Miller Wayne L, Fudim Marat, Kittipibul Veraprapas, Yaranov Dmitry M, Carry Brendan J, Silver Marc A
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Duke University Medical Center, Durham, North Carolina, USA.
ESC Heart Fail. 2025 Feb;12(1):142-149. doi: 10.1002/ehf2.15070. Epub 2024 Sep 12.
Quantitative methods have shown clinically significant heterogeneity in blood volume (BV) profiles across heart failure (HF) phenotypes. These profiles extend from hypovolaemia to normal BV and to variable degrees of BV hypervolaemia, frequently with similar clinical presentations. However, a comprehensive survey of BV profiles providing practical clinical guidance for the interpretation and management of quantitative plasma volume (PV) and red blood cell (RBC) mass findings has not been reported. The intent of this study is to advance this concept through a multicentre analysis.
A retrospective analysis of clinical and BV data was undertaken in stable NYHA class II-III HF patients (N = 546). BV was quantitated using established nuclear medicine indicator-dilution methodology. Differing combinations of PV and RBC mass were identified contributing to marked heterogeneity in overall BV profiles. A quantitatively normal BV was identified in 32% of the cohort but of these only ~1/3 demonstrated a true normal BV (i.e., normal PV + normal RBC mass). The remaining portion of normal BV profiles reflected balanced combinations of compensatory PV expansion with RBC mass deficit (anaemia) (14% of cohort) and PV contraction with RBC mass excess (erythrocythemia) (6% of cohort). Main contributors to BV hypervolaemia were PV excess with a normal RBC mass (21% of cohort; 23% female) and PV excess with erythrocythemia (24% of cohort; 26% female). Hypovolaemia was predominately defined by RBC mass deficit with a normal PV (6% of cohort; 57% female) or RBC mass deficit with PV contraction (5% of cohort; 48% female).
Findings support the clinical relevance of identifying and accurately interpreting the varying combinations of PV and RBC mass in patients with chronic HF. This in turn helps guide appropriate individualized patient management strategies. A practical volume-based guideline is provided in an effort to aid clinician interpretation.
定量方法已显示，心力衰竭（HF）各表型的血容量（BV）分布存在临床上显著的异质性。这些分布范围从血容量不足到正常BV，再到不同程度的BV高血容量，且临床表现常常相似。然而，尚未有关于BV分布的全面调查可为定量血浆容量（PV）和红细胞（RBC）量的结果解释及管理提供实用的临床指导。本研究的目的是通过多中心分析推进这一概念。
对纽约心脏协会（NYHA）II-III级稳定HF患者（N = 546）的临床和BV数据进行回顾性分析。使用既定的核医学指示剂稀释法对BV进行定量。确定了PV和RBC量的不同组合导致总体BV分布存在显著异质性。在32%的队列中确定了定量正常的BV，但其中只有约1/3表现出真正的正常BV（即正常PV + 正常RBC量）。正常BV分布的其余部分反映了代偿性PV扩张与RBC量不足（贫血）的平衡组合（占队列的14%）以及PV收缩与RBC量过多（红细胞增多症）的平衡组合（占队列的6%）。BV高血容量的主要原因是RBC量正常时PV过多（占队列的21%；女性占23%）和红细胞增多症时PV过多（占队列的24%；女性占26%）。血容量不足主要由PV正常时RBC量不足（占队列的6%；女性占57%）或PV收缩时RBC量不足（占队列的5%；女性占48%）定义。
研究结果支持识别并准确解释慢性HF患者PV和RBC量的不同组合的临床相关性。这反过来有助于指导适当的个体化患者管理策略。提供了一个基于容量的实用指南，以帮助临床医生进行解释。
