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Proposal for heart failure progression based on the 'chloride theory': worsening heart failure with increased vs.
1Division of Internal Medicine, Nishida Hospital, Saiki city, Oita, Japan.
Insights
Changes in serum chloride (Cl) levels can indicate different clinical outcomes in heart failure (HF) patients. Increased serum Cl during worsening HF is associated with greater vascular expansion and fewer clinical signs.
Area of Science:
- Cardiology
- Nephrology
- Internal Medicine
Background:
- Chloride (Cl) is a key electrolyte regulating the renin-angiotensin-aldosterone system.
- Serum Cl plays a role in body fluid distribution in heart failure (HF) patients.
- Clinical differences in worsening HF based on serum Cl changes are not well understood.
Purpose of the Study:
- To investigate the clinical differences in worsening heart failure (HF) status based on changes in serum chloride (Cl) concentration.
- To explore the pathophysiologic features associated with increased serum Cl in HF patients experiencing worsening symptoms.
Main Methods:
- Analysis of data from 47 chronic HF patients experiencing worsening HF.
- Measurement of hemoglobin (Hb), hematocrit (Ht), mean red blood cell volume (MCV), albumin, serum solutes, and b-type natriuretic peptide.
- Estimation of relative plasma volume change (%PV) between stable and worsening HF states.
- Division of patients into groups based on serum Cl concentration changes (increased vs. non-increased).
Main Results:
- Patients with increased serum Cl (n=31) showed a greater increase in serum sodium (2.94 ± 4.15 mEq/L) compared to non-increased Cl group (n=16) (-0.69 ± 3.75 mEq/L).
- The increased Cl group exhibited higher vascular expansion (12 ± 11.1% vs. 4.81 ± 7.94%) and a tendency towards greater MCV (1.23 ± 2.36 fL vs. -0.06 ± 1.88 fL).
- Increased Cl group had fewer HF signs (2.65 ± 0.71 vs. 3.31 ± 0.79) and preserved renal function, with no significant increase in serum creatinine.
Conclusions:
- A new clinical entity of worsening HF status is suggested: HF with increased vs. non-increased serum Cl concentration.
- Changes in serum Cl concentration from clinical stability to worsening HF are associated with distinct pathophysiologic features and clinical presentations.
- This finding highlights the importance of monitoring serum Cl levels in HF management.
Aims:
Chloride (Cl) is an established key electrolyte for the activation of the renin-angiotensin-aldosterone system. Recent studies have shown the serum Cl as a key electrolyte for the regulation of body fluid distribution in heart failure (HF) patients. The clinical differences of worsening HF status according to the changes in serum Cl concentration are unclear.
Methods And Results:
Data from 47 chronic HF patients were analysed. Upon worsening HF, each patient exhibited at least two HF-related signs. Blood tests included haemoglobin (Hb), haematocrit (Ht), mean red blood cell volume (MCV), albumin, serum solutes, and b-type natriuretic peptide. The relative change in the plasma volume (%PV) from stable to worsening HF was estimated as follows: 100 × {Hb (stable) × [1 - Ht (worse)]}/{Hb (worse) × [1 - Ht (stable)]} - 100. When patients were divided into two groups based on changes in serum Cl concentration from stable to worsening HF, the pathophysiologic features of the patients with increased Cl (range 1-23 mEq/L; n = 31) included a greater increase in serum sodium (2.94 ± 4.15 vs. -0.69 ± 3.75 mEq/L, P = 0.005), higher vascular expansion (12 ± 11.1 vs. 4.81 ± 7.94%, P = 0.026), a tendency towards a greater MCV (1.23 ± 2.36 vs. -0.06 ± 1.88 fL, P = 0.065), and preserved renal function defined by the absence of an increase of serum creatinine (-0.24 ± 0.39 vs. -0.05 ± 0.12 mg/dL, P = 0.057) compared to patients with non-increased Cl (range -9 to 0 mEq/L; n = 16). Clinically, the increased Cl group had fewer HF signs (2.65 ± 0.71 vs. 3.31 ± 0.79, P = 0.005) although the change in symptoms did not differ between groups (48% vs. 63%, P = 0.54).
Conclusions:
The present study suggests a new clinical entity of worsening HF status, that is, HF with increased vs. non-increased serum Cl concentration from clinical stability to worsening HF.
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