Prognostic importance of sodium level trajectory in acute heart failure

Yuya Matsue, Kenji Yoshioka, Makoto Suzuki, Sho Torii, Satoshi Yamaguchi, Seiji Fukamizu, Yuichi Ono, Hiroyuki Fujii, Takeshi Kitai, Toshihiko Nishioka, Kaoru Sugi, Yuko Onishi, Makoto Noda, Nobuyuki Kagiyama, Yasuhiro Satoh, Kazuki Yoshida, Steven R. Goldsmith

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Low sodium levels are strongly associated with poor prognosis in acute heart failure (AHF); however, the prognostic impact of the sodium level trajectory overtime has not been determined. A secondary analysis of the AQUAMARINE study in which patients with AHF and renal impairment were randomized to receive either tolvaptan or conventional treatment was performed. Sodium levels were evaluated at the baseline and at 6, 12, 24, and 48 h. We defined ‘sodium dipping’ as sodium level falling below the baseline level at any time point. The primary endpoint was the combined event of all-cause death and heart failure rehospitalization during follow-up. The analysis included 184 patients with a median follow-up of 21.1 months. Sodium levels more steeply increased during the 48 h in patients without events as compared to sodium levels in patients with events (P = 0.018 in linear-mixed effect model). The sodium dipping group (n = 100; 54.3%) demonstrated significantly less urine output, less body weight reduction, and poorer diuretic response within 48 h compared to the non-dipping group. The sodium dipping group was also significantly associated with a low combined-event-free survival after adjustment for other prognostic factors (HR 1.97; 95% CI 1.06–3.38; P = 0.033). The trajectory of sodium levels during the acute phase is associated with the prognosis of patients with AHF independently of the baseline sodium level.

Original languageEnglish (US)
Pages (from-to)1498-1505
Number of pages8
JournalHeart and Vessels
Issue number12
StatePublished - Dec 1 2017

Bibliographical note

Funding Information:
The AQUAMARINE study was funded by a Japan Heart Foundation Multicenter Study Grant.

Publisher Copyright:
© 2017, Springer Japan KK.


  • Acute heart failure
  • Prognosis
  • Serum sodium


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