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Background: Hyponatremia is associated with adverse outcomes in heart failure and after cardiac surgery. We hypothesized that hyponatremia is associated with poorer short-term and longer term survival in patients after continuous-flow left ventricular assist device (CF-LVAD) placement. Methods:We reviewed a single-center database of patients who received a CF-LVAD during 2012-2017. Sodium (Na) values obtained within 14 days before CF-LVAD insertion were averaged; patients (n = 332) were divided into hyponatremia (mean Na <135 mEq/L; n = 160; 48.2%) and normonatremia groups (mean Na 135-145 mEq/L; n = 172; 51.8%). Patients requiring preoperative dialysis or pump exchange were excluded. We compared outcomes between preoperative hyponatremia and normonatremia groups.

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Purpose:The EPHESUS trial demonstrated that aldosterone blockade with eplerenone significantly decreased risk of all-cause mortality and CV death in post-AMI patients with HF by 15% (P = 0.008) and 17% (P = 0.005), respectively. This post hoc analysis of the EPHESUS trial explored trends in mortality data by baseline LVEF and Killip class. Methods: 6632 patients with signs and symptoms of CHF post-AMI with LVSD (EF < 40%) were randomized to receive eplerenone or placebo plus standard therapy. The trial continued until 1012 deaths occurred (mean follow-up = 16 months). The primary endpoint was all-cause mortality and the composite of time to CV mortality or CV hospitalization. Subjects were stratified based on baseline LVEF and Killip class. Cox regression analyses with treatment (eplerenone vs placebo), Killip class, and LVEF as explanatory variables in the model, as well as interaction of Killip class and LVEF were performed. Results: Risk of all-cause death was 71% higher in subjects with LVEF< 30% vs those with LVEF ≥ 30%. Risk of all cause death was 85% higher in subjects in Killip Class III/IV vs those in Killip Class I/II. There were statistically significant interactions between Killip class and LVEF for all-cause mortality and CV mortality. Cox regression analysis revealed that mortality risk in patients with Killip class I/II doubled when LVEF was < 30% vs LVEF ≥ 30% (P < 0.001). However, among patients in Killip class III/IV mortality risk increased 20% (P = 0.129) when LVEF was < 30% vs LVEF ≥ 30%.