Tamaki Shunsuke, Yamada Takahisa, Morita Takashi, Furukawa Yoshio, Iwasaki Yusuke, Kawasaki Masato, Kikuchi Atsushi, Kawai Tsutomu, Seo Masahiro, Abe Makoto, Nakamura Jun, Yamamoto Kyoko, Kayama Kiyomi, Kawahira Masatsugu, Tanabe Kazuya, Ueda Kunpei, Kimura Takanari, Sakamoto Daisuke, Fukunami Masatake
Division of Cardiology, Osaka General Medical Center Osaka Japan.
Circ Rep. 2019 Aug 24;1(9):361-371. doi: 10.1253/circrep.CR-19-0039.
Congestion is one of the main predictors of poor outcome in patients with heart failure (HF); thus, a simple tool to evaluate plasma volume (PV), which can be used for risk stratification of HF patients, is necessary. We sought to compare the prognostic values of commonly used formulas for the estimation of PV and relative PV status (PVS) in patients admitted with acute decompensated HF (ADHF). We analyzed 384 consecutive ADHF patients who survived to discharge. The PV was calculated by 3 commonly used formulas (Strauss, Kaplan, and Hakim), and the relative PVS was calculated using the Hakim formula at both admission and discharge. The primary endpoint was a composite of all-cause mortality and hospitalization for worsening HF. The secondary endpoints were pump failure death (PFD) and sudden cardiac death (SCD). During a median follow-up of 743 days, 175 patients reached the primary endpoint, 28 patients had PFD, and 20 patients had SCD. Multivariate Cox analysis revealed that among the PV indices, only the PVS values at admission and discharge were independent predictors of the primary endpoint. In addition, the PVS values at admission and discharge were independent predictors of PFD and SCD in the multivariate analysis. Among the indices of PV, the calculated PVS may be the most useful for predicting prognosis in ADHF patients.
充血是心力衰竭（HF）患者预后不良的主要预测因素之一；因此，需要一种简单的工具来评估血浆容量（PV），可用于HF患者的风险分层。我们试图比较常用公式估算急性失代偿性HF（ADHF）患者PV及相对PV状态（PVS）的预后价值。我们分析了384例存活至出院的连续性ADHF患者。PV通过3种常用公式（施特劳斯、卡普兰和哈基姆公式）计算，相对PVS在入院和出院时均使用哈基姆公式计算。主要终点是全因死亡率和因HF恶化住院的复合终点。次要终点是泵衰竭死亡（PFD）和心源性猝死（SCD）。在中位随访743天期间，175例患者达到主要终点，28例患者发生PFD，20例患者发生SCD。多变量Cox分析显示，在PV指标中，只有入院和出院时的PVS值是主要终点的独立预测因素。此外，在多变量分析中，入院和出院时的PVS值是PFD和SCD的独立预测因素。在PV指标中，计算得出的PVS可能对预测ADHF患者的预后最有用。
