Prognostic Value of Calculated Plasma Volume Status in Patients Admitted for Acute Decompensated Heart Failure　― A Prospective Comparative Study With Other Indices of Plasma Volume ―

Abstract

Background: Congestion is one of the main predictors of poor outcome in patients with heart failure (HF); thus, a simple tool to evaluate plasma volume (PV), which can be used for risk stratification of HF patients, is necessary. We sought to compare the prognostic values of commonly used formulas for the estimation of PV and relative PV status (PVS) in patients admitted with acute decompensated HF (ADHF). Methods and Results: We analyzed 384 consecutive ADHF patients who survived to discharge. The PV was calculated by 3 commonly used formulas (Strauss, Kaplan, and Hakim), and the relative PVS was calculated using the Hakim formula at both admission and discharge. The primary endpoint was a composite of all-cause mortality and hospitalization for worsening HF. The secondary endpoints were pump failure death (PFD) and sudden cardiac death (SCD). During a median follow-up of 743 days, 175 patients reached the primary endpoint, 28 patients had PFD, and 20 patients had SCD. Multivariate Cox analysis revealed that among the PV indices, only the PVS values at admission and discharge were independent predictors of the primary endpoint. In addition, the PVS values at admission and discharge were independent predictors of PFD and SCD in the multivariate analysis. Conclusions: Among the indices of PV, the calculated PVS may be the most useful for predicting prognosis in ADHF patients.

Impact of plasma volume status on mortality following left ventricular assist device implantation

“…8 There are several methodologies to estimate PV; subsequently, we used the Hakim formula given prior comparative studies. 6 This accuracy was validated by comparing scintigraphy tests, 7,8 with prognostic implication on heart failure recurrence and mortality also demonstrated in prior published studies. 7,8 PV additionally has been shown to predict clinical risk in several clinical settings other than heart failure, including transcatheter aortic valve replacement and coronary artery bypass grafting registries.…”

“…PV may represent an important index of subclinical congestion not always realized with routine hemodynamic testing 8 . There are several methodologies to estimate PV; subsequently, we used the Hakim formula given prior comparative studies 6 . This accuracy was validated by comparing scintigraphy tests, 7,8 with prognostic implication on heart failure recurrence and mortality also demonstrated in prior published studies 7,8 .…”

“…All patients underwent venous blood sampling and BW and body height measurements within 3 days before LVAD implantation. The estimated PV was calculated with the Hakim formula 6 : estimated PV (L) = [1−Ht (%)] × [a × (b × (lean body mass))], in which a = 1530 for males and 864 for females, and b = 41.0 for males and 47.2 for females. The lean body mass was calculated as follows: 0.33 × BW (kg) + 0.34 × [body height (cm)] −29.5 for males and 0.30 × BW (kg) + 0.42 × [body height (cm)] −43.3 for females 12 .…”

“…congestion, hemodynamics, mechanical circulatory support, plasma volume procedure to noninvasively estimate plasma volume (PV) simply using hematocrit (Ht) and body weight (BW), has been proposed. 6 This specific accuracy was validated using scintigraphy tests, 7,8 and its prognostic implication in heart failure cohorts was demonstrated in several clinical settings. 9,10 Estimated PV using the proposed formula might be a promising tool to risk stratify patients following LVAD implantation.…”

“…Although invasive hemodynamic assessment is the gold standard method to quantify fluid status, limitations in routine use include resource utilization and relative bleeding risk given the necessity for ongoing anticoagulation 5 . Recently, a novel procedure to noninvasively estimate plasma volume (PV) simply using hematocrit (Ht) and body weight (BW), has been proposed 6 . This specific accuracy was validated using scintigraphy tests, 7,8 and its prognostic implication in heart failure cohorts was demonstrated in several clinical settings 9,10 …”