Hemodynamic factors associated with serum chloride in ambulatory patients with advanced heart failure

Justin L. Grodin, Wilfried Mullens, Matthias Dupont, David O. Taylor, Paul M. McKie, Randall C. Starling, Jeffrey M. Testani, W. H.Wilson Tang

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background Lower serum chloride (Cl) is associated with mortality in heart failure patients and may be more prognostically relevant than sodium. However, the association of hemodynamics and Cl levels is unknown. Methods 438 sequential patients with advanced chronic heart failure (ACHF) underwent invasive hemodynamic assessment with measured serum Cl levels during an evaluation for ACHF. Patients were followed for death, heart transplant (HT), or ventricular assist device placement (VAD). A backwards regression model determined hemodynamic predictors of Cl (removal, P < 0.1) with candidate variables: Fick cardiac index (FCI), pulmonary capillary wedge pressure (PCWP), right atrial pressure (RAP), mean arterial pressure (MAP), heart rate (HR), and pulmonary artery systolic pressure (PASP). All models were also adjusted for serum sodium and bicarbonate. Results In this cohort, the median Cl level was 102 [98–104] meq/L (range 86–113 meq/L). Chloride was weakly correlated with FCI (rho 0.12, P = 0.01) and MAP (rho 0.21, P < 0.001); but not PCWP, RAP, HR or PASP (P > 0.05 for all). In the multivariable model, FCI (beta 0.73 meq/L/L/min/m2, P = 0.002) but not RAP (P = 0.3) or MAP (P = 0.2), remained associated with Cl. Lower Cl was associated with increased risk of death, HT, or VAD placement (HR 0.94/meq/L, 95% CI 0.89–0.99, P = 0.01). However, this association was attenuated after additional adjustment for BUN (P = 0.27) and PCWP and FCI (0.48). Conclusions Lower FCI, not lower MAP or higher cardiac filling pressures, was associated with lower chloride. Although lower chloride was associated with poor long-term outcomes, this risk attenuates with adjustment for more conventional clinical parameters.

Original languageEnglish (US)
Pages (from-to)112-116
Number of pages5
JournalInternational Journal of Cardiology
Volume252
DOIs
StatePublished - Feb 1 2018

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Chlorides
Heart Failure
Hemodynamics
Heart-Assist Devices
Serum
Transplants
Blood Urea Nitrogen
Sodium
Pressure
Mortality

Keywords

  • And chloride
  • Electrolytes
  • Heart failure
  • Hemodynamics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Hemodynamic factors associated with serum chloride in ambulatory patients with advanced heart failure. / Grodin, Justin L.; Mullens, Wilfried; Dupont, Matthias; Taylor, David O.; McKie, Paul M.; Starling, Randall C.; Testani, Jeffrey M.; Tang, W. H.Wilson.

In: International Journal of Cardiology, Vol. 252, 01.02.2018, p. 112-116.

Research output: Contribution to journalArticle

Grodin, Justin L. ; Mullens, Wilfried ; Dupont, Matthias ; Taylor, David O. ; McKie, Paul M. ; Starling, Randall C. ; Testani, Jeffrey M. ; Tang, W. H.Wilson. / Hemodynamic factors associated with serum chloride in ambulatory patients with advanced heart failure. In: International Journal of Cardiology. 2018 ; Vol. 252. pp. 112-116.
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abstract = "Background Lower serum chloride (Cl) is associated with mortality in heart failure patients and may be more prognostically relevant than sodium. However, the association of hemodynamics and Cl levels is unknown. Methods 438 sequential patients with advanced chronic heart failure (ACHF) underwent invasive hemodynamic assessment with measured serum Cl levels during an evaluation for ACHF. Patients were followed for death, heart transplant (HT), or ventricular assist device placement (VAD). A backwards regression model determined hemodynamic predictors of Cl (removal, P < 0.1) with candidate variables: Fick cardiac index (FCI), pulmonary capillary wedge pressure (PCWP), right atrial pressure (RAP), mean arterial pressure (MAP), heart rate (HR), and pulmonary artery systolic pressure (PASP). All models were also adjusted for serum sodium and bicarbonate. Results In this cohort, the median Cl level was 102 [98–104] meq/L (range 86–113 meq/L). Chloride was weakly correlated with FCI (rho 0.12, P = 0.01) and MAP (rho 0.21, P < 0.001); but not PCWP, RAP, HR or PASP (P > 0.05 for all). In the multivariable model, FCI (beta 0.73 meq/L/L/min/m2, P = 0.002) but not RAP (P = 0.3) or MAP (P = 0.2), remained associated with Cl. Lower Cl was associated with increased risk of death, HT, or VAD placement (HR 0.94/meq/L, 95{\%} CI 0.89–0.99, P = 0.01). However, this association was attenuated after additional adjustment for BUN (P = 0.27) and PCWP and FCI (0.48). Conclusions Lower FCI, not lower MAP or higher cardiac filling pressures, was associated with lower chloride. Although lower chloride was associated with poor long-term outcomes, this risk attenuates with adjustment for more conventional clinical parameters.",
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T1 - Hemodynamic factors associated with serum chloride in ambulatory patients with advanced heart failure

AU - Grodin, Justin L.

AU - Mullens, Wilfried

AU - Dupont, Matthias

AU - Taylor, David O.

AU - McKie, Paul M.

AU - Starling, Randall C.

AU - Testani, Jeffrey M.

AU - Tang, W. H.Wilson

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N2 - Background Lower serum chloride (Cl) is associated with mortality in heart failure patients and may be more prognostically relevant than sodium. However, the association of hemodynamics and Cl levels is unknown. Methods 438 sequential patients with advanced chronic heart failure (ACHF) underwent invasive hemodynamic assessment with measured serum Cl levels during an evaluation for ACHF. Patients were followed for death, heart transplant (HT), or ventricular assist device placement (VAD). A backwards regression model determined hemodynamic predictors of Cl (removal, P < 0.1) with candidate variables: Fick cardiac index (FCI), pulmonary capillary wedge pressure (PCWP), right atrial pressure (RAP), mean arterial pressure (MAP), heart rate (HR), and pulmonary artery systolic pressure (PASP). All models were also adjusted for serum sodium and bicarbonate. Results In this cohort, the median Cl level was 102 [98–104] meq/L (range 86–113 meq/L). Chloride was weakly correlated with FCI (rho 0.12, P = 0.01) and MAP (rho 0.21, P < 0.001); but not PCWP, RAP, HR or PASP (P > 0.05 for all). In the multivariable model, FCI (beta 0.73 meq/L/L/min/m2, P = 0.002) but not RAP (P = 0.3) or MAP (P = 0.2), remained associated with Cl. Lower Cl was associated with increased risk of death, HT, or VAD placement (HR 0.94/meq/L, 95% CI 0.89–0.99, P = 0.01). However, this association was attenuated after additional adjustment for BUN (P = 0.27) and PCWP and FCI (0.48). Conclusions Lower FCI, not lower MAP or higher cardiac filling pressures, was associated with lower chloride. Although lower chloride was associated with poor long-term outcomes, this risk attenuates with adjustment for more conventional clinical parameters.

AB - Background Lower serum chloride (Cl) is associated with mortality in heart failure patients and may be more prognostically relevant than sodium. However, the association of hemodynamics and Cl levels is unknown. Methods 438 sequential patients with advanced chronic heart failure (ACHF) underwent invasive hemodynamic assessment with measured serum Cl levels during an evaluation for ACHF. Patients were followed for death, heart transplant (HT), or ventricular assist device placement (VAD). A backwards regression model determined hemodynamic predictors of Cl (removal, P < 0.1) with candidate variables: Fick cardiac index (FCI), pulmonary capillary wedge pressure (PCWP), right atrial pressure (RAP), mean arterial pressure (MAP), heart rate (HR), and pulmonary artery systolic pressure (PASP). All models were also adjusted for serum sodium and bicarbonate. Results In this cohort, the median Cl level was 102 [98–104] meq/L (range 86–113 meq/L). Chloride was weakly correlated with FCI (rho 0.12, P = 0.01) and MAP (rho 0.21, P < 0.001); but not PCWP, RAP, HR or PASP (P > 0.05 for all). In the multivariable model, FCI (beta 0.73 meq/L/L/min/m2, P = 0.002) but not RAP (P = 0.3) or MAP (P = 0.2), remained associated with Cl. Lower Cl was associated with increased risk of death, HT, or VAD placement (HR 0.94/meq/L, 95% CI 0.89–0.99, P = 0.01). However, this association was attenuated after additional adjustment for BUN (P = 0.27) and PCWP and FCI (0.48). Conclusions Lower FCI, not lower MAP or higher cardiac filling pressures, was associated with lower chloride. Although lower chloride was associated with poor long-term outcomes, this risk attenuates with adjustment for more conventional clinical parameters.

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