定点尿钠在门诊心力衰竭患者中的作用。

IF 7.2 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista española de cardiología (English ed.) Pub Date : 2025-03-01 DOI:10.1016/j.rec.2024.07.002

Miguel Lorenzo , Rafael de la Espriella , Gema Miñana , Gonzalo Núñez , Arturo Carratalá , Enrique Rodríguez , Enrique Santas , Neus Valls , Sandra Villar , Víctor Donoso , Antoni Bayés-Genís , Juan Sanchis , Julio Núñez

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引用次数: 0

摘要

引言和目的：尿钠（UNa+）定点测定已成为监测急性心力衰竭（AHF）患者利尿剂反应的有用工具。然而，门诊患者的相关证据却很少。我们的目的是研究慢性心力衰竭患者的尿钠浓度与死亡率和心力衰竭（WHF）恶化风险之间的关系：这项观察性和前瞻性研究纳入了 1145 名慢性心力衰竭门诊患者，他们均在一家中心的心力衰竭专科门诊接受随访。每次就诊前 1-5 天进行 UNa+ 评估。研究终点为UNa+与以下风险之间的关系：a）长期死亡；b）AHF-住院和总WHF事件（包括AHF-住院、急诊就诊或在HF门诊使用肠外环利尿剂），通过多变量Cox和负二项回归进行评估：平均年龄（标准差）为 73 ± 11 岁，670 例（58.5%）为男性，902 例（78.8%）处于稳定的 NYHA II 级，595 例（52%）LFEF ≥ 50%。UNa+ 的中位数（四分位数间距）为 72 (51-94) mmol/L。在中位 2.63（1.70-3.36）年的随访期间，293 名患者（25.6%）死亡，233 名患者（20.3%）发生 382 例 WHF 事件（244 例 AHF-入院）。经过多变量调整后，基线 UNa+ 与总 WHF（IRR，1.07；95%CI，1.02-1.12；P = .007）和 AHF-入院（IRR，1.08；95%CI，1.02-1.14；P = .012）风险呈反向线性相关，与全因死亡率呈边缘相关（HR，1.04；95%CI，0.99-1.09；P = .068）：结论：在慢性心房颤动门诊患者中，较低的 UNa+ 与较高的复发性 WHF 事件风险相关。

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Role of spot urinary sodium in outpatients with heart failure

Introduction and objectives

Spot determination of urinary sodium (UNa+) has emerged as a useful tool for monitoring diuretic response in patients with acute heart failure (AHF). However, the evidence in outpatients is scarce. We aimed to examine the relationship between spot UNa+ levels and the risk of mortality and worsening heart failure (WHF) events in individuals with chronic HF.

Methods

This observational and ambispective study included 1145 outpatients with chronic HF followed in a single center specialized HF clinic. UNa+ assessment was carried out 1-5 days before each visit. The endpoints of the study were the association between UNa+ and risk of a) long-term death and b) AHF-hospitalization and total WHF events (including AHF-hospitalization, emergency department visits or parenteral loop-diuretic administration in HF clinic), assessed by multivariate Cox and negative binomial regressions.

Results

The mean ± standard deviation of age was 73 ± 11 years, 670 (58.5%) were men, 902 (78.8%) were on stable NYHA class II, and 595 (52%) had LFEF ≥ 50%. The median (interquartile range) UNa+ was 72 (51-94) mmol/L. Over a median follow-up of 2.63 (1.70-3.36) years, there were 293 (25.6%) deaths and 382 WHF events (244 AHF-admissions) in 233 (20.3%) patients. After multivariate adjustment, baseline UNa+ was inverse and linearly associated with the risk of total WHF (IRR, 1.07; 95%CI, 1.02-1.12; P = .007) and AHF-admissions (IRR, 1.08; 95%CI, 1.02-1.14; P = .012) and borderline associated with all-cause mortality (HR, 1.04; 95%CI, 0.99-1.09; P = .068).