INSERM, Centre d'Investigations Cliniques 1433, CHRU de Nancy, Inserm 1116 and INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Université de Lorraine, 4, rue du Morvan, 54500, Vandoeuvre-Les-Nancy, France.
Service de Cardiologie Et Maladies Vasculaires Et CIC-IT 1414, CHU Rennes, 35000, Rennes, France.
Clin Res Cardiol. 2020 Aug;109(8):1060-1069. doi: 10.1007/s00392-020-01599-9. Epub 2020 Jan 31.
Estimated plasma volume status (ePVS) has diagnostic and prognostic value in patients with heart failure (HF). However, it remains unclear which congestion markers (i.e., biological, imaging, and hemodynamic markers) are preferentially associated with ePVS. In addition, there is evidence of sex differences in both the hematopoietic process and myocardial structure/function.
Patients with significant dyspnea (NYHA ≥ 2) underwent echocardiography and lung ultrasound within 4 h prior to cardiac catheterization. Patients were divided according to tertiles based on sex-specific ePVS thresholds calculated from hemoglobin and hematocrit measurements using Duarte's formula. Among the 78 included patients (median age 74.5 years; males 69.2%; HF 48.7%), median ePVS was 4.1 (percentile = 3.7-4.9) mL/g in males (N = 54) and 4.8 (4.4-5.3) mL/g in females (N = 24). Patients with the highest ePVS had more frequently HF, higher NT-proBNP, larger left atrial volume, and higher E/e' (all p values < 0.05), but no difference in inferior vena cava diameter or pulmonary congestion assessed by lung ultrasound (all p values > 0.10). In multivariable analysis, higher E/e' and lower diastolic blood pressure were significantly associated with increased ePVS. The association between ePVS and congestion variables was not sex-dependent except for left-ventricular end-diastolic pressure, which was only correlated with ePVS in females (Spearman Rho = 0.53, p < 0.01 in females and Spearman Rho = - 0.04, p = 0.76 in males; p = 0.08).
ePVS is associated with E/e' regardless of sex, while only associated with invasively measured left-ventricular end-diastolic pressure in females. These results suggest that ePVS is preferably associated with left-sided hemodynamic markers of congestion.
估计的血浆容量状态（ePVS）在心衰（HF）患者中有诊断和预后价值。然而，目前尚不清楚哪些充血标志物（即生物学、影像学和血流动力学标志物）与 ePVS 有优先关联。此外，造血过程和心肌结构/功能在性别上都存在差异。
有明显呼吸困难（NYHA≥2）的患者在心脏导管插入术前 4 小时内进行了超声心动图和肺部超声检查。根据 Duarte 公式根据血红蛋白和血细胞比容测量值计算的性别特异性 ePVS 阈值，将患者分为三分位组。在 78 名纳入患者中（中位年龄 74.5 岁；男性 69.2%；HF 48.7%），男性（N=54）的中位 ePVS 为 4.1（百分位=3.7-4.9）mL/g，女性（N=24）的中位 ePVS 为 4.8（4.4-5.3）mL/g。ePVS 最高的患者更常患有 HF、更高的 NT-proBNP、更大的左心房容积和更高的 E/e'（所有 p 值均<0.05），但下腔静脉直径或肺部充血超声评估无差异（所有 p 值均>0.10）。多变量分析显示，更高的 E/e'和更低的舒张压与 ePVS 增加显著相关。除左心室舒张末期压力外，ePVS 与充血变量的相关性不受性别影响，而左心室舒张末期压力仅与女性的 ePVS 相关（Spearman Rho=0.53，p<0.01 在女性中，Spearman Rho=-0.04，p=0.76 在男性中；p=0.08）。
ePVS 与 E/e'相关，而与性别无关，而仅与女性的有创性测量的左心室舒张末期压力相关。这些结果表明，ePVS 与充血的左侧血液动力学标志物有更好的关联。
