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 A Kuskowski, Jay N Cohn, Simon Woldman, Inder Anand, Darlington O. Okonko

Research output: Contribution to journalArticle

29 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 125Iodine-human serum albumin. Second, we derived PVS as: [(calculated aPV - ideal PV)/ideal PV] x 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, χ2 = 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 languageEnglish (US)
Pages (from-to)35-43
Number of pages9
JournalEuropean Journal of Heart Failure
Volume17
Issue number1
DOIs
StatePublished - Jan 1 2015

Fingerprint

Plasma Volume
Heart Failure
Valsartan
Brain Natriuretic Peptide
Hematocrit
Serum Albumin
Outpatients
Biomarkers
Confidence Intervals
Weights and Measures
Mortality

Keywords

  • Chronic heart failure
  • Plasma volume
  • Prognosis

Cite this

Ling, H. Z., Flint, J., Damgaard, M., Bonfils, P. K., Cheng, A. S., Aggarwal, 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

Calculated plasma volume status and prognosis in chronic heart failure. / Ling, Hua Zen; Flint, Julia; Damgaard, Morten; Bonfils, Peter K.; Cheng, Adrian S.; Aggarwal, Suneil; Velmurugan, Shanti; Mendonca, Michelle; Rashid, Mohammed; Kang, Swan; Papalia, Francesco; Weissert, Susanne; Coats, Caroline J.; Thomas, Martin; Kuskowski, Michael A; Cohn, Jay N; Woldman, Simon; Anand, Inder; Okonko, Darlington O.

In: European Journal of Heart Failure, Vol. 17, No. 1, 01.01.2015, p. 35-43.

Research output: Contribution to journalArticle

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, MA, Cohn, JN, Woldman, S, Anand, I & 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
Ling HZ, Flint J, Damgaard M, Bonfils PK, Cheng AS, Aggarwal S et al. Calculated plasma volume status and prognosis in chronic heart failure. European Journal of Heart Failure. 2015 Jan 1;17(1):35-43. https://doi.org/10.1002/ejhf.193
Ling, Hua Zen ; Flint, Julia ; Damgaard, Morten ; Bonfils, Peter K. ; Cheng, Adrian S. ; Aggarwal, Suneil ; Velmurugan, Shanti ; Mendonca, Michelle ; Rashid, Mohammed ; Kang, Swan ; Papalia, Francesco ; Weissert, Susanne ; Coats, Caroline J. ; Thomas, Martin ; Kuskowski, Michael A ; Cohn, Jay N ; Woldman, Simon ; Anand, Inder ; Okonko, Darlington O. / Calculated plasma volume status and prognosis in chronic heart failure. In: European Journal of Heart Failure. 2015 ; Vol. 17, No. 1. pp. 35-43.
@article{9619effb19b14397aaecfbedf4bb28d6,
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 125Iodine-human serum albumin. Second, we derived PVS as: [(calculated aPV - ideal PV)/ideal PV] x 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, χ2 = 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 = "Chronic heart failure, Plasma volume, Prognosis",
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 Kuskowski, {Michael A} and Cohn, {Jay N} and Simon Woldman and Inder Anand and Okonko, {Darlington O.}",
year = "2015",
month = "1",
day = "1",
doi = "10.1002/ejhf.193",
language = "English (US)",
volume = "17",
pages = "35--43",
journal = "European Journal of Heart Failure",
issn = "1388-9842",
publisher = "Oxford University Press",
number = "1",

}

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 A

AU - Cohn, Jay N

AU - Woldman, Simon

AU - Anand, Inder

AU - Okonko, Darlington O.

PY - 2015/1/1

Y1 - 2015/1/1

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 125Iodine-human serum albumin. Second, we derived PVS as: [(calculated aPV - ideal PV)/ideal PV] x 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, χ2 = 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 125Iodine-human serum albumin. Second, we derived PVS as: [(calculated aPV - ideal PV)/ideal PV] x 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, χ2 = 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 - Chronic heart failure

KW - Plasma volume

KW - Prognosis

UR - http://www.scopus.com/inward/record.url?scp=84921436081&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84921436081&partnerID=8YFLogxK

U2 - 10.1002/ejhf.193

DO - 10.1002/ejhf.193

M3 - Article

VL - 17

SP - 35

EP - 43

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

SN - 1388-9842

IS - 1

ER -