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Prognostic value of estimated plasma volume in acute heart failure in three cohort studies

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Abstract

Aims

Estimated plasma volume status (ePVS) predicts prognosis in patients with heart failure (HF). It remains unclear whether admission, discharge or change ePVS best predicts post-discharge outcome in patients with acute decompensated heart failure (ADHF).

Methods

We retrospectively analyzed three cohort studies: 383 patients admitted at the Tokyo Medical University hospital, 165 patients admitted at the Centro Hospitalar do Porto and 164 patients admitted at the Nancy University Hospital (ICALOR study). ePVS at admission and at discharge as well as its change thereof were, respectively, calculated using the Duarte and Strauss formulas, both derived from hemoglobin and hematocrit ratios. Clinical variables including physical assessment, biological and echocardiographic parameters were recorded. The clinical outcome was a composite of re-hospitalization for worsening HF or all-cause mortality.

Results

The primary outcomes occurred in 27.2% at 1 year (in the Tokyo cohort), 45.3% at 6 months (in the Porto cohort) and 53.9% at median terms of 298.3 days (in the ICALOR study). After adjusting for potential confounders including natriuretic peptide, discharge ePVS remained significantly associated with increased rates of composite outcome in the Tokyo and Porto cohorts and ICALOR study [hazard ratio (HR) 1.21 (1.01–1.44), p = 0.04; HR 1.45 (1.16–1.81), p < 0.01; HR 1.45 (1.16–1.81), p < 0.01, respectively]. In addition, a pooled analysis yielded a significant improvement in reclassification with discharge ePVS [net reclassification index 13.6% (5.9–22.7), p = 0.004].

Conclusions

As validated in three independent ADHF cohorts, ePVS at discharge was independently associated with post-discharge clinical outcomes and improved the risk stratification of patients admitted for ADHF on top of well-established prognostic markers.

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Acknowledgements

We thank all the patients who participated in this study.

Author information

Authors and Affiliations

  1. INSERM, Centre d’Investigations Cliniques 1433, Centre d’Investigation Clinique Pierre Drouin, CHRU de Nancy, Inserm 1116 and INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Institut lorrain du coeur et des, vaisseaux Louis Mathieu, Université de Lorraine, 4, rue du Morvan, 54500, Nancy, Vandoeuvre-Les-Nancy, France

    Masatake Kobayashi, Patrick Rossignol, João Pedro Ferreira, Kevin Duarte, Faiez Zannad & Nicolas Girerd

  2. Department of Cardiology, Tokyo Medical University, Tokyo, Japan

    Masatake Kobayashi, Yuki Paku, Yoichi Iwasaki & Masataka Watanabe

  3. Département de Cardiologie, CHRU de Nancy, Nancy, France

    Patrick Rossignol, Faiez Zannad & Nicolas Girerd

  4. Cardiovascular Research and Development Unit, Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal

    João Pedro Ferreira & Irene Aragão

  5. Duke University Medical Center, Durham, NC, USA

    Marat Fudim

  6. Duke Clinical Research Institute, Durham, NC, USA

    Marat Fudim

Authors
  1. Masatake Kobayashi
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Corresponding author

Correspondence to Nicolas Girerd.

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Conflict of interest

PR, JF, FZ and NG are supported by a public grant overseen by the French National Research Agency (ANR) as part of the second “Investissements d’Avenir” program FIGHT-HF (reference: ANR-15-RHU-0004). F.Z. has received consulting fees from Actelion, Amgen, AstraZeneca, Bayer, Boehringer, Boston Science, CEVA, CVRx, Vifor-Fresenius, GE Healthcare, J&J, KBP BioSciences, Livanova, Novartis, NovoNordisk, Pfizer, Quantum Genomics, Relypsa, Resmed, Roche, Takeda and ZS pharma. P.R. has received fees from Honoraria, research grants and/or travel grants from AstraZeneca, Bayer, BG Medicine, BMS, CVRx, Daichii-Sankyo, Fresenius, Gambro, HAC-Pharma, Novartis, Relypsa, Roche, Sanofi, Servier, Stealth Peptides, CTMA and Vifor Fresenius Medical Care Renal Pharma. N.G. has received Board and consulting Fees (Honoraria) for Novartis and consulting fees (Honoraria) for Servier. M.F. received a grant from the American Heart Association and consulting fees from Coridea, Axon Therapies, Galvani and GE Healthcare. M.W. has received consulting fees from Medtronic and Philips, and Y.I. has received consulting fees from Medtronic. All other authors have no conflict of interest to declare.

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The original version of this article was revised: Modifications have been made to the Abstract. Full information regarding the corrections made can be found in the correction for this article.

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Kobayashi, M., Rossignol, P., Ferreira, J.P. et al. Prognostic value of estimated plasma volume in acute heart failure in three cohort studies. Clin Res Cardiol 108, 549–561 (2019). https://doi.org/10.1007/s00392-018-1385-1

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  • DOI: https://doi.org/10.1007/s00392-018-1385-1

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