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Calculated Plasma Volume Status and Prognosis in Chronic Heart Failure
Abstract
Aims: Plasma volume (PV) expansion hallmarks worsening chronic heart failure (CHF) but no non-invasive means of quantifying volume status exists. Because weight and haematocrit are related to PV, they can be used to calculate relative PV status (PVS). We tested the validity and prognostic utility of calculated PVS in CHF patients. Methods and results: First, we evaluated the agreement between calculated actual PV (aPV) and aPV levels measured using 125Iodine-human serum albumin. Second, we derived PVS as: [(calculated aPV – ideal PV)/ideal PV] × 100%. Third, we assessed the prognostic implications of PVS in 5002 patients from the Valsartan in Heart Failure Trial (Val-HeFT), and validated this in another 246 routine CHF outpatients. On analysis, calculated and measured aPV values correlated significantly in 119 normal subjects and 30 CHF patients. In the Val-HeFT cohort, mean (+SD) PVS was –9 ± 8% and related to volume biomarkers such as brain natriuretic peptide (BNP). Over 2 years, 977 (20%) patients died. Plasma volume status was associated with death and first morbid events in a ‘J-shaped’ fashion with the highest risk seen with a PVS > –4%. Stratification into PVS quartiles confirmed that a PVS > –4% was associated with increased mortality (unadjusted hazard ratio 1.65, 95% confidence interval 1.44–1.88, χ2 = 54, P < 0.001) even after adjusting for 22 variables, including brain natriuretic peptide. These results were mirrored in the validation cohort. Conclusions: Relative PVS calculated from simple clinical indices reflects the degree to which patients have deviated from their ideal PV and independently relates to outcomes. The utility of PVS-driven CHF management needs further evaluation.
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The analysis estimated PV using a weight-based formula (the Kaplan-Hakim equation), and according to this formula, the weight loss produced by tirzepatide would be mathematically expected to reduce PV.
“The major limitation of this analysis centers on the fact that we estimated PV using a weight-based formula (the Kaplan–Hakim equation)36, and according to this formula, the weight loss produced by tirzepatide would be mathematically expected to reduce PV.”
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Citations
Cites
A Randomized Trial of the Angiotensin-Receptor Blocker Valsartan in Chronic Heart Failure
Cohn, J. N., & Tognoni, G. (2001) · New England Journal of Medicine · doi:10.1056/nejmoa010713 · Cited by 3,108
Self-citationESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012
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Sorted by citations
Borlaug, B. A., Zile, M. R., Kramer, C. M., Baum, S. J., Hurt, K., Litwin, S. E., Murakami, M., Ou, Y., Upadhyay, N., & Packer, M. (2025) · Nature Medicine · doi:10.1038/s41591-024-03374-z · Cited by 166
Oshima, M., Neuen, B. L., Jardine, M. J., Bakris, G., Edwards, R., Levin, A., Mahaffey, K. W., Neal, B., Pollock, C., Rosenthal, N., et al. (2020) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(20)30300-4 · Cited by 135
Obesity, venous capacitance, and venous compliance in heart failure with preserved ejection fraction
Sorimachi, H., Burkhoff, D., Verbrugge, F. H., Omote, K., Obokata, M., Reddy, Y. N. V., Takahashi, N., Sunagawa, K., & Borlaug, B. A. (2021) · European Journal of Heart Failure · doi:10.1002/ejhf.2254 · Cited by 124
Reddy, Y. N. V., Obokata, M., Testani, J. M., Felker, G. M., Tang, W. H. W., Abou-Ezzeddine, O. F., Sun, J.-L., Chakrabothy, H., McNulty, S., Shah, S. J., et al. (2020) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2019.09.015 · Cited by 51
Metadata
- Authors
- Ling, H. Z., Flint, J., Damgaard, M., Bonfils, P. K., Cheng, A. S., Aggarwal, S., Velmurugan, S., Mendonca, M., Rashid, M., Kang, S., Papalia, F., Weissert, S., Coats, C. J., Thomas, M., Kuskowski, M., Cohn, J. N., Woldman, S., Anand, I. S., & Okonko, D. O.
- Venue
- European Journal of Heart Failure
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-12-03
- Volume
- 17
- Issue
- 1
- Pages
- 35-43
- ISSN
- 1388-9842
- 1879-0844
- Cited by
- 130
- References
- 2
- Language
- en
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