Author + information
- Petra Nijst,
- Pieter Martens,
- Frederik Verbrugge,
- Matthias Dupont,
- Wai Hong Tang and
- Wilfried Mullens
Background: Volume overload and increased cardiac filling pressures are hallmark features of heart failure. This study investigates the relationship between intravascular volume and cardiac filling pressures in heart failure with reduced ejection fraction (HFREF), in which the transition from euvolemia to intravascular volume overload is mimicked.
Methods: 40 HFREF patients (LVEF 36±10%) (10 subjects with a pulmonary artery catheter) underwent intravascular volume expansion with 1 liter hydroxyl-ethyl-starch with coinciding intravascular volume measurement (99Technetium-labeled red blood cells).
Results: Intravascular blood volume increased from 5.0±1.0 L to 5.7±1.0 L (p<0.0001). No change in clinical status, NT-proBNP levels (670[225;1383] ng/L vs 615[217;521] ng/L; p=0.86) or echocardiographic indices of cardiac filling pressures was noticed, with only a limited increase in invasively measured right atrial pressure (4±2 mmHg to 7±3 mmHg; p=0.04) and pulmonary arterial wedge pressure (PAWP) (10±3 mmHg to 14±4 mmHg; p=0.04) The increase in PAWP is similar to healthy subjects (* adopted from Fujimoto et al. Circulation 2013) (Figure 1A). The accuracy of cardiac filling pressure (-estimates) to predict intravascular volume expansion was low (all AUC <0.65) (Figure 1B).
Conclusions: Euvolemic HFREF patients can handle intravascular volume expansion with 1 liter. The diagnostic accuracy of cardiac filling pressure (-estimates) as a surrogate for intravascular volume expansion is poor.
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: 1123-279
- 2017 American College of Cardiology Foundation