TY - JOUR
T1 - Plasma Volume Status and Its Association With In-Hospital and Postdischarge Outcomes in Decompensated Heart Failure
AU - Fudim, Marat
AU - Lerman, Joseph B.
AU - Page, Courtney
AU - Alhanti, Brooke
AU - Califf, Robert M.
AU - Ezekowitz, Justin A.
AU - Girerd, Nicolas
AU - Grodin, Justin L.
AU - Miller, Wayne L.
AU - Pandey, Ambarish
AU - Rossignol, Patrick
AU - Starling, Randall C.
AU - Tang, W. H.Wilson
AU - Zannad, Faiez
AU - Hernandez, Adrian F.
AU - O'connor, Christopher M.
AU - Mentz, Robert J.
N1 - Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2021/3
Y1 - 2021/3
N2 - Background: Prior analyses suggest an association between formula-based plasma volume (PV) estimates and outcomes in heart failure (HF). We assessed the association between estimated PV status by the Duarte-ePV and Kaplan Hakim (KH-ePVS) formulas, and in-hospital and postdischarge clinical outcomes, in the ASCEND-HF trial. Methods and Results: The KH-ePVS and Duarte-ePV were calculated on admission. We assessed associations with in-hospital worsening HF, 30-day composite cardiovascular mortality or HF rehospitalization and 180-day all-cause mortality. There were 6373 (89.2%), and 6354 (89.0%) patients who had necessary characteristics to calculate KH-ePVS and Duarte-ePV, respectively. There was no association between PV by either formula with in-hospital worsening HF. KH-ePVS showed a weak correlation with N-terminal prohormone BNP, and with measures of decongestion such as body weight change and urine output (r < 0.3 for all). Duarte-ePV was trending toward an association with worse 30-day (adjusted odds ratio 1.07, 95% confidence interval [CI] 1.00–1.15, P = .058), but not 180-day outcomes (adjusted hazard ratio 1.03, 95% CI 0.97–1.09, P =. 289). A continuous KH-ePVS of >0 (per 10-unit increase) was associated with improved 30-day outcomes (adjusted odds ratio 0.75, 95% CI 0.62–0.91, P = .004). The continuous KH-ePVS was not associated with 180-day outcomes (adjusted hazard ratio 1.05, 95% CI 0.98–1.12, P =. 139). Conclusions: Baseline PV estimates had a weak association with in-hospital measures of decongestion. The Duarte-ePV trended toward an association with early clinical outcomes in decompensated HF, and may improve risk stratification in HF.
AB - Background: Prior analyses suggest an association between formula-based plasma volume (PV) estimates and outcomes in heart failure (HF). We assessed the association between estimated PV status by the Duarte-ePV and Kaplan Hakim (KH-ePVS) formulas, and in-hospital and postdischarge clinical outcomes, in the ASCEND-HF trial. Methods and Results: The KH-ePVS and Duarte-ePV were calculated on admission. We assessed associations with in-hospital worsening HF, 30-day composite cardiovascular mortality or HF rehospitalization and 180-day all-cause mortality. There were 6373 (89.2%), and 6354 (89.0%) patients who had necessary characteristics to calculate KH-ePVS and Duarte-ePV, respectively. There was no association between PV by either formula with in-hospital worsening HF. KH-ePVS showed a weak correlation with N-terminal prohormone BNP, and with measures of decongestion such as body weight change and urine output (r < 0.3 for all). Duarte-ePV was trending toward an association with worse 30-day (adjusted odds ratio 1.07, 95% confidence interval [CI] 1.00–1.15, P = .058), but not 180-day outcomes (adjusted hazard ratio 1.03, 95% CI 0.97–1.09, P =. 289). A continuous KH-ePVS of >0 (per 10-unit increase) was associated with improved 30-day outcomes (adjusted odds ratio 0.75, 95% CI 0.62–0.91, P = .004). The continuous KH-ePVS was not associated with 180-day outcomes (adjusted hazard ratio 1.05, 95% CI 0.98–1.12, P =. 139). Conclusions: Baseline PV estimates had a weak association with in-hospital measures of decongestion. The Duarte-ePV trended toward an association with early clinical outcomes in decompensated HF, and may improve risk stratification in HF.
KW - Heart failure
KW - congestion
KW - plasma volume
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U2 - 10.1016/j.cardfail.2020.09.478
DO - 10.1016/j.cardfail.2020.09.478
M3 - Article
C2 - 33038532
AN - SCOPUS:85095588075
SN - 1071-9164
VL - 27
SP - 297
EP - 308
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 3
ER -