Hyponatraemia in acute heart failure is a marker of increased mortality but not when associated with hyperglycaemia

Previous studies suggest that hyponatraemia is a marker of neurohormonal activation and increased mortality in patients with acute heart failure (AHF). Although diabetes is a common co-morbidity in heart failure, no prior study has considered the impact of serum glucose on this relationship. METHODS: Over four consecutive months we prospectively registered all patients admitted due to AHF. Sodium and glucose levels were determined immediately upon admission. Patients were followed through admission and for the next 6 months. Of 342 patients enrolled, complete data were available for 331 patients. RESULTS: Hyponatraemia (sodium <135 mmol/L) was detected in 22% of patients. However, 47% of patients with hyponatraemia had concomitant hyperglycaemia (glucose level >11 mmol/L). Hyponatraemia was associated with increased 6-month mortality (21 vs. 8%, p=0.002). This association was restricted to patients who had hyponatraemia without concomitant hyperglycaemia. The 6-month mortality of patients with and without hyponatraemia was 11% versus 10% (p=0.87) when hyperglycaemia was present versus 29% and 7% (p<0.001) when hyperglycaemia was absent. CONCLUSIONS: In this preliminary study, hyperglycaemia-associated hyponatraemia was present in a significant proportion of patients admitted with AHF. In patients with hyperglycaemia, hyponatraemia had no prognostic significance, whereas in patients without hyperglycaemia, hyponatraemia remained a powerful predictor of mortality. These results need confirmation in a larger study.     

Effects of Glucocorticoids in Potentiating Diuresis in Heart Failure Patients With Diuretic Resistance

Diuretic resistance in heart failure is defined as a state in which diuretic response is diminished or lost before the therapeutic goal of relief from congestion has been reached. Diuretic resistance is very common and is associated with poor outcomes. Over the past decade, several new drugs and devices targeting decongestion and improvement in renal function in patients with heart failure have failed to show benefit in randomized clinical trials. Glucocorticoids had been used to manage diuretic resistance before the advent of loop diuretics. More recent evidence appears to confirm that glucocorticoids may also help to overcome resistance to loop diuretics. This review tries to summarize the available evidence and potential mechanisms related to glucocorticoid therapy in patients with heart failure and its effect on diuretic resistance.     

Very Early Diuretic Response After Admission for Acute Heart Failure

Background

In hospitalized heart failure patients, a poor diuretic response (DR) during the first days of hospital admission is associated with worse outcomes. However, it remains unknown whether DR in the first hours has similar prognostic value. Moreover, data on the sequential change in DR during hospital admission are lacking.

慢性心力衰竭与急性冠状动脉综合征患者细胞因子释放部位的对比分析

目的研究慢性心力衰竭和急性冠状动脉综合征患者肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)释放部位的区别.方法选取接受心导管检查及治疗的60例患者,按疾病类型分为三组,急性冠状动脉综合征17例(急性冠状动脉综合征组),慢性心力衰竭15例(慢性心力衰竭组),另28例为对照组.分别自股动脉、股静脉、冠状动脉左主干和冠状静脉窦4处取血,比较各部位TNF-α、IL-6水平的差异.结果①慢性心力衰竭组和急性冠状动脉综合征组各部位TNF-α、IL-6水平均高于对照组(P＜0.01);②急性冠状动脉综合征组冠状静脉窦TNF-α、IL-6水平高于左主干,而慢性心力衰竭组和对照组无此现象.结论慢性心力衰竭炎性因子主要来源于心外低灌注组织;急性冠状动脉综合征患者中心内组织炎性细胞因子水平明显升高.     

Diuretic usage in heart failure: a continuing conundrum in 2005.

Several large well-designed clinical trials have shown that the use of diuretics is beneficial in patients with hypertension. However, similarly robust data regarding their role in chronic heart failure are lacking. Historically, diuretics were developed for treatment of sodium and water retention in oedematous disorders and clinically, they remain the most potent drugs available to relieve symptoms and eliminate oedema in the congested patient with heart failure. In the non-congested patient, however, diuretics continue to be used on a purely clinical basis without sufficient characterization of benefits, adverse effects, and potential influence on mortality. There are also concerns that chronic diuretic usage can cause adverse vascular effects, unfavourable neuroendocrine activation, electrolyte imbalances, and life-threatening arrhythmias. In this article, we review the limited evidence available regarding the benefits and perils of using diuretics in heart failure.     

心力衰竭管理模式探讨

目的:评价不同管理模式对慢性收缩性心力衰竭(心衰)患者神经内分泌、心功能、心脏事件、生活质量和医疗费用的影响。方法:120例慢性心功能不全患者,在常规治疗心衰的前提下,随机分为心衰管理组和心衰非管理组各60例,治疗后两年其对神经内分泌、心功能、心脏事件、生活质量和医疗费用的影响。结果:心衰管理组治疗后心功能、生活质量、神经内分泌较心衰非管理组治疗后改善(P<0.05),心衰恶化再入院减少(P<0.05),心脏事件较心衰非管理组明显减少(P<0.05),年心衰治疗费用较后者减少(P<0.05),差异均有统计学意义。结论:通过心衰管理能改善心功能及生活质量,减少心衰医疗费用、心脏事件的发生。     

卡维地洛和普萘洛尔对心力衰竭治疗作用比较

目的 :比较 β肾上腺素受体阻滞剂卡维地洛 (carvedilol)和普萘洛尔 ( propranolol)在心力衰竭 (心衰 )治疗中的作用。方法 :40只Wistar大鼠随机分为 4组 (n均 =10 ) ,分别进行空白处理 (对照组 )、过度游泳训练 8周 (心衰组 )、过度游泳训练 8周后服普萘洛尔 4mg/(kg·d) 8周 (普萘洛尔组 )、过度游泳训练 8周后服卡维地洛 6mg/(kg·d) 8周 (卡维地洛组 )。 16周后测血流动力学指标、心肌细胞凋亡率、左心室质量指数、心肌间质纤维化程度等。结果 :心衰组、普萘洛尔组、卡维地洛组间血流动力学各项指标无显著差异 ,与对照组相比均有显著差异 (P <0 0 1～ 0 0 5 ) ;心衰组与对照组左心室重构及心肌细胞凋亡率均有显著差异 (P <0 0 1～ 0 0 5 ) ;而心肌细胞凋亡率对照组 <卡维地洛组 <普萘洛尔组 <心衰组 ,有显著差异 (P <0 0 1～ 0 0 5 )。结论 :卡维地洛和普萘洛尔对心肌细胞都有保护作用 ,以卡维地洛更明显。     

Observation of Patients Transitioned to an Oral Loop Diuretic Before Discharge and Risk of Readmission for Acute Decompensated Heart Failure

Background

Heart failure (HF) is associated with high 30-day readmission rates and places significant financial burden on the health care system. The aim of this study was to determine if the duration of observation on an oral loop diuretic before discharge is associated with a reduction in 30-day HF readmission in patients with acute decompensated HF (ADHF).

The Association Between Serum Calcium Levels and Short-Term Mortality in Patients with Chronic Heart Failure

Background

Patients with chronic heart failure have vulnerable myocardial function and are susceptible to electrolyte disturbances. In these patients, diuretic treatment is frequently prescribed, though it is known to cause electrolyte disturbances. Therefore, we investigated the association between altered calcium homeostasis and the risk of all-cause mortality in chronic heart failure patients.