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Prognostic importance of the serum magnesium concentration in patients with congestive heart failure
S S Gottlieb1, L Baruch, M L Kukin
1Division of Cardiology, Mount Sinai School of Medicine, New York, New York.
Insights
Abnormal serum magnesium levels in heart failure patients are linked to worse outcomes. Both low (hypomagnesemia) and high (hypermagnesemia) magnesium concentrations indicate a poorer prognosis and increased mortality risk.
Area of Science:
- Cardiology
- Clinical Biochemistry
Background:
- Magnesium abnormalities are frequent in congestive heart failure (CHF).
- The clinical and prognostic impact of serum magnesium levels in CHF is not well understood.
Purpose of the Study:
- To investigate the relationship between serum magnesium concentration and clinical characteristics.
- To evaluate the long-term prognostic significance of serum magnesium levels in patients with chronic heart failure.
Main Methods:
- Serum magnesium concentrations were measured in 199 patients with chronic heart failure.
- Patients were categorized into hypomagnesemia (<1.6 mEq/L), normal range (1.6-2.1 mEq/L), and hypermagnesemia (>2.1 mEq/L) groups.
- Clinical characteristics, neurohormonal variables, renal function, and long-term survival rates were analyzed.
Main Results:
- Hypomagnesemia was associated with more ventricular arrhythmias and a worse 1-year survival rate (45%) compared to normal levels (71%).
- Hypermagnesemia was linked to more severe symptoms, greater neurohormonal activation, worse renal function, and a poorer prognosis (37% 1-year survival) than normal levels (71%).
- Despite similar CHF severity and neurohormonal variables between hypomagnesemic and normal groups, prognosis differed significantly.
Conclusions:
- Serum magnesium concentration measurement offers crucial clinical and prognostic insights for patients with chronic heart failure.
- Both hypomagnesemia and hypermagnesemia are associated with significantly worse long-term outcomes in CHF patients.
- Abnormal magnesium levels, not just low levels, are important indicators of prognosis in heart failure.
Abstract:
Magnesium abnormalities are common in patients with congestive heart failure but the clinical and prognostic significance of an abnormal serum magnesium concentration in this disorder has not been investigated. Therefore, the relation between serum magnesium concentration and the clinical characteristics and long-term outcome of 199 patients with chronic heart failure was evaluated. The serum magnesium concentration was less than 1.6 mEq/liter in 38 patients (19%), within the normal range in 134 patients (67%) and greater than 2.1 mEq/liter in 27 patients (14%). Patients with hypomagnesemia had more frequent ventricular premature complexes and episodes of ventricular tachycardia than did patients with a normal serum magnesium concentration (p less than 0.05). Even though the two groups were similar with respect to severity of heart failure and neurohormonal variables, patients with a low serum magnesium concentration had a significantly worse prognosis during long-term follow-up (45% versus 71% 1 year survival, p less than 0.05). Patients with hypermagnesemia had more severe symptoms, greater neurohormonal activation and worse renal function than did patients with a normal serum magnesium concentration but tended to have fewer ventricular arrhythmias. Hypermagnesemic patients had a worse prognosis than did those with a normal magnesium concentration (37% versus 71% 1 year survival, p less than 0.05). In conclusion, the measurement of serum magnesium concentration provides important clinical and prognostic information in patients with chronic heart failure.