Author + information
- Francesco Papalia,
- Klio Konstantinou,
- Karl Norrington,
- Hua Zen Ling and
- Darlington Okonko
Background: Plasma volume (PV) expansion is difficult to quantify in chronic heart failure (CHF) with numerous equations proposed for its estimation. We tested the prognostic utility of the Strauss formula in unselected patients and performed a direct comparison of PV equations.
Methods: In 303 CHF outpatients (age 68±12yr, 39% NYHA class > 2, LVEF 28±8%), we analysed the relation between mortality and change in PV as assessed by the Strauss (ΔPV) formula (([(Hb baseline /Hb end) × ((100- Hct end) / (100- Hct baseline))]-1) × 100%), ΔHb, ΔHct, and calculated PV status (PVS; (([1-Hct end] × [a + (b × weight end)] – [c × weight end]) / [c × weight end] × 100%; a, b, c = gender-specific constants).
Results: Median ΔPV/month was 0.25% with 58% of patients exhibiting PV expansion. Over 11±7 months, 57 (19%) patients died. Higher ΔPV/month predicted increased mortality in a graded fashion (Fig A), independently of (adjusted HR 1.07, 1.03 – 1.10, P<0.0001) and incremental to (Δ χ2 16, P<0.001) age, β-blocker use, Δdiastolic BP, and ΔNYHA. A cut-off of 0.36 %/month (HR 3.64, P<0.01) was optimal. ΔHb, ΔHct, and PVS were also prognostic (all P<0.05) with optimal cut-offs of −0.005 g/dL/month (HR 0.33), −0.1 %/month (HR 0.3) and −3.4% (HR 4.70). Calculated PVS (AUC 0.8) was prognostically superior to ΔPV (AUC 0.66, P=0.04), ΔHb (AUC 0.60, P<0.01), and ΔHct (AUC 0.61, P<0.01).
Conclusions: Estimates of PV expansion are prognostic in CHF but calculated PVS provides the highest discriminative power and could be used to guide decongestion.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Making Progress in Understanding Heart Failure
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1123-275
- 2017 American College of Cardiology Foundation