Targeting Sodium in Heart Failure.

A dominant event determining the course of heart failure (HF) includes the disruption of the delicate sodium (Na+ ) and water balance leading to (Na+ ) and water retention and edema formation. Although incomplete decongestion adversely affects outcomes, it is unknown whether interventions directly targeting (Na+ ), such as strict dietary (Na+ ) restriction, intravenous hypertonic saline, and diuretics, reverse this effect. As a result, it is imperative to implement (Na+ )-targeting interventions in selected HF patients with established congestion on top of quadruple therapy with angiotensin receptor neprilysin inhibitor, β-adrenergic receptor blocker, mineralocorticoid receptor antagonist, and sodium glucose cotransporter 2 inhibitor, which dramatically improves outcomes. The limited effectiveness of (Na+ )-targeting treatments may be partly due to the fact that the current metrics of HF severity have a limited capacity of foreseeing and averting episodes of congestion and guiding (Na+ )-targeting treatments, which often leads to dysnatremias, adversely affecting outcomes. Recent evidence suggests that spot urinary sodium measurements may be used as a guide to monitor (Na+ )-targeting interventions both in chronic and acute HF. Further, the classical (2)-compartment model of (Na+ ) storage has been displaced by the (3)-compartment model emphasizing the non-osmotic accumulation of (Na+ ), chiefly in the skin. 23(Na+ ) magnetic resonance imaging (MRI) enables the accurate and reliable quantification of tissue (Na+ ). Another promising approach enabling tissue (Na+ ) monitoring is based on wearable devices employing ion-selective electrodes for electrolyte detection, including (Na+ ) and (Cl- ). Undoubtably, further studies using 23(Na+ )-MRI technology and wearable sensors are required to learn more about the clinical significance of tissue (Na+ ) storage and (Na+ )-related mechanisms of morbidity and mortality in HF.