Comparison of Blood Volume Characteristics in Anemic Patients With Low Versus Preserved Left Ventricular Ejection Fractions

Abstract

Anemia is a significant co-morbidity in patients with heart failure (HF) irrespective of EF (EF) and is routinely quantified by hemoglobin concentration. Hemodilution as a cause of anemia has been described in systolic HF. This study aims to further investigate the effects of plasma volume in HF patients by 1) assessing prevalence of dilutional anemia in patients with anemia and a preserved EF and 2) exploring the relation between hemoglobin and red cell volume in these patients. Forty-six anemic patients (as determined by standard hemoglobin measurement): 22 with HF and low EFs (HFLEF) and 24 with HF and a preserved EFs (HFPEF) all underwent plasma volume measurement with I-131 labeled albumin. Hemoglobin values did not differ between subjects with HFLEF and HFPEF (10.8±1.0 vs. 11.0±1.0 gm/dl, p=0.55) but a red cell deficit was found in 88% of patients with HFPEF as compared with 59% of HFLEF (p=0.04). This was the result of a higher prevalence of an expansion of plasma volume in HFLEF patients (100%) as compared with HFPEF patients (71%). Among all patients, no correlation was found between hemoglobin and red cell volume (r = 0.09, p=0.54), but a correlation did exist among patients with normal blood volumes (r=0.55, p = 0.02). In conclusion, dilutional anemia resulting from an expansion in plasma volume without a red cell deficit occurs more commonly in HFLEF than HFPEF patients and hemoglobin does not correlated with red cell volume in anemic HF patients.

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

“…Its prevalence is similar to that of CKD, diabetes, and COPD 229, 230, 231. Anemia is mostly prevalent in elderly women with advanced HFpEF, CKD, and diabetes 232, 233, 234.…”

Effect of Estimated Plasma Volume Reduction on Renal Function for Acute Heart Failure Differs Between Patients With Preserved and Reduced Ejection Fraction

“…Abramov et al 9 reported that patients with heart failure with preserved ejection fraction (HFpEF) had a lower total blood volume (ie, the intravascular volume) than those with heart failure with reduced ejection fraction (HFrEF). Similarly, Schwartzenberg et al 10 reported a greater stroke volume reduction in HFpEF than in HFrEF after vasodilation treatment, indicating the presence of occult intravascular hypovolemia in HFpEF.…”

“…Second, we estimated the intravascular volume using the ideal body weight method. 28 Although this method was validated in both healthy volunteers and in patients with heart failure, 9 changes in the ratio of intravascular volume to body weight, which are likely to occur during AHF treatment, may modify the results. Therefore, in future studies, PV needs to be evaluated more precisely using scintigraphy or bioimpedance analysis.…”

“…13 In addition, we multiplied 1.31 to the estimated PV from the ideal body weight method in HFrEF and by 1.10 in HFpEF, according to a previous report that validated the ideal body weight method with radiolabeled albumin in both HFpEF and HFrEF. 9,14,15 Patients in the top tertile of the estimated PVR rate were classified as the PVR+ group. 8 Patients with HFpEF were defined as patients with AHF with left ventricular ejection fraction of ≥40% at admission.…”

Fluid Volume Overload and Congestion in Heart Failure

“…However, a primary pathophysiologic derangement of HF is the expansion of the PV and, therefore, it becomes difficult to accurately differentiate true anemia from dilution-related anemia or even the presence of excess RBCM (polycythemia) based on peripheral hemoglobin or hematocrit measurements alone. [22][23][24] Although the importance of a low hemoglobin and its causes in chronic HF should not be underestimated in terms of outcome implications, 25 the concept of pseudoanemia secondary to PV excess and even with RBCM polycythemia has been underrecognized. As a result, in the clinical setting of volume overload chronic HF, the complex of true anemia, pseudoanemia, and RBCM polycythemia with PV expansion and the relation to peripheral venous hemoglobin values has gone, with a few exceptions, 12,26 largely unreported and with it the implications for volume management.…”