Targeting high-normal plasma potassium levels (4.5-5.0 mmol/l) improved Global Longitudinal Strain by a mean difference of -1.0% compared to standard care in patients with reduced LVEF.
RCT (n=50)
Open-label
1:1
Yes
Does targeting high-normal plasma potassium levels (4.5-5.0 mmol/l) improve systolic and diastolic myocardial function in patients with low-normal to moderately reduced LVEF?
Increasing plasma potassium to high-normal levels (4.5-5.0 mmol/l) improves echocardiographic indices of systolic and diastolic function in patients with moderately reduced LVEF.
Effect estimate: Mean difference -1.0% (95% CI -2.0;-0.02)
Absolute Event Rate: -1.1% vs -0.068%
p-value: p=<0.05
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.
Winsløw et al. (Thu,) conducted a rct in Low-normal to moderately reduced left ventricular ejection fraction (n=50). Potassium-rich diet guidance, oral potassium supplements, and mineralocorticoid receptor antagonists vs. Standard medical treatment was evaluated on Change in Global Longitudinal Strain (GLS) (Mean difference -1.0%, 95% CI -2.0;-0.02, p=<0.05). Targeting high-normal plasma potassium levels (4.5-5.0 mmol/l) improved Global Longitudinal Strain by a mean difference of -1.0% compared to standard care in patients with reduced LVEF.