La hiponatremia como marcador de riesgo en pacientes sometidos a implante de desfibrilador en prevención primaria

Abstract

Introduction and objectivesHyponatremia is a prognostic factor in patients with heart failure. Our objective was to assess the impact of hyponatremia in the evolution of patients undergoing cardioverter implantation in primary prevention. MethodThis is a multicenter retrospective observational study in which serum sodium periimplant and adverse events (all-cause and cardiovascular mortality, first admission for heart failure, first appropriate and inappropriate therapy) were assessed in a Spanish cohort receiving cardioverter in primary prevention. Patients with mild hyponatremia (Na≤135mEq/L) and those with moderate to severe hyponatremia (Na≤131mEq/L) were compared to those without hyponatremia. Results725 patients, with a mean value of sodium in blood peri-implant of 139±3.6mEq/L and a mean follow-up was 34.1±18.5months. In patients with Na≤135mEq/L (n=105), an increased incidence of first admission for heart failure was observed (Odds Ratio: 1.701; P=.031). In patients with moderate to severe hyponatremia (n=18), higher total mortality (Hazard Ratio: 3.552; P=.002) and increased cardiovascular mortality (Hazard Ratio: 4.24; P=.003) were observed. None of those values of hyponatremia were associated with increased incidence of appropriate or inappropriate therapies ConclusionsMild hyponatremia at the time of cardioverter implantation is related with a higher incidence of hospitalization for heart failure during follow-up, while moderate to severe hyponatremia increases the risk of death during follow-up