The Effect of Hypomagnesemia on Hospitalization in Preserved Ejection Fraction Heart Failure Patients

Introduction: Hypomagnesemia is an electrolyte anomaly that is frequently seen in heart failure patients as a result of overactivation of the renin-angiotensin-aldosterone system, use of diuretics, and nutritional deficiency and it affects clinical outcomes. Although the long-term effects are well known in large-scale studies in heart failure patients with low ejection fraction, its clinical significance in patients with preserved ejection fraction (HFpEF) remains unclear, because HFpEF has different pathophysiology. HFpEF is accompanied by many metabolic co-morbidities such as body fluid status, chronic lung and kidney problems, apart from the heart. Purpose: Due to the effects of hypomagnesemia on arrhythmia and long-term cardiovascular events, it was planned to evaluate the possible adverse cardiac effects in patients with HFpEF with 1-year hospitalization. Method: A total of 209 patients were included in the study. The diagnosis of HFpEF was made according to the 2021 ESC heart failure guidelines. The history of hospitalization for decompensated heart failure within 1 year after inclusion of the patients was recorded. The low magnesium limit was < 1.7mg/dL and the normal magnesium limit was > 1.7mg/dL. Patients were divided into two groups as those with and without hospitalization history. Clinical, laboratory and demographic data between the groups were compared. Results: Fifty-one patients had hypomagnesemia. Hospitalization was detected in 46 patients. The magnesium level in hospitalized patients was 1.77 ± 0.43 and 1.92 ± 0.31 in those not hospitalized (p = 0.026). The presence of atrial fibrillation (AF), age, hemoglobin, lymphocyte, uric acid, creatinine, albumin, and serum C-reactive protein levels were significantly different between the two groups. In univariate analysis, age (OR: 1.053, 95%CI: 1.021-1.085; p=0.007), hemoglobin level (OR: 0.693, 95%CI: 0.597-0.803; p = < 0.01), serum uric acid level (OR: 1.068), 95%CI: 1.033-1.091; p = 0.004), creatinine level (OR:1.370, 95%CI: 1.002-1.875; p = 0.0047), albumin level (OR:0.929, 95%CI: 0.890-0.970; p = 0.005), magnesium level (OR: 0.942, 95%CI: 0.928-0.970; p = 0.011) and presence ofAF (OR: 1.067, 95%CI: 1.014-1.098; p = 0.002) were found as possible risk factors predicting hospitalization. In the multivariate regression analysis which these factors were evaluated together, age (OR: 1.047, 95%CI: 1.007-1.088; p = 0.020), presence of AF (OR:1.103, 95%CI: 1.057-1.351; p = 0.004), hemoglobin level