The effect of increased plasma potassium on myocardial function; a randomized POTCAST substudy.
Ulrik WinsløwTharsika SakthivelChaoqun ZhengBerit PhilbertMichael VintherEmil FrandsenKasper IversenHenning BundgaardChristian JønsNiels RisumPublished in: The international journal of cardiovascular imaging (2023)
Plasma potassium (p-K) in the high-normal range has been suggested to reduce risk of cardiovascular arrythmias and mortality through electrophysiological and mechanical effects on the myocardium. In this study, it was to investigated if increasing p-K to high-normal levels improves systolic- and diastolic myocardial function in patients with low-normal to moderately reduced left ventricular ejection fraction (LVEF). The study included 50 patients (mean age 58 years (SD 14), 81% men), with a mean p-K 3.95 mmol/l (SD 0.19), mean LVEF 48% (SD 7), and mean Global Longitudinal Strain (GLS) -14.6% (SD 3.1) patients with LVEF 35-55% from "Targeted potassium levels to decrease arrhythmia burden in high-risk patients with cardiovascular diseases trial" (POTCAST). Patients were given standard therapy and randomized (1:1) to an intervention that included guidance on potassium-rich diets, potassium supplements, and mineralocorticoid receptor antagonists targeting high-normal p-K levels (4.5-5.0 mmol/l). Echocardiography was done at baseline and after a mean follow-up of 44 days (SD 18) and the echocardiograms were analyzed for changes in GLS, mechanical dispersion, E/A, e', and E/e'. At follow-up, mean difference in changes in p-K was 0.52 mmol/l (95%CI 0.35;0.69), P<0.001 in the intervention group compared to controls. GLS was improved with a mean difference in changes of -1.0% (-2;-0.02), P<0.05 and e' and E/e' were improved with a mean difference in changes of 0.9 cm/s (0.02;1.7), P = 0.04 and ? 1.5 (-2.9;-0.14), P = 0.03, respectively. Thus, induced increase in p-K to the high-normal range improved indices of systolic and diastolic function in patients with low-normal to moderately reduced LVEF.
Keyphrases
- left ventricular
- ejection fraction
- aortic stenosis
- end stage renal disease
- heart failure
- blood pressure
- newly diagnosed
- randomized controlled trial
- hypertrophic cardiomyopathy
- mitral valve
- cardiovascular disease
- chronic kidney disease
- acute myocardial infarction
- cardiac resynchronization therapy
- clinical trial
- peritoneal dialysis
- stem cells
- prognostic factors
- high glucose
- oxidative stress
- atrial fibrillation
- drug delivery
- risk factors
- metabolic syndrome
- acute coronary syndrome
- weight loss
- cardiovascular risk factors
- mesenchymal stem cells
- double blind
- endothelial cells
- pulmonary hypertension
- coronary artery disease
- aortic valve