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Abstract
BackgroundComplicated pathophysiology makes it difficult to identify the prognosis of heart failure with preserved ejection fraction (HFpEF). While plasma osmolality has been reported to have prognostic importance, mainly in heart failure with reduced ejection fraction (HFrEF), its prognostic meaning for HFpEF has not been elucidated.MethodsWe prospectively studied 960 patients in PURSUIT-HFpEF, a multicenter observational study of acute decompensated HFpEF inpatients. We divided patients into three groups according to the quantile values of plasma osmolality on admission. During a follow-up averaging 366 days, we examined the primary composite endpoint of cardiac mortality or heart failure re-admission using Kaplan–Meier curve analysis and Cox proportional hazard testing.Results216 (22.5%) patients reached the primary endpoint. Kaplan–Meier curve analysis revealed that the highest quantile of plasma osmolality on admission (higher than 300.3 mOsm/kg) was significantly associated with adverse outcomes (Log-rank P = 0.0095). Univariable analysis in the Cox proportional hazard model also revealed significantly higher rates of adverse outcomes in the higher plasma osmolality on admission (hazard ratio [HR] 7.29; 95% confidence interval [CI] 2.25–23.92, P = 0.0009). Multivariable analysis in the Cox proportional hazard model also showed that higher plasma osmolality on admission was significantly associated with adverse outcomes (HR 5.47; 95% CI 1.46–21.56, P = 0.0113) independently from other confounding factors such as age, gender, comorbid of atrial fibrillation, hypertension history, diabetes, anemia, malnutrition, E/e′, and N-terminal pro-B-type natriuretic peptide elevation.ConclusionsHigher plasma osmolality on admission was prognostically important for acute decompensated HFpEF inpatients.
Highlights
There are many common problems in heart failure (HF) that are linked to hospitalization and mortality [1]
The components of the formula, namely sodium [5], blood urea nitrogen [6], serum glucose [7], and other parameters interacting with osmolality such as serum albumin [8] and renal function [9] have been proven to affect the prognosis of HF, little has been elucidated about the prognostic meaning of osmolality itself in acute decompensated HF (ADHF)
Plasma osmolality has been reported to be influenced by well-known prognostic factors such as arginine vasopressin (AVP), the renin–angiotensin–aldosterone system (RAAS), and natriuretic peptides [10,11,12], which suggests that osmolality itself could be associated with the prognosis of HF
Summary
There are many common problems in heart failure (HF) that are linked to hospitalization and mortality [1]. Independent from left ventricular ejection fraction (LVEF), Arévalo-Lorido et al reported higher osmolality in ADHF patients could predict worse outcomes accompanied by higher comorbidities through the National Registry of Heart Failure (RICA) [15]. Complicated pathophysiology makes it difficult to identify the prognosis of heart failure with preserved ejection fraction (HFpEF). While plasma osmolality has been reported to have prognostic importance, mainly in heart failure with reduced ejection fraction (HFrEF), its prognostic meaning for HFpEF has not been elucidated
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