Lower serum chloride levels were associated with a 2.93-fold increased risk of cardiac death in ICD patients with heart failure, while improving discharge in those without heart failure.
Does lower serum chloride level increase the risk of appropriate ICD discharge and cardiac death in patients with implantable cardioverter defibrillators?
237 patients with implantable cardioverter defibrillators (ICD), mean age 65±14 years, 81% male, mean LVEF 47±17%. 144 patients had heart failure (diagnosed based on history of hospitalization for worsening HF, symptoms due to HF, or LVEF <50%).
Lower serum chloride levels (<median value)
Higher serum chloride levels (≥median value)
Appropriate ICD discharge and cardiac deathhard clinical
Lower serum chloride levels are an adverse prognostic marker, predicting appropriate ICD therapies in patients without heart failure and cardiac death in those with heart failure.
Abstract Background Although hypochloremia is a well-established adverse prognostic marker in heart failure (HF) patients, there is no information available on the impact of serum chloride levels (sCL) on the prognosis of patients with implantable cardioverter defibrillators (ICD), relating to HF. Methods We prospectively enrolled 237 patients with ICD (age: 65±14 years old, male: 81%, LVEF: 47±17%) and 144 patients had HF diagnosed based on a history of hospitalization for worsening HF, symptoms due to HF, or left ventricular dysfunction (LVEF50%). We performed venous blood sampling at entry. The endpoints of this study were appropriate ICD discharge and cardiac death. Results During a mean follow up period of 4.3 ± 2.8 years, 74 of 237 patients received at least one appropriate ICD therapy and 45 patients died. Median values of sCL were 102 (95%CI:100-105) mEq/L in patients with HF, and 104 (95%CI:102-106) mEq/L in patients without HF. At multivariate Cox analysis, lower sCL (median value) was significantly associated with appropriate ICD discharge (adjusted HR 2.26, 95%CI:1.01-5.27, p=0.046) in patients without HF, independent of age, gender and non-sustained ventricular tachycardia. However, this was not observed in patients with HF. Conversely, lower sCL was significantly associated with cardiac death in patients with HF (adjusted HR 2.93, 95%CI:1.66-5.27, p=0.0002), while this was not observed in patients without HF (interaction p=0.039). Kaplan-Meier analysis showed that patients with lower sCL and without HF had a significantly greater risk of appropriate ICD discharge compared to those with higher sCL (40% vs 20%, p=0.043). Conversely, patients with lower sCL and HF had a significantly higher risk of cardiac death compared to those with higher sCL (62% vs 28%, p=0.0001). Conclusion The serum chloride levels might be associated with ventricular tachyarrhythmias in ICD patients without HF and cardiac death in ICD patients with HF.
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M Kawasaki
T Yamada
Mitsutoshi Asai
European Heart Journal
Osaka Prefectural Medical Center
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Kawasaki et al. (Sat,) reported a other. Lower serum chloride levels were associated with a 2.93-fold increased risk of cardiac death in ICD patients with heart failure, while improving discharge in those without heart failure.
www.synapsesocial.com/papers/698586ad8f7c464f2300a793 — DOI: https://doi.org/10.1093/eurheartj/ehaf784.618