Calculated plasma volume status and prognosis in chronic heart failure

Hua Zen Ling; Julia Flint; Morten Damgaard; Peter K Bonfils; Adrian S Cheng; Suneil Aggarwal; Shanti Velmurugan; Michelle Mendonca; Mohammed Rashid; Swan Kang; Francesco Papalia; Susanne Weissert; Caroline J Coats; Martin Thomas; Michael Kuskowski; Jay N Cohn; Simon Woldman; Inder S Anand; Darlington O Okonko

doi:10.1002/ejhf.193

Calculated plasma volume status and prognosis in chronic heart failure

Hua Zen Ling, Julia Flint, Morten Damgaard, Peter K Bonfils, Adrian S Cheng, Suneil Aggarwal, Shanti Velmurugan, Michelle Mendonca, Mohammed Rashid, Swan Kang, Francesco Papalia, Susanne Weissert, Caroline J Coats, Martin Thomas, Michael Kuskowski, Jay N Cohn, Simon Woldman, Inder S Anand, Darlington O Okonko

Farr Institute of Health Informatics Research

Research output: Contribution to journal › Article › peer-review

112 Citations (Scopus)

Abstract

AIMS: Plasma volume (PV) expansion hallmarks worsening chronic heart failure (CHF) but no non-invasive means of quantifying volume status exists. Because weight and haematocrit are related to PV, they can be used to calculate relative PV status (PVS). We tested the validity and prognostic utility of calculated PVS in CHF patients.

METHODS AND RESULTS: First, we evaluated the agreement between calculated actual PV (aPV) and aPV levels measured using (125)Iodine-human serum albumin. Second, we derived PVS as: [(calculated aPV - ideal PV)/ideal PV] × 100%. Third, we assessed the prognostic implications of PVS in 5002 patients from the Valsartan in Heart Failure Trial (Val-HeFT), and validated this in another 246 routine CHF outpatients. On analysis, calculated and measured aPV values correlated significantly in 119 normal subjects and 30 CHF patients. In the Val-HeFT cohort, mean (+SD) PVS was -9 ± 8% and related to volume biomarkers such as brain natriuretic peptide (BNP). Over 2 years, 977 (20%) patients died. Plasma volume status was associated with death and first morbid events in a 'J-shaped' fashion with the highest risk seen with a PVS > -4%. Stratification into PVS quartiles confirmed that a PVS > -4% was associated with increased mortality (unadjusted hazard ratio 1.65, 95% confidence interval 1.44-1.88, χ(2) = 54, P < 0.001) even after adjusting for 22 variables, including brain natriuretic peptide. These results were mirrored in the validation cohort.

CONCLUSIONS: Relative PVS calculated from simple clinical indices reflects the degree to which patients have deviated from their ideal PV and independently relates to outcomes. The utility of PVS-driven CHF management needs further evaluation.

Original language	English
Pages (from-to)	35-43
Number of pages	9
Journal	EUROPEAN JOURNAL OF HEART FAILURE
Volume	17
Issue number	1
Early online date	3 Dec 2014
DOIs	https://doi.org/10.1002/ejhf.193
Publication status	Published - 16 Jan 2015

Keywords

Aged
Aged, 80 and over
Body Weight
Chronic Disease
Cohort Studies
Female
Heart Failure/diagnosis
Hematocrit
Humans
Male
Middle Aged
Plasma Volume
Prognosis
Radioisotope Dilution Technique
Reproducibility of Results
Serum Albumin, Radio-Iodinated

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1002/ejhf.193

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Ling, H. Z., Flint, J., Damgaard, M., Bonfils, P. K., Cheng, A. S., Aggarwal, S., Velmurugan, S., Mendonca, M., Rashid, M., Kang, S., Papalia, F., Weissert, S., Coats, C. J., Thomas, M., Kuskowski, M., Cohn, J. N., Woldman, S., Anand, I. S., & Okonko, D. O. (2015). Calculated plasma volume status and prognosis in chronic heart failure. EUROPEAN JOURNAL OF HEART FAILURE, 17(1), 35-43. https://doi.org/10.1002/ejhf.193

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title = "Calculated plasma volume status and prognosis in chronic heart failure",

abstract = "AIMS: Plasma volume (PV) expansion hallmarks worsening chronic heart failure (CHF) but no non-invasive means of quantifying volume status exists. Because weight and haematocrit are related to PV, they can be used to calculate relative PV status (PVS). We tested the validity and prognostic utility of calculated PVS in CHF patients.METHODS AND RESULTS: First, we evaluated the agreement between calculated actual PV (aPV) and aPV levels measured using (125)Iodine-human serum albumin. Second, we derived PVS as: [(calculated aPV - ideal PV)/ideal PV] × 100%. Third, we assessed the prognostic implications of PVS in 5002 patients from the Valsartan in Heart Failure Trial (Val-HeFT), and validated this in another 246 routine CHF outpatients. On analysis, calculated and measured aPV values correlated significantly in 119 normal subjects and 30 CHF patients. In the Val-HeFT cohort, mean (+SD) PVS was -9 ± 8% and related to volume biomarkers such as brain natriuretic peptide (BNP). Over 2 years, 977 (20%) patients died. Plasma volume status was associated with death and first morbid events in a 'J-shaped' fashion with the highest risk seen with a PVS > -4%. Stratification into PVS quartiles confirmed that a PVS > -4% was associated with increased mortality (unadjusted hazard ratio 1.65, 95% confidence interval 1.44-1.88, χ(2) = 54, P < 0.001) even after adjusting for 22 variables, including brain natriuretic peptide. These results were mirrored in the validation cohort.CONCLUSIONS: Relative PVS calculated from simple clinical indices reflects the degree to which patients have deviated from their ideal PV and independently relates to outcomes. The utility of PVS-driven CHF management needs further evaluation.",

keywords = "Aged, Aged, 80 and over, Body Weight, Chronic Disease, Cohort Studies, Female, Heart Failure/diagnosis, Hematocrit, Humans, Male, Middle Aged, Plasma Volume, Prognosis, Radioisotope Dilution Technique, Reproducibility of Results, Serum Albumin, Radio-Iodinated",

author = "Ling, {Hua Zen} and Julia Flint and Morten Damgaard and Bonfils, {Peter K} and Cheng, {Adrian S} and Suneil Aggarwal and Shanti Velmurugan and Michelle Mendonca and Mohammed Rashid and Swan Kang and Francesco Papalia and Susanne Weissert and Coats, {Caroline J} and Martin Thomas and Michael Kuskowski and Cohn, {Jay N} and Simon Woldman and Anand, {Inder S} and Okonko, {Darlington O}",

note = "{\textcopyright} 2014 The Authors. European Journal of Heart Failure {\textcopyright} 2014 European Society of Cardiology.",

year = "2015",

month = jan,

day = "16",

doi = "10.1002/ejhf.193",

language = "English",

volume = "17",

pages = "35--43",

journal = "EUROPEAN JOURNAL OF HEART FAILURE",

issn = "1388-9842",

publisher = "John Wiley & Sons, Ltd",

number = "1",

}

Ling, HZ, Flint, J, Damgaard, M, Bonfils, PK, Cheng, AS, Aggarwal, S, Velmurugan, S, Mendonca, M, Rashid, M, Kang, S, Papalia, F, Weissert, S, Coats, CJ, Thomas, M, Kuskowski, M, Cohn, JN, Woldman, S, Anand, IS & Okonko, DO 2015, 'Calculated plasma volume status and prognosis in chronic heart failure', EUROPEAN JOURNAL OF HEART FAILURE, vol. 17, no. 1, pp. 35-43. https://doi.org/10.1002/ejhf.193

TY - JOUR

T1 - Calculated plasma volume status and prognosis in chronic heart failure

AU - Ling, Hua Zen

AU - Flint, Julia

AU - Damgaard, Morten

AU - Bonfils, Peter K

AU - Cheng, Adrian S

AU - Aggarwal, Suneil

AU - Velmurugan, Shanti

AU - Mendonca, Michelle

AU - Rashid, Mohammed

AU - Kang, Swan

AU - Papalia, Francesco

AU - Weissert, Susanne

AU - Coats, Caroline J

AU - Thomas, Martin

AU - Kuskowski, Michael

AU - Cohn, Jay N

AU - Woldman, Simon

AU - Anand, Inder S

AU - Okonko, Darlington O

PY - 2015/1/16

Y1 - 2015/1/16

N2 - AIMS: Plasma volume (PV) expansion hallmarks worsening chronic heart failure (CHF) but no non-invasive means of quantifying volume status exists. Because weight and haematocrit are related to PV, they can be used to calculate relative PV status (PVS). We tested the validity and prognostic utility of calculated PVS in CHF patients.METHODS AND RESULTS: First, we evaluated the agreement between calculated actual PV (aPV) and aPV levels measured using (125)Iodine-human serum albumin. Second, we derived PVS as: [(calculated aPV - ideal PV)/ideal PV] × 100%. Third, we assessed the prognostic implications of PVS in 5002 patients from the Valsartan in Heart Failure Trial (Val-HeFT), and validated this in another 246 routine CHF outpatients. On analysis, calculated and measured aPV values correlated significantly in 119 normal subjects and 30 CHF patients. In the Val-HeFT cohort, mean (+SD) PVS was -9 ± 8% and related to volume biomarkers such as brain natriuretic peptide (BNP). Over 2 years, 977 (20%) patients died. Plasma volume status was associated with death and first morbid events in a 'J-shaped' fashion with the highest risk seen with a PVS > -4%. Stratification into PVS quartiles confirmed that a PVS > -4% was associated with increased mortality (unadjusted hazard ratio 1.65, 95% confidence interval 1.44-1.88, χ(2) = 54, P < 0.001) even after adjusting for 22 variables, including brain natriuretic peptide. These results were mirrored in the validation cohort.CONCLUSIONS: Relative PVS calculated from simple clinical indices reflects the degree to which patients have deviated from their ideal PV and independently relates to outcomes. The utility of PVS-driven CHF management needs further evaluation.

AB - AIMS: Plasma volume (PV) expansion hallmarks worsening chronic heart failure (CHF) but no non-invasive means of quantifying volume status exists. Because weight and haematocrit are related to PV, they can be used to calculate relative PV status (PVS). We tested the validity and prognostic utility of calculated PVS in CHF patients.METHODS AND RESULTS: First, we evaluated the agreement between calculated actual PV (aPV) and aPV levels measured using (125)Iodine-human serum albumin. Second, we derived PVS as: [(calculated aPV - ideal PV)/ideal PV] × 100%. Third, we assessed the prognostic implications of PVS in 5002 patients from the Valsartan in Heart Failure Trial (Val-HeFT), and validated this in another 246 routine CHF outpatients. On analysis, calculated and measured aPV values correlated significantly in 119 normal subjects and 30 CHF patients. In the Val-HeFT cohort, mean (+SD) PVS was -9 ± 8% and related to volume biomarkers such as brain natriuretic peptide (BNP). Over 2 years, 977 (20%) patients died. Plasma volume status was associated with death and first morbid events in a 'J-shaped' fashion with the highest risk seen with a PVS > -4%. Stratification into PVS quartiles confirmed that a PVS > -4% was associated with increased mortality (unadjusted hazard ratio 1.65, 95% confidence interval 1.44-1.88, χ(2) = 54, P < 0.001) even after adjusting for 22 variables, including brain natriuretic peptide. These results were mirrored in the validation cohort.CONCLUSIONS: Relative PVS calculated from simple clinical indices reflects the degree to which patients have deviated from their ideal PV and independently relates to outcomes. The utility of PVS-driven CHF management needs further evaluation.

KW - Aged

KW - Aged, 80 and over

KW - Body Weight

KW - Chronic Disease

KW - Cohort Studies

KW - Female

KW - Heart Failure/diagnosis

KW - Hematocrit

KW - Humans

KW - Male

KW - Middle Aged

KW - Plasma Volume

KW - Prognosis

KW - Radioisotope Dilution Technique

KW - Reproducibility of Results

KW - Serum Albumin, Radio-Iodinated

U2 - 10.1002/ejhf.193

DO - 10.1002/ejhf.193

M3 - Article

C2 - 25469484

SN - 1388-9842

VL - 17

SP - 35

EP - 43

JO - EUROPEAN JOURNAL OF HEART FAILURE

JF - EUROPEAN JOURNAL OF HEART FAILURE

IS - 1

ER -

Calculated plasma volume status and prognosis in chronic heart failure

Abstract

Keywords

UN SDGs

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