Urinary sodium and right ventricular function in acute heart failure

Area of Science:

• Cardiology
• Nephrology
• Echocardiography

Background:

• Urinary sodium (UNa) predicts adverse events in acute heart failure (AHF).
• The mechanism linking UNa to AHF outcomes, particularly concerning venous congestion and renal function, is not fully understood.
• Right ventricular (RV) function plays a crucial role in the cardiorenal syndrome observed in AHF.

Purpose of the Study:

• To investigate the relationship between RV function and UNa in AHF patients.
• To evaluate the prognostic interaction between RV function and UNa in predicting clinical outcomes.
• To understand the role of RV dysfunction in diuretic response and adverse events in AHF.

Main Methods:

• Prospective analysis of 101 hospitalized AHF patients.
• Division into high or low natriuresis groups based on furosemide stress test response.
• Comprehensive echocardiographic assessment of RV size and function, including tricuspid regurgitation.
• 6-month composite endpoint: all-cause mortality, heart failure rehospitalization, or heart transplantation.

Main Results:

• Low natriuresis was associated with greater RV dilation, right atrial dilation, inferior vena cava dilation, and higher prevalence of RV dysfunction and moderate-to-severe tricuspid regurgitation.
• RV dysfunction correlated with low natriuresis (OR 3.93), poorer diuretic response (p=0.037), and increased adverse events (p=0.002).
• Combined RV dysfunction and low natriuresis identified patients with the worst prognosis (HR 38.67).

Conclusions:

• Low natriuresis in AHF signifies a phenotype of advanced right-sided remodeling and RV dysfunction.
• This phenotype is linked to increased diuretic resistance and a higher risk of adverse outcomes.
• RV function assessment can enhance prognostic stratification in AHF patients with impaired natriuretic response.