Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.
Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
J Card Fail. 2019 Apr;25(4):240-248. doi: 10.1016/j.cardfail.2018.11.019. Epub 2018 Dec 5.
Progressive plasma volume (PV) expansion is a hallmark of chronic heart failure (HF), ultimately contributing to decompensated heart failure. Monitoring PV might offer prognostic information and might be a target for tailored therapy.
The correlation between technetium-99 (Tc)-labeled red blood cell measured PV and calculated PV was first determined in a validation cohort. The relationship between PV status (PVS; a marker how much actual PV deviated from the ideal PV) and outcome was analyzed with the use of Cox proportional modeling in a prospective chronic HF (CHF) population (the outcome cohort). Thirty-one HF patients were included in the validation cohort. Calculated PV correlated well with Tc-measured PV (r = 0.714; P = .001). A total of 1173 patients (HF with reduced ejection fraction [HFrEF]: n = 872; HF with mid-range EF [HFmrEF]: n = 229; HF with preserved EF [HFpEF]: n = 72) were prospectively included in the outcome cohort. The mean PVS in the outcome cohort was -6.7% ± 10%, indicating slight PV contraction. Higher PVS was independently associated with increased risk for HF hospitalization and all-cause mortality (hazard ratio 1.016; 95% confidence interval 1.006-1.027 per 1% increase in PVS; P = .002). Receiver operating characteristic curve analysis indicated that a PVS of -6.5% optimally predicted absence of adverse outcome. Hazard ratio analysis indicated that CHF patients were less equipped in tolerating PV expansion in comparison to PV contraction. The use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and mineralocorticoid receptor antagonists were independently associated with a higher odds of having an optimal PVS in HFrEF and HFmrEF (all P < .05), but not in HFpEF.
Calculated PV correlates well with measured PV in HF patients. An increase in PV is independently associated with a higher risk of adverse outcome, and a slight contraction of the predicted PV seems to be related to less adverse events. Higher dosages of renin-angiotensin-aldosterone blockers are associated with higher odds of having an optimal PV status.
进行性血浆容量（PV）扩张是慢性心力衰竭（HF）的标志，最终导致心力衰竭失代偿。监测 PV 可能提供预后信息，并可能成为靶向治疗的目标。
首先在验证队列中确定了锝-99（Tc）标记红细胞测量的 PV 与计算的 PV 之间的相关性。使用 Cox 比例模型分析前瞻性慢性 HF（CHF）人群（结局队列）中 PV 状态（PVS；实际 PV 偏离理想 PV 的程度的标志物）与结局的关系。验证队列纳入 31 例 HF 患者。计算的 PV 与 Tc 测量的 PV 相关性良好（r=0.714；P=0.001）。共有 1173 例患者（射血分数降低的 HF [HFrEF]：n=872；射血分数中间范围的 HF [HFmrEF]：n=229；射血分数保留的 HF [HFpEF]：n=72）前瞻性纳入结局队列。结局队列中的平均 PVS 为-6.7%±10%，表明 PV 略有收缩。较高的 PVS 与 HF 住院和全因死亡率的风险增加独立相关（风险比 1.016；每增加 1% PVS，95%置信区间为 1.006-1.027；P=0.002）。受试者工作特征曲线分析表明，PVS 为-6.5%时可最佳预测不良结局缺失。风险比分析表明，与 PV 扩张相比，CHF 患者在耐受 PV 收缩方面的能力较低。HFpEF 患者中，HFmrEF 和 HFrEF 患者使用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂和盐皮质激素受体拮抗剂与更优的 PVS 相关（均 P<0.05），但在 HFpEF 患者中则不然。
HF 患者的计算 PV 与测量的 PV 相关性良好。PV 的增加与不良结局的风险增加独立相关，而预测 PV 的轻微收缩似乎与不良事件减少有关。更高剂量的肾素-血管紧张素-醛固酮抑制剂与更优的 PV 状态相关。
