Department of Internal Medicine, Nishida Hospital, Tsuruoka-Nishi-Machi 2-266, Saiki, Oita, 876-0047, Japan.
ESC Heart Fail. 2022 Jun;9(3):2044-2048. doi: 10.1002/ehf2.13927. Epub 2022 Apr 6.
Two types of heart failure (HF) progression were recently proposed on the basis of an increased vs. non-increased serum chloride concentration. The applicability of this concept to real-world HF pathophysiology requires further investigation. The present study evaluated the mechanisms of HF progression to a different type according to changes in the estimated plasma volume status (ePVS).
Data from 47 patients (32% men; 78.2 ± 9.7 years of age) with stable to worsening HF (37.5 ± 16 days) were analysed. Physical examination, standard blood tests, and b-type natriuretic peptide (BNP) measurements were conducted. The ePVS was calculated as follows: ePVS (dL/g) = [100 - haematocrit (%)]/[haemoglobin (g/dL)]. For the study subjects as a whole (n = 47), changes in the ePVS correlated positively with changes in the serum chloride concentration from stable to worsening HF (r = 0.398, P = 0.0056). When divided into two groups of worsening HF with an increased (n = 31) vs. non-increased serum chloride concentration (n = 16), no significant baseline differences in body weight, serum logBNP, or ePVS were detected between groups. Under worsening HF, the increase in body weight (2.34 ± 1.12 vs. 2.59 ± 1.56 kg, P = 0.57) and logBNP (0.39 ± 0.30 vs. 0.54 ± 0.31 pg/mL, P = 0.13) did not differ between groups, but the increase in the ePVS was smaller in the group with a non-increased serum chloride concentration compared with that with an increased serum chloride concentration (0.292 ± 0.49 vs. 0.653 ± 0.60 dL/g, P = 0.044). An increase in the %change in ePVS ≥ 10% was less common in patients with a non-increased chloride concentration (37% vs. 71%, P = 0.03). Patients with a non-increased serum chloride concentration had more HF signs (3.31 ± 0.79 vs. 2.65 ± 0.71, P = 0.005) and a higher incidence of pulmonary rales (63% vs. 16%, P = 0.0024) than those with an increased serum chloride concentration.
According to the changes in the ePVS, HF progression may result from a difference between two HF types (i.e. increased vs. non-increased serum chloride concentration) in the cardiac reserve in response to a given cardiac burden by modulating plasma volume status via the possible tonicity potential of chloride.
最近基于血清氯浓度增加与不增加提出了两种心力衰竭（HF）进展类型。这一概念在真实世界 HF 病理生理学中的适用性需要进一步研究。本研究根据估计的血浆容量状态（ePVS）变化评估了不同类型 HF 进展的机制。
分析了 47 例（32%为男性；78.2±9.7 岁）稳定至恶化 HF（37.5±16 天）患者的数据。进行了体格检查、标准血液检查和 B 型利钠肽（BNP）测量。ePVS 计算如下：ePVS（dL/g）=[100-红细胞压积（%）]/[血红蛋白（g/dL）]。对于作为一个整体的研究对象（n=47），从稳定到恶化 HF 时 ePVS 的变化与血清氯浓度的变化呈正相关（r=0.398，P=0.0056）。当分为血清氯浓度增加（n=31）与不增加（n=16）两组恶化 HF 时，两组间体重、血清 logBNP 或 ePVS 无显著基线差异。在恶化 HF 下，体重增加（2.34±1.12 与 2.59±1.56kg，P=0.57）和 logBNP（0.39±0.30 与 0.54±0.31pg/mL，P=0.13）无组间差异，但 ePVS 的增加在血清氯浓度不增加组中小于血清氯浓度增加组（0.292±0.49 与 0.653±0.60dL/g，P=0.044）。血清氯浓度不增加的患者中，ePVS 增加≥10%的比例较少（37%比 71%，P=0.03）。血清氯浓度不增加的患者 HF 体征更多（3.31±0.79 与 2.65±0.71，P=0.005），肺部啰音发生率更高（63%比 16%，P=0.0024）。
根据 ePVS 的变化，HF 进展可能源于两种 HF 类型（即血清氯浓度增加与不增加）的差异，这是由于心脏储备对给定的心脏负荷的反应不同，通过氯离子的可能渗透压来调节血浆容量状态。
