Subclinical Volume Overload Across the Spectrum of Heart Failure: Lessons From Total Blood Volume Measurements

Carry, Brendan; Katz, Stuart D.

doi:10.1016/j.cardfail.2018.04.007

Cited by 3 publications

(4 citation statements)

References 19 publications

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“…Research studies using radioactive iodinated serum albumin (RISA) and chromium 51 erythrocyte (RBC) labeling have been used to measure PV and RBC volumes, respectively. These studies have identified many areas where measurement of PV and BV would be clinically useful including congestive HF [21, 23-26], sepsis [27], and surgical patients [28]. Research radioisotope measurements, using the indicator dilution technique have traditionally been considered the gold standard for BV and PV assessment [22, 29-32], but they are cumbersome and expensive, especially at the bedside.…”

Section: Discussionmentioning

confidence: 99%

“…A measured hematocrit, taken prior to dosing on the same day of VFI dosing, was used to calculate BV by the following formula: BV = total PV/(1 – hematocrit) [22]. Nadler’s estimated BV was converted to PV by subtracting the volume occupied by the cells from the BV determination [21]. …”

Section: Methodsmentioning

confidence: 99%

“…12-lead electrocardiograms were obtained. The estimated GFR (eGFR) was calculated using the CKD-EPI formula [21]. …”

Section: Methodsmentioning

confidence: 99%

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A Novel Fluorescent Clinical Method to Rapidly Quantify Plasma Volume

Molitoris¹,

George²,

Murray³

et al. 2019

Cardiorenal Med

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Objectives: To determine the performance of a rapid fluorescent indicator technique for measuring plasma volume (PV). Methods: This was an open-label, observational evaluation of a two-component intravenous visible fluorescent dye technique to rapidly measure PV in 16 healthy subjects and 16 subjects with chronic kidney disease (8 stage 3 and 8 stage 4 CKD), at 2 clinical research sites. The method consisted of a single intravenous injection of 12 mg of a large 150-kDa carboxy-methyl dextran conjugated to a fluorescent rhodamine-derived dye as the PV marker (PVM), and 35 mg of a small 5-kDa carboxy-methyl dextran conjugated to fluorescein, the renal clearance marker. Dye concentrations were quantified 15 min after the injections for initial PV measurements using the indicator-dilution principle. Additional samples were taken over 8 h to evaluate the stability of the PVM as a determinant of PV. Blood volumes (BV) were calculated based on PV and the subject’s hematocrit. Pharmacokinetic parameters were calculated from the plasma concentration data taken over several days using noncompartmental methods (Phoenix WinNonlin®). Linear correlation and Bland-Altman plots were used to compare visible fluorescent injectate-measured PV compared to Nadler’s formula for estimating PV. Finally, 8 healthy subjects received 350 mL infusion of a 5% albumin solution in normal saline over 30 min and a repeat PV determination was then carried out. Results: PV and BV varied according to weight and body surface area, with PV ranging from 2,115 to 6,234 mL and 28.6 to 41.9 mL/kg when weight adjusted. Both parameters were stable for > 6 h with repeated plasma measurements of the PVM. There was no difference between healthy subjects and CKD subjects. Overall, there was general agreement with Nadler’s estimation formula for the mean PV in subjects. A 24-h repeat dose measurement in 8 healthy subjects showed PV variability of 98 ± 121 mL (mean = 3.8%). Additionally, following an intravenous bolus of 350 mL of a 5% albumin solution in normal saline in 8 healthy subjects, the mean (SD) measured increase in PV was 356 (±50.0) mL post-infusion. There were no serious adverse events reported during the study. Conclusions: This minimally invasive fluorescent dye approach safely allowed for rapid, accurate, and reproducible determination of PV, BV, and dynamic monitoring of changes following fluid administration.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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A Novel Fluorescent Clinical Method to Rapidly Quantify Plasma Volume

Molitoris¹,

George²,

Murray³

et al. 2019

Cardiorenal Med

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“…In chronic heart failure (CHF), the composition of blood volume (BV) continues to be of interest to fully understand pathophysiological adaptations [ 1 , 2 ]. Quantitative measurement of total BV was considered essential to identify the heterogeneity of BV regulation [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Blood volume and hemoglobin mass in long-term heart transplant recipients with and without Anemia

Seiler

Ahlgrim

Birkner

et al. 2021

J Cardiothorac Surg

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Background In systolic chronic heart failure, a heterogeneous blood volume (BV) regulation can be found with plasma volume expansion in many cases, possibly leading to pseudoanemia. Little is known about the volume status after heart transplantation (HTX). So far, anemia of HTX recipients was solely investigated using hemoglobin-concentration that may be misleading in a clinical context. The objective of the study was whether a difference in plasma volume and red cell volume can be observed in clinically stable heart transplant recipients compared to matched control subjects. Secondary, the aim was to describe anemia in the long-term after HTX based on quantitative data. Methods Blood volume and its constituents red cell volume and plasma volume were quantified using an abbreviated carbon monoxide rebreathing method (aCORM) with focus on its primary measure total hemoglobin mass (Hbmass) and coincidental anemia in 36 (7 women) heart transplant recipients. For comparison, a matched control group of 46 (5 women) healthy subjects was selected. Results Neither Hbmass nor blood volumes were significantly different in HTX patients compared to matched healthy control group subjects. The prevalence of anemia 6.3 ± 4.3 years after transplantation was 19%. Hbmass and red cell volume were significantly lower in anemic HTX patients compared to non-anemic patients while plasma volume was not expanded. Various immunosuppressant regimens did not have an effect on Hbmass, plasma volume or red cell volume. Conclusions There was no difference in blood volumes and Hbmass between HTX patients and control subjects. The pathophysiologic blood volume regulation in chronic heart failure does not seem to be longer active in long-term HTX recipients. However, in the long-term after HTX, anemia occurs in a considerable number of patients as true anemia without a clear association with immunosuppression. Trial registration German registry for clinical studies, DRKS00006078. Registered 09 May 2014, https://www.drks.de/drks_web/navigate.do?navigationId=trial. HTML&TRIAL_ID=DRKS00006078.

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