Elevated blood bicarbonate levels and long-term adverse outcomes in patients with chronic heart failure.

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  • Additional Information
    • Source:
      Publisher: John Wiley & Sons Ltd on behalf of the European Society of Cardiology Country of Publication: England NLM ID: 101669191 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2055-5822 (Electronic) Linking ISSN: 20555822 NLM ISO Abbreviation: ESC Heart Fail Subsets: MEDLINE
    • Publication Information:
      Original Publication: [Oxford] : John Wiley & Sons Ltd on behalf of the European Society of Cardiology, [2014]-
    • Subject Terms:
      Heart Failure*/blood ; Heart Failure*/drug therapy ; Heart Failure*/physiopathology ; Bicarbonates*/blood; Humans ; Male ; Female ; Aged ; Prognosis ; Follow-Up Studies ; Chronic Disease ; Stroke Volume/physiology ; Time Factors ; Biomarkers/blood ; Survival Rate/trends ; Retrospective Studies ; Ventricular Function, Left/physiology ; Middle Aged
    • Abstract:
      Aims: The bicarbonate (HCO 3 - ) buffer system is crucial for maintaining acid-base homeostasis and blood pH. Recent studies showed that elevated serum HCO 3 - levels serve as an indicator of the beneficial effects of acetazolamide in improving decongestion in acute heart failure. In this study, we sought to clarify the clinical relevance and prognostic impact of HCO 3 - in chronic heart failure (CHF).
      Methods: This cohort study enrolled 694 hospitalized patients with CHF (mean age 68.6 ± 14.6, 62% male) who underwent arterial blood sampling and exhibited neutral pH ranging from 7.35 to 7.45. We characterized the patients based on HCO 3 - levels and followed them to register cardiac events.
      Results: Among the patients, 17.3% (120 patients) had HCO 3 - levels exceeding 26 mmol/L. Patients presenting HCO 3 -  > 26 mmol/L were more likely to use loop diuretics and had higher serum sodium and lower potassium levels, but left ventricular ejection fraction did not differ compared with those with HCO 3 - between 22 and 26 (379 patients) or those with HCO 3 -  < 22 mmol/L (195 patients). During a median follow-up period of 1950 days, Kaplan-Meier analysis revealed that patients with HCO 3 -  > 26 mmol/L had the lowest event-free survival rate from either cardiac deaths or heart failure-related rehospitalization (P < 0.01 and 0.03, respectively). In the multivariable Cox model, the presence of HCO 3 -  > 26 mmol/L independently predicted increased risks of each cardiac event with a hazard ratio of 2.31 and 1.69 (P < 0.01 and 0.02, respectively), while HCO 3 -  < 22 mmol/L was not associated with these events (hazard ratios, 0.99 and 1.19; P = 0.98 and 0.43, respectively).
      Conclusions: Elevated blood HCO 3 - levels may signify enhanced proximal nephron activation and loop diuretic resistance, leading to long-term adverse outcomes in patients with CHF, even within a normal pH range.
      (© 2024 The Author(s). ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
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    • Grant Information:
      22K08107 Japan Society for the Promotion of Science KAKENHI; 23K06870 Japan Society for the Promotion of Science KAKENHI
    • Contributed Indexing:
      Keywords: acid–base homeostasis; bicarbonate; biomarker; heart failure; prognosis
    • Accession Number:
      0 (Bicarbonates)
      0 (Biomarkers)
    • Publication Date:
      Date Created: 20240706 Date Completed: 20241210 Latest Revision: 20241212
    • Publication Date:
      20241212
    • Accession Number:
      PMC11631286
    • Accession Number:
      10.1002/ehf2.14900
    • Accession Number:
      38970235