Plasma Volume Status and Its Association With In-Hospital and Postdischarge Outcomes in Decompensated Heart Failure |
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| Authors: | Marat Fudim Joseph B. Lerman Courtney Page Brooke Alhanti Robert M. Califf Justin A. Ezekowitz Nicolas Girerd Justin L. Grodin Wayne L. Miller Ambarish Pandey Patrick Rossignol Randall C. Starling W.H. Wilson Tang Faiez Zannad Adrian F. Hernandez Christopher M. O'connor Robert J. Mentz |
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| Affiliation: | 1. Duke Clinical Research Institute, Durham, North Carolina;2. Division of Cardiology, Duke University Medical Center, Durham, North Carolina;3. Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada;4. Université de Lorraine, Centre d''Investigation Clinique Plurithématique 1433, INSERM U1116, CHRU de Nancy, FCRIN INI-CRCT, Nancy, France;5. Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas;6. Division of Cardiology, Mayo Clinic, Rochester, Minnesota;7. Division of Cardiology, Cleveland Clinic, Cleveland, Ohio;8. Inova Heart and Vascular Institute, Falls Church, Virginia;1. Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan;2. Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio;1. New England Heart and Vascular Institute, Catholic Medical Center, Manchester, New Hampshire;2. Boston Scientific, Minneapolis, Minnesota;1. McGaw Medical Center of Northwestern University Feinberg School of Medicine, Department of Medicine, Chicago, Illinois;2. Center for Translational Metabolism and Health, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois;3. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois;4. Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota;5. Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts;6. Division of Nephrology, Department of Medicine, Duke University, Durham, North Carolina;7. Division of Nephrology and Hypertension, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois;8. Division of Nephrology, Department of Medicine, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois;1. Duke Clinical Research Institute and Division of Cardiology, Duke University School of Medicine, Durham, North Carolina;2. Department of Surgery, Duke University School of Medicine, Durham, North Carolina;3. Division of Cardiology, Brigham and Women''s Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts;4. Department of Surgery, Washington University School of Medicine, St Louis, Missouri;5. Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York;6. Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia |
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| Abstract: | BackgroundPrior analyses suggest an association between formula-based plasma volume (PV) estimates and outcomes in heart failure (HF). We assessed the association between estimated PV status by the Duarte-ePV and Kaplan Hakim (KH-ePVS) formulas, and in-hospital and postdischarge clinical outcomes, in the ASCEND-HF trial.Methods and ResultsThe KH-ePVS and Duarte-ePV were calculated on admission. We assessed associations with in-hospital worsening HF, 30-day composite cardiovascular mortality or HF rehospitalization and 180-day all-cause mortality. There were 6373 (89.2%), and 6354 (89.0%) patients who had necessary characteristics to calculate KH-ePVS and Duarte-ePV, respectively. There was no association between PV by either formula with in-hospital worsening HF. KH-ePVS showed a weak correlation with N-terminal prohormone BNP, and with measures of decongestion such as body weight change and urine output (r < 0.3 for all). Duarte-ePV was trending toward an association with worse 30-day (adjusted odds ratio 1.07, 95% confidence interval [CI] 1.00–1.15, P = .058), but not 180-day outcomes (adjusted hazard ratio 1.03, 95% CI 0.97–1.09, P = .289). A continuous KH-ePVS of >0 (per 10-unit increase) was associated with improved 30-day outcomes (adjusted odds ratio 0.75, 95% CI 0.62–0.91, P = .004). The continuous KH-ePVS was not associated with 180-day outcomes (adjusted hazard ratio 1.05, 95% CI 0.98–1.12, P = .139).ConclusionsBaseline PV estimates had a weak association with in-hospital measures of decongestion. The Duarte-ePV trended toward an association with early clinical outcomes in decompensated HF, and may improve risk stratification in HF. |
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