Fudim Marat, Kittipibul Veraprapas, Molinger Jeroen, Yaranov Dmitry M, Miller Wayne L
Department of Medicine, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC.
Department of Medicine, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC.
J Card Fail. 2025 Feb;31(2):379-387. doi: 10.1016/j.cardfail.2024.05.013. Epub 2024 Jun 14.
Quantitative methods have shown clinically significant heterogeneity in blood volume (BV) profiles in patients with chronic heart failure (HF). How patients' sex might impact this volume heterogeneity and its relationship to cardiac hemodynamics remains to be defined.
Retrospective analysis of clinical and quantitative BV, plasma volume (PV) and red blood cell (RBC) mass data was undertaken across 3 medical centers. BV was quantitated using nuclear medicine I-131-labeled plasma albumin indicator-dilution methodology with cardiac hemodynamics obtained within 24 hours.
In an analysis of 149 males and 106 females, absolute BV was greater, on average, in males (6.9 ± 1.7 vs 5.0 ± 1.2 liters; P < 0.001); however, a wide range in BVs was demonstrated in both sexes (2.9-14.5 liters). Male sex was associated with higher prevalence of large (+ 25% of normal) BV and PV expansions (36% vs 15% and 51% vs 21%, respectively; both P < 0.001). In contrast, female sex was associated with higher prevalence of normal total BV (44% vs 27%; P = 0.005), PV (54% vs 27%; P < 0.001), hypovolemia (23% vs 11%; P = 0.005), and true anemia (42% vs 26%; P < 0.001). Cardiac hemodynamics differed by sex, but only modest associations were demonstrated between volume profiles and cardiac filling pressures.
Findings support unique intravascular volume profiles reflecting sex-specific differences in the prevalence and distributions of total BV, PV and RBC mass profiles in patients with chronic HF. This underscores the importance of recognizing patients' sex as a significant factor influencing volume homeostasis, which needs to be taken into account to individualize volume-management strategies effectively.
定量方法已显示慢性心力衰竭（HF）患者的血容量（BV）分布存在临床上显著的异质性。患者性别如何影响这种容量异质性及其与心脏血流动力学的关系仍有待确定。
对3个医疗中心的临床及定量BV、血浆容量（PV）和红细胞（RBC）质量数据进行回顾性分析。使用核医学I-131标记的血浆白蛋白指示剂稀释法对BV进行定量，并在24小时内获取心脏血流动力学数据。
在对149名男性和106名女性的分析中，男性的绝对BV平均更大（6.9±1.7升对5.0±1.2升；P<0.001）；然而，两性的BV范围都很广（2.9 - 14.5升）。男性与较大（+25%正常）BV和PV扩张的较高患病率相关（分别为36%对15%和51%对21%；均P<0.001）。相比之下，女性与正常总BV（44%对27%；P = 0.005）、PV（54%对27%；P<0.001）、血容量不足（23%对11%；P = 0.005）和真性贫血（42%对26%；P<0.001）的较高患病率相关。心脏血流动力学因性别而异，但容量分布与心脏充盈压之间仅显示出适度的关联。
研究结果支持独特的血管内容量分布，反映了慢性HF患者总BV、PV和RBC质量分布的患病率和分布存在性别差异。这强调了认识到患者性别是影响容量稳态的重要因素的重要性，为有效制定个体化容量管理策略，需要考虑这一因素。
