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Prognostic impact of potassium levels in patients with ventricular tachyarrhythmias

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Abstract

Background

The study sought to assess the prognostic impact of potassium levels (K) in patients with ventricular tachyarrhythmias.

Methods

A large retrospective registry was used including all consecutive patients presenting with ventricular tachyarrhythmias on admission from 2002 to 2016. Patients with hypokalemia (i.e., K < 3.3 mmol/L), normokalemia (i.e., K 3.3–4.5 mmol/L), and hyperkalemia (i.e., K > 4.5 mmol/L) were compared applying multi-variable Cox regression models and propensity-score matching for evaluation of the primary endpoint of all-cause mortality at 3 years. Secondary endpoints were early cardiac death at 24 h, in-hospital death, death at 30 days, as well as the composite endpoint of early cardiac death at 24 h, recurrences of ventricular tachyarrhythmias, and appropriate ICD therapies at 3 years.

Results

In 1990 consecutive patients with ventricular tachyarrhythmias, 63% of the patients presented with normokalemia, 30% with hyperkalemia, and 7% with hypokalemia. After propensity matching, both hypokalemic (HR = 1.545; 95% CI 0.970–2.459; p = 0.067) and hyperkalemic patients (HR = 1.371; 95% CI 1.094–1.718; p = 0.006) were associated with the primary endpoint of all-cause mortality at 3 years compared to normokalemic patients. Hyperkalemia was associated with even worse prognosis directly compared to hypokalemia (HR = 1.496; 95% CI 1.002–2.233; p = 0.049). In contrast, potassium measurements were not associated with the composite endpoint at 3 years.

Conclusion

In patients presenting with ventricular tachyarrhythmias, normokalemia was associated with best short- and long-term survival, whereas hyperkalemia and hypokalemia were associated with increased mortality at 30 days and at 3 years.

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Acknowlegments

We greatly acknowledge  Mr. Dominik Dannehl for his help in  designing the graphical abstract.

Author information

Authors and Affiliations

  1. Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany

    Tobias Schupp, Max von Zworowsky, Seung-Hyun Kim, Kathrin Weidner, Jonas Rusnak, Christian Barth, Linda Reiser, Gabriel Taton, Thomas Reichelt, Dominik Ellguth, Niko Engelke, Armin Bollow, Martin Borggrefe, Ibrahim Akin & Michael Behnes

  2. Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, General Hospital Nuremberg, Paracelsus Medical University, Nuremberg, Germany

    Thomas Bertsch

  3. Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany

    Muharrem Akin

  4. Department of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany

    Kambis Mashayekhi

  5. Department of Cardiology, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany

    Dirk Große Meininghaus

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  1. Tobias Schupp
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Correspondence to Ibrahim Akin.

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Schupp, T., Bertsch, T., von Zworowsky, M. et al. Prognostic impact of potassium levels in patients with ventricular tachyarrhythmias. Clin Res Cardiol 109, 1292–1306 (2020). https://doi.org/10.1007/s00392-020-01624-x

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  • DOI: https://doi.org/10.1007/s00392-020-01624-x

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