Distribution of admission serum sodium in patients hospitalized

Distribution of admission serum sodium in patients hospitalized with a primary discharge diagnosis of heart failure (48 612 patients from 259 hospitals). M. Gheorghiade et al, European Heart Journal (2007) 28, 980– 988

From: Hyponatremia and Long-term Mortality in Survivors of Acute ST-Elevation Myocardial Infarction Arch Intern Med. 2006; 166(7): 781 -786. doi: 10. 1001/archinte. 166. 7. 781 Figure Legend: Long-term mortality or admission for the treatment of heart failure (HF) among strata of patients, according to deciles of sodium levels. Date of download: 9/8/2012 Copyright © 2012 American Medical Association. All rights reserved.

From: Hyponatremia and Long-term Mortality in Survivors of Acute ST-Elevation Myocardial Infarction Arch Intern Med. 2006; 166(7): 781 -786. doi: 10. 1001/archinte. 166. 7. 781 Figure Legend: Adjusted hazard ratios for long-term mortality after hospital discharge according to sodium level, clinical evidence of heart failure on admission, and left ventricular systolic function. The percentage of events in each group is given above each bar. LVEF indicates left ventricular ejection fraction. Date of download: 9/8/2012 Copyright © 2012 American Medical Association. All rights reserved.

From: Hyponatremia and Long-term Mortality in Survivors of Acute ST-Elevation Myocardial Infarction Arch Intern Med. 2006; 166(7): 781 -786. doi: 10. 1001/archinte. 166. 7. 781 Figure Legend: Kaplan-Meier plot showing the crude cumulative incidence of death according to sodium level. Date of download: 9/8/2012 Copyright © 2012 American Medical Association. All rights reserved.

Relationship between admission serum sodium level and in-hospital mortality. Restrictive cubic spline transformation plot with 95% confidence intervals is shown. M. Gheorghiade et al, European Heart Journal (2007) 28, 980– 988

Figure 2. Kaplan and Meier estimates of survival (all-cause mortality) in patients stratified by serum sodium. Paul R et al, Am J Respir Crit Care Med. 2008 June 15; 177(12): 1364– 1369

Table 1. Clinical factors and predictors for the long-term clinical outcomes on univariate analysis Korean circulation journal. 2011; 41: 363 -71

Figure 3. Neurohumoral activation in response to arterial underfilling secondary to a decrease in cardiac output. ↓ = decreased; ↑ = increased. (Adapted from Ann Intern Med. 3)

Figure 4. Neurohumoral activation in response to relative arterial underfilling secondary to systemic arterial vasodilation. Cardiac output increases secondary to the diminished cardiac afterload. AVP = arginine vasopressin; RAAS = renin-angiotensin-aldosterone system; SNS = sympathetic nervous system. ↑ = increased. (Adapted from Ann Intern Med. 3)

Figure 5. During arterial underfilling the renal consequences lead to decreased distal sodium and water delivery to the collecting duct with resultant impaired aldosterone escape and resistance to natriuretic peptides. ↓ = decreased; ↑ = increased; GFR = glomerular filtration rate. (Adapted from J Am Coll Cardiol. 23)

Figure 6. Vasopressin V 1 receptor activation. Finley J J et al. Circulation 2008;

Figure 7. Vasopressin V 2 receptor activation. Finley J J et al. Circulation 2008;

Effect of tolvaptan, placebo, and furosemide on urine flow (UVol. R; A), urinary sodium excretion (UNa. V; B), urinary potassium excretion (UKV; C), urine osmolality (U-Osm; D), renal blood flow (RBF; E), and glomerular filtration rate (GFR; F). Costello-Boerrigter L C et al. Am J Physiol Renal Physiol 2006; 290: F 273 -F 278 © 2006 by American Physiological Society

Changes in serum sodium concentration from baseline. Costello-Boerrigter L C et al. Am J

Changes in serum potassium concentration from baseline. Costello-Boerrigter L C et al. Am J

Figure 1. Mean decreases from baseline in body weight, the primary efficacy variable, were observed on day 1 of tolvaptan treatment at all doses and maintained throughout the study (last-observation-carried-forward analysis). Gheorghiade M et al. Circulation 2003; 107: 2690 -2696 Copyright © American Heart Association

Figure 2. Mean changes in serum sodium concentrations over time. Gheorghiade M et al.

Figure 3. Mean absolute changes in serum sodium concentrations over time in patients with hyponatremia (serum Na+ <136 m. Eq/L) at baseline. Gheorghiade M et al. Circulation 2003; 107: 2690 -2696 Copyright © American Heart Association

From: Effects of Tolvaptan, a Vasopressin Antagonist, in Patients Hospitalized With Worsening Heart Failure: A Randomized Controlled Trial JAMA. 2004; 291(16): 1963 -1971. doi: 10. 1001/jama. 291. 16. 1963 Figure Legend: Heart Rate, Blood Pressure, Electrolyte Levels, and Renal Function Date of download: 9/8/2012 Copyright © 2012 American Medical Association. All rights reserved.

From: Effects of Tolvaptan, a Vasopressin Antagonist, in Patients Hospitalized With Worsening Heart Failure: A Randomized Controlled Trial JAMA. 2004; 291(16): 1963 -1971. doi: 10. 1001/jama. 291. 16. 1963 Figure Legend: *Indicates P =. 002; †, P =. 009; ‡, P =. 006; and §, P =. 008 for comparisons with placebo group. Error barsindicate interquartile range. Date of download: 9/8/2012 Copyright © 2012 American Medical Association. All rights reserved.

From: Effects of Tolvaptan, a Vasopressin Antagonist, in Patients Hospitalized With Worsening Heart Failure: A Randomized Controlled Trial JAMA. 2004; 291(16): 1963 -1971. doi: 10. 1001/jama. 291. 16. 1963 Figure Legend: P<. 001 for all comparisons of tolvaptangroups vs placebo, except for 30 mg tolvaptan vs placebo, for which P =. 02 for both day 1 and discharge. Error bars indicate. SEM. Date of download: 9/8/2012 Copyright © 2012 American Medical Association. All rights reserved.

Patient-assessed dyspnoea status at inpatient Day 1 in the combined EVEREST trial population. Pang P S et al. Eur Heart J 2009; eurheartj. ehp 253 Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals. permissions@oxfordjournals. org

Figure 1 Figure Legend: Mortality of patients in EVEREST Study Source: American Heart Journal 2010; 159: 841 -849. e 1 (DOI: 10. 1016/j. ahj. 2010. 023 ) Copyright © 2010 Mosby, Inc. Terms and Conditions

Figure 2 Figure Legend: Hospitalization rates in EVEREST Study Source: American Heart Journal 2010; 159: 841 -849. e 1 (DOI: 10. 1016/j. ahj. 2010. 023 ) Copyright © 2010 Mosby, Inc. Terms and Conditions

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