Long-term Prognostic Value of Estimated Plasma Volume in Heart Failure with Preserved Ejection Fraction

Abstract

Plasma volume, estimated by several indirect methods, has been viewed as a biological surrogate for intravascular fluid status. The clinical implication of estimated plasma volume status (ePVS) for long term outcomes in heart failure with preserved ejection fraction (HFpEF) remains unclear. We investigate the prognostic value of ePVS calculated by Strauss formula and its association with cardiovascular events and mortality in a prospective HFpEF cohort. There were 449 individuals met the inclusion criteria of our cohort. Estimated plasma volume variation (ΔePVS) and its instantaneous derivatives were calculated by the Strauss formula. Our study endpoints were events of heart failure hospitalization and mortality. Kaplan–Meier estimates and Cox regression analysis were applied to determine the power of ΔePVS and baseline ePVS in predicting long term cardiovascular outcomes. Both baseline ePVS and ΔePVS were independent predictors of heart failure hospitalization and mortality. Kaplan-Meier estimates of these outcomes stratified by optimal cut-off value showed that HFpEF individuals with higher baseline ePVS and ΔePVS were associated with elevated risk of composite endpoint of heart failure hospitalization and mortality. This study demonstrated the prognostic value of a novel biological surrogate, instantaneous derivatives ePVS, in predicting long term cardiovascular outcomes in HFpEF population. Monitoring instantaneous plasma volume may assist in identifying patients at high risk for future cardiovascular events. Further prospective studies validating the role of ePVS in predicting long-term prognosis in patients with HFpEF are warranted.

Prognostic impact of plasma volume estimated from hemoglobin and hematocrit in heart failure with preserved ejection fraction

“…In the present analysis, median Duarte-derived ePVS was 4.9±1.0 ml/g, which is in line with previous reports 10,12,19 . Our results furthermore showed that Duarte-derived ePVS was associated with the primary outcome.…”

“…In the present study, the highest quartile of PV estimated from Duarte's formula (≥5.5ml/g) appeared to drive a higher risk of study outcomes regardless of renal function. This threshold for the prognostic value of ePVS (≥5.5ml/g) is in keeping with recent data regarding ePVS in patients with acute or chronic HF 12,13,19 . Further studies are needed to determine whether this threshold may help optimize decongestion therapy and the monitoring of ambulatory patients.…”

“…HR=1.06 (0.98 -1.16) p=0.17 for the primary endpoint). In a previous report assessing the association between Duarte-derived ePVS and the composite of HF hospitalization or all-cause mortality in 449 patients with HFpEF 19 , after a median follow-up of 10.7 years, the best-cut off point, ePVS>5.5ml/g, was found to associated with poor outcomes (21.6% of patients died and 24.7% had HF hospitalization) 19 . However, the analyses were not adjusted for natriuretic peptide, which could result in residual confounding.…”

“…PV may be estimated from the Duarte formula (based on hemoglobin and hematocrit) or from the Hakim formula (based on hematocrit and dry body weight), both of which have been reported to be associated with clinical outcomes in patients with acute HF and HF with reduced ejection fraction (HFrEF) [10][11][12][13][14][15][16] . However, despite published data on the different fluid distributions between HFrEF and preserved ejection fraction (HFpEF) 17,18 , whether estimated plasma volume status (ePVS) contributes to poor clinical outcome in patients with HFpEF has not been sufficiently investigated 19,20 . Recent data showed that the Duarte formula rather than Hakim formula was associated with left-sided hemodynamic marker of congestion 21 .…”

Prognostic value of estimated plasma volume status in patients with sepsis

“…Recently, Duarte et al proposed to use a simple formula based on hemoglobin and hematocrit to estimate the plasma volume in patients with heart failure [7]. Previous studies have reported that high estimated plasma volume status (ePVS) was related to poor prognosis of these patients [8,9]. Furthermore, studies have previously shown that ePVS value at emergency department admission correlated with the risk of death in patients with fever or dyspnea [10,11].…”