stephen C Mathai, Micah R Fisher, Traci Housten-Harris, Anna R Hemnes, Hunter C Champion, Reda E Girgis, Paul M Hassoun
Affiliations

Hyponatremia predicts right heart failure and poor survival in pulmonary arterial hypertension

Paul R Forfia et al. Am J Respir Crit Care Med. .

Abstract

Rationale: Hyponatremia is associated with decompensated heart failure and poor prognosis in patients with left ventricular systolic dysfunction.

Objectives: We sought to determine if hyponatremia is associated with right heart failure and worse prognosis in patients with pulmonary arterial hypertension (PAH).

Methods: We prospectively followed 40 patients with PAH and examined the relationship between serum sodium and right heart function as well as survival.

Measurements and main results: Subjects with hyponatremia (Na < or = 136 mEq/L) were more symptomatic (11/13 World Health Organization [WHO] class III/IV vs. 12/27 WHO class III/IV; P = 0.02), had more peripheral edema (69 vs. 26%; P = 0.009), and had higher hospitalization rates (85 vs. 41%; P = 0.009) than normonatremic subjects. Hyponatremic subjects had higher right atrial pressure (14 +/- 6 vs. 9 +/- 3 mm Hg; P < 0.001), lower stroke volume index (21 +/- 7 vs. 32 +/- 10 ml/m(2); P < 0.01), larger right ventricular:left ventricular area ratio (1.8 +/- 0.4 vs. 1.3 +/- 0.4; P < 0.001), and lower tricuspid annular plane systolic excursion (1.4 +/- 0.3 vs. 2.0 +/- 0.6 cm; P = 0.001), despite similar mean pulmonary artery pressure (49 +/- 10 vs. 47 +/- 12 mm Hg; P = 0.60). The 1- and 2-year survival estimates were 93% (95% confidence interval [CI], 73-98%) and 85% (95% CI, 65-94%), and 38% (95% CI, 14-63%) and 15% (95% CI, 2-39%) for normonatremic and hyponatremic subjects, respectively (log-rank chi(2) = 25.19, P < 0.001). The unadjusted risk of death (hazard ratio) in hyponatremic compared with normonatremic subjects was 10.16 (95% CI, 3.42-30.10, P < 0.001). Hyponatremia predicted outcome after adjusting for WHO class, diuretic use, as well as right atrial pressure and cardiac index.

Conclusions: Hyponatremia is strongly associated with right heart failure and poor survival in PAH.

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Figures

<b>Figure 1.</b>
Figure 1.
Kaplan and Meier estimates of survival (all-cause mortality) in patients stratified by serum sodium.
See this image and copyright information in PMC

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