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Splenic size as an indicator of hemodynamics and prognosis in patients with heart failure

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Abstract

The spleen is an important immune organ that releases erythrocytes and monocytes and destroys aged platelets. It also reserves 20–30% of the total blood volume, and its size decreases in hypovolemic shock. However, the clinical significance of splenic size in patients with heart failure (HF) remains unclear. We retrospectively analyzed the data of 206 patients with clinically stable HF gathered between January 2001 and August 2020 and recorded in a single-center registry. All patients underwent right heart catheterization and computed tomography (CT). Splenic size was measured using CT volumetry. The primary outcomes were composite cardiac events occurring for the first time during follow-up, namely, cardiac death and hospitalization for worsening HF. The median splenic volume and splenic volume index (SVI) were 118.0 mL and 68.9 mL/m2, respectively. SVI was positively correlated with cardiac output (r = 0.269, P < 0.001) and stroke volume (r = 0.228, P = 0.002), and negatively correlated with systemic vascular resistance (r =  − 0.302, P < 0.001). Seventy cardiac events occurred, and the optimal receiver operating characteristic curve SVI cutoff value for predicting cardiac events was 68.9 mL/m2. The median blood adrenaline concentration was higher in the low-SVI group than the high-SVI group (0.039 ng/mL vs. 0.026 ng/mL, respectively; P = 0.004), and the low-SVI group experienced more cardiac events (log-rank test, P < 0.001). Multivariate Cox proportional hazards regression revealed that a low SVI was an independent predictor of cardiac events, even when adjusted for the validated HF risk score, blood–brain natriuretic peptide concentration, blood catecholamine concentrations, and hemodynamic parameters. Splenic size reflects hemodynamics, including systemic circulating blood volume status and sympathetic nerve activity, and is associated with HF prognosis.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

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Funding

This research was supported in part by Grant-in-Aid for Scientific Research of the Japan Society for the Promotion of Science (JSPS KAKENHI [grant numbers JP21K16085 to H.H. and JP19K17592 to T.O.]).

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Authors and Affiliations

  1. Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466–8550, Japan

    Hiroaki Hiraiwa, Takahiro Okumura, Takashi Araki, Takashi Mizutani, Shingo Kazama, Yuki Kimura, Naoki Shibata, Hideo Oishi, Tasuku Kuwayama, Toru Kondo, Kenji Furusawa, Ryota Morimoto & Toyoaki Murohara

  2. Department of Cardiology, Ichinomiya Municipal Hospital, 2-2-22 Bunkyo, Ichinomiya, 491-8558, Japan

    Akinori Sawamura

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  1. Hiroaki Hiraiwa
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Correspondence to Hiroaki Hiraiwa or Takahiro Okumura.

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Conflict of interest

TO received research grants from Ono Pharmaceutical Co. Ltd., Bayer Pharmaceutical Co. Ltd., Daiichi-Sankyo Pharma Inc., and Amgen Astellas BioPharma KK outside of the submitted work. TO received honorariums from Ono Pharmaceutical Co. Ltd., Otsuka Pharmaceutical Co. Ltd., Novartis Pharma KK, and Medtronic Japan Co. Ltd. TM received lecture fees from Bayer Pharmaceutical Co. Ltd., Daiichi-Sankyo Co. Ltd., Sumitomo Dainippon Pharma Co. Ltd., Kowa Co. Ltd., MSD KK, Mitsubishi Tanabe Pharma Co., Nippon Boehringer Ingelheim Co. Ltd., Novartis Pharma KK, Pfizer Japan Inc., Sanofi-Aventis KK, and Takeda Pharmaceutical Co. Ltd. TM received an unrestricted research grant for the Department of Cardiology, Nagoya University Graduate School of Medicine from Astellas Pharma Inc., Daiichi-Sankyo Co. Ltd., Sumitomo Dainippon Pharma Co. Ltd., Kowa Co. Ltd., MSD KK, Mitsubishi Tanabe Pharma Co., Nippon Boehringer Ingelheim Co. Ltd., Novartis Pharma KK, Otsuka Pharma Ltd., Pfizer Japan Inc., Sanofi-Aventis KK, Takeda Pharmaceutical Co. Ltd., and Teijin Pharma Ltd. The remaining authors have no conflicts of interest relevant to this article to disclose.

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The study protocol complied with the Declaration of Helsinki, and the protocol was approved by the ethics review board of our institution.

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Hiraiwa, H., Okumura, T., Sawamura, A. et al. Splenic size as an indicator of hemodynamics and prognosis in patients with heart failure. Heart Vessels 37, 1344–1355 (2022). https://doi.org/10.1007/s00380-022-02030-1

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