Prognostic relevance of elevated plasma osmolality on admission in acute decompensated heart failure with preserved ejection fraction: insights from PURSUIT-HFpEF registry

• Main Authors: Akito Nakagawa, Yoshio Yasumura, Chikako Yoshida, Takahiro Okumura, Jun Tateishi, Junichi Yoshida, Shunsuke Tamaki, Masamichi Yano, Takaharu Hayashi, Yusuke Nakagawa, Takahisa Yamada, Daisaku Nakatani, Shungo Hikoso, Yasushi Sakata, Osaka CardioVascular Conference (OCVC) Heart Failure Investigators
• Format: Article
• Language: English
• Published: BMC 2021-06-01
• Series: BMC Cardiovascular Disorders
• Subjects: HFpEF; Plasma osmolality; Prognosis
• Online Access: https://doi.org/10.1186/s12872-021-02098-z

Abstract Background Complicated pathophysiology makes it difficult to identify the prognosis of heart failure with preserved ejection fraction (HFpEF). While plasma osmolality has been reported to have prognostic importance, mainly in heart failure with reduced ejection fraction (HFrEF), its prognostic meaning for HFpEF has not been elucidated. Methods We prospectively studied 960 patients in PURSUIT-HFpEF, a multicenter observational study of acute decompensated HFpEF inpatients. We divided patients into three groups according to the quantile values of plasma osmolality on admission. During a follow-up averaging 366 days, we examined the primary composite endpoint of cardiac mortality or heart failure re-admission using Kaplan–Meier curve analysis and Cox proportional hazard testing. Results 216 (22.5%) patients reached the primary endpoint. Kaplan–Meier curve analysis revealed that the highest quantile of plasma osmolality on admission (higher than 300.3 mOsm/kg) was significantly associated with adverse outcomes (Log-rank P = 0.0095). Univariable analysis in the Cox proportional hazard model also revealed significantly higher rates of adverse outcomes in the higher plasma osmolality on admission (hazard ratio [HR] 7.29; 95% confidence interval [CI] 2.25–23.92, P = 0.0009). Multivariable analysis in the Cox proportional hazard model also showed that higher plasma osmolality on admission was significantly associated with adverse outcomes (HR 5.47; 95% CI 1.46–21.56, P = 0.0113) independently from other confounding factors such as age, gender, comorbid of atrial fibrillation, hypertension history, diabetes, anemia, malnutrition, E/e′, and N-terminal pro-B-type natriuretic peptide elevation. Conclusions Higher plasma osmolality on admission was prognostically important for acute decompensated HFpEF inpatients.