Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Division of Diagnostic Radiology/Nuclear Medicine, Mayo Clinic, Rochester, Minnesota.
JACC Heart Fail. 2016 Jun;4(6):453-9. doi: 10.1016/j.jchf.2016.01.005. Epub 2016 Mar 9.
This study aimed to characterize volume profiles and their differences in heart failure (HF) patients with preserved (HFpEF) and reduced (HFrEF) ventricular systolic function.
The extent and distribution of volume overload and the associated implications for volume management have not been studied in decompensated HFpEF compared with HFrEF.
Total blood volume (TBV) was quantitated using a standardized computer-based radiolabeled albumin dilution technique.
Twenty HFpEF and 35 HFrEF patients were evaluated at hospital admission. TBV was expanded by 27 ± 21% (range -5.2% to 77%; p = 0.002) and 37 ± 25% (0% to 107%; p < 0.001), respectively, above normal volumes. Red cell mass (RBCM) was expanded in HFrEF (24 ± 31%; p = 0.004) but within normal limits in HFpEF (8 ± 34%; p = 0.660) with, however, large variability in both groups. RBCM excess was more prominent in HFrEF (63% vs. 45%) than the RBCM deficit in HFpEF (35% vs.14%). With diuresis, TBV decreased to 25 ± 20% (p = 0.029) in HFrEF but was not changed in HFpEF (18 ± 20% [p = 0.173]). Body weight declined 6.6 ± 4.4 kg in HFrEF and 10.5 ± 8.3 kg (p = 0.026) in HFpEF. Interstitial fluid losses accounted for 85 ± 13% (HFrEF) and 93 ± 6% (HFpEF) (p = 0.012) of total volume removed.
TBV profiles differ between HFpEF and HFrEF patients with DCHF. Quantitated volume analysis revealed both significant RBCM (polycythemia) and plasma volume excess in HFrEF, whereas a higher RBCM deficit (true anemia) was demonstrated in HFpEF. Diuresis produced only a modest reduction in intravascular volumes with persistent hypervolemia in both groups at discharge, but overall more total body fluid was lost in HFpEF. These profile differences have implications for individualizing volume management.
本研究旨在描述并比较射血分数保留心衰（HFpEF）和射血分数降低心衰（HFrEF）患者的心衰容积特点。
与 HFrEF 相比，HFpEF 患者失代偿时的心衰容积过载的程度和分布及其对容量管理的影响尚未得到研究。
采用基于计算机的放射性标记白蛋白稀释技术定量总血容量（TBV）。
20 例 HFpEF 和 35 例 HFrEF 患者在入院时接受了评估。TBV 分别扩张了 27±21%（范围-5.2%至 77%；p=0.002）和 37±25%（0%至 107%；p<0.001），分别高于正常容量。HFrEF 中红细胞质量（RBCM）扩张（24±31%；p=0.004），但 HFpEF 中 RBCM 仍在正常范围内（8±34%；p=0.660），但两组的变化都很大。HFrEF 中 RBCM 过多（63%）比 HFpEF 中 RBCM 过少（35%）更为明显。利尿剂治疗后，HFrEF 中 TBV 下降至 25±20%（p=0.029），而 HFpEF 中 TBV 无变化（18±20%[p=0.173]）。HFrEF 体重减轻 6.6±4.4kg，HFpEF 体重减轻 10.5±8.3kg（p=0.026）。间质液丢失占总去除容量的 85±13%（HFrEF）和 93±6%（HFpEF）（p=0.012）。
DCHF 的 HFpEF 和 HFrEF 患者的 TBV 特征不同。定量容积分析显示，HFrEF 中 RBCM（红细胞增多症）和血浆容积过多，而 HFpEF 中 RBCM 不足（真性贫血）更为明显。利尿剂治疗仅使血管内容积适度减少，两组出院时仍持续存在高血容量，但 HFpEF 中总体更多的全身液体丢失。这些特征差异对个体化容量管理具有重要意义。
