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Gao B, Chen R, Zhao H, Zhang H, Wang X, Liu D. Estimated plasma volume status as a simple and accessible predictor of 28-day mortality in septic shock: insights from a retrospective study of the MIMIC-IV database. Front Med (Lausanne) 2024; 11:1416396. [PMID: 38903828 PMCID: PMC11187084 DOI: 10.3389/fmed.2024.1416396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 05/27/2024] [Indexed: 06/22/2024] Open
Abstract
Background Assessing volume status in septic shock patients is crucial for tailored fluid resuscitation. Estimated plasma volume status (ePVS) has emerged as a simple and effective tool for evaluating patient volume status. However, the prognostic value of ePVS in septic shock patients remains underexplored. Methods The study cohort consisted of septic shock patients admitted to the ICU, sourced from the MIMIC-IV database. Patients were categorized into two groups based on 28-day survival outcomes, and their baseline characteristics were compared. According to the ePVS (6.52 dL/g) with a hazard ratio of 1 in the restricted cubic spline (RCS) analysis, patients were further divided into high and low ePVS groups. A multivariable Cox regression model was utilized to evaluate the association between ePVS and 28-day mortality rate. The Kaplan-Meier survival curve was plotted, and all-cause mortality was compared between the high and low groups using the log-rank test. Results A total of 7,607 septic shock patients were included in the study, among whom 2,144 (28.2%) died within 28 days. A J-shaped relationship was observed between ePVS at ICU admission and 28-day mortality, with an increase in mortality risk noted when ePVS exceeded 6.52 dL/g. The high ePVS group exhibited notably higher mortality rates compared to the low ePVS group (28-day mortality: 26.2% vs. 30.2%; 90-day mortality: 35% vs. 42.3%). After adjustment for confounding factors, ePVS greater than 6.52 dL/g independently correlated with an increased risk of 28-day mortality (HR: 1.20, 95% CI: 1.10-1.31, p < 0.001) and 90-day mortality (HR: 1.25, 95% CI: 1.15-1.35, p < 0.001). Kaplan-Meier curves demonstrated a heightened risk of mortality associated with ePVS values exceeding 6.52 dL/g. Conclusion A J-shaped association was observed between ePVS and 28-day mortality in septic shock patients, with higher ePVS levels associated with increased risk of mortality.
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Affiliation(s)
- Beijun Gao
- Department of Critical Care Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Rongping Chen
- Department of Critical Care Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Hua Zhao
- Department of Critical Care Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Hongmin Zhang
- Department of Health Care, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Xiaoting Wang
- Department of Critical Care Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Dawei Liu
- Department of Critical Care Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
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Turcato G, Zaboli A, Sibilio S, Brigo F. Estimated plasma volume status is a simple and quick tool that could help define the severity of patients with infection on arrival at the emergency department. Am J Med Sci 2024; 367:343-351. [PMID: 38354776 DOI: 10.1016/j.amjms.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 12/18/2023] [Accepted: 02/08/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Infectious states are subtle and rapidly evolving conditions observed daily in the emergency department (ED), and their prognostic evaluation remains a complex clinical challenge. Recently, estimated plasma volume status (ePVS) has been suggested to have a prognostic role in conditions where volemic alteration is central to the pathophysiology. The aim of this study was to verify whether ePVS recorded at ED admission can provide prognostic indications of 30-day mortality in patients with infection. METHODS A prospective observational study was performed between 1 January 2021 and 31 December 2021 at the ED of the Merano Hospital. All patients with infection were enrolled. ePVS values were derived from haemoglobin and haematocrit measured on the immediate arrival of patients in the ED. The predictive power of ePVS for 30-day mortality was assessed using a multivariate model adjusted for severity, comorbidity and urgency. Kaplan-Meier analysis was also performed. RESULTS Of the 949 patients with infection enrolled in the study (47.9%, SOFA ≥2), 8.9% (84/949) died at 30 days. The median ePVS value was higher in patients who died at 30 days than in patients who survived (5.83 vs. 4.61, p < 0.001). Multivariate analysis revealed that ePVS in both continuous and categorical form around the median was an independent risk factor for 30-day mortality even after adjusting for severity, comorbidity and urgency. Kaplan-Meier analysis confirmed an increased risk of death in patients with high ePVS values. CONCLUSIONS ePVS recorded on ED admission of patients with infection was an independent predictor of risk for 30-day mortality.
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Affiliation(s)
- Gianni Turcato
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy.
| | - Arian Zaboli
- Department of Emergency Medicine, Hospital of Merano-Meran (SABES-ASDAA), Merano-Meran, Italy; Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria
| | - Serena Sibilio
- Department of Emergency Medicine, Hospital of Merano-Meran (SABES-ASDAA), Merano-Meran, Italy; Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria
| | - Francesco Brigo
- Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria; Department of Neurology, Hospital of Merano-Meran (SABES-ASDAA), Merano-Meran, Italy
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Miyoshi T. Estimated plasma volume status as a prognostic marker in patients with lower extremity artery disease. Hypertens Res 2023; 46:2412-2414. [PMID: 37495844 DOI: 10.1038/s41440-023-01383-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/29/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
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Cuthbert JJ, Pellicori P, Rigby AS, Abel AAI, Kalvickbacka-Bennet A, Shah P, Kearsley JW, Kazmi S, Cleland JGF, Clark AL. Are non-invasive estimations of plasma volume an accurate measure of congestion in patients with chronic heart failure? EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:281-292. [PMID: 35723241 DOI: 10.1093/ehjqcco/qcac035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/10/2022] [Accepted: 06/15/2022] [Indexed: 05/17/2023]
Abstract
AIMS We report associations between different formulae for estimating plasma volume status (PVS) and clinical and ultrasound markers of congestion in patients with chronic heart failure (CHF) enrolled in the Hull Lifelab registry. METHODS AND RESULTS Cohort 1 comprised patients with data on signs and symptoms at initial evaluation (n = 3505). Cohort 2 included patients with ultrasound assessment of congestion [lung B-line count, inferior vena cava (IVC) diameter, jugular vein distensibility (JVD) ratio] (N = 341). Two formulae for PVS were used: (a) Hakim (HPVS) and (b) Duarte (DPVS). Results were compared with clinical and ultrasound markers of congestion. Outcomes assessed were mortality and the composite of heart failure (HF) hospitalisation and all-cause mortality. In cohort 1, HPVS was associated with mortality [hazard ratio (HR) per unitary increase = 1.02 (1.01-1.03); P < 0.001]. In cohort 2, HPVS was associated with B-line count (HR) = 1.05 [95% confidence interval (CI) (1.01-1.08); P = 0.02] and DPVS with the composite outcome [HR = 1.26 (1.01-1.58); P = 0.04]. HPVS and DPVS were strongly related to haemoglobin concentration and HPVS to weight. After multivariable analysis, there were no strong or consistent associations between PVS and measures of congestion, severity of symptoms, or outcome. By contrast, log[NTproBNP] was strongly associated with all three. CONCLUSION Amongst patients with CHF, HPVS and DPVS are not strongly or consistently associated with clinical or ultrasound evidence of congestion, nor clinical outcomes after multivariable adjustment. They appear only to be surrogates of the variables from which they are calculated with no intrinsic clinical utility.
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Affiliation(s)
- J J Cuthbert
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
- Department of Cardiology, Hull University Hospitals Trust, Castle Hill Hospital, Castle Road, Cottingham, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU16 5JQ
| | - P Pellicori
- Robertson Centre for Biostatistics, Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - A S Rigby
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
| | - A A I Abel
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
- Department of Cardiology, Hull University Hospitals Trust, Castle Hill Hospital, Castle Road, Cottingham, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU16 5JQ
| | - A Kalvickbacka-Bennet
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
| | - P Shah
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
| | - J W Kearsley
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
| | - S Kazmi
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
| | - J G F Cleland
- Robertson Centre for Biostatistics, Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - A L Clark
- Department of Cardiology, Hull University Hospitals Trust, Castle Hill Hospital, Castle Road, Cottingham, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU16 5JQ
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Impact of Estimated Plasma Volume Status on Mortality in Right Heart Failure Patients: A Retrospective Cohort Study in Indonesia. Glob Heart 2022; 17:60. [PMID: 36051319 PMCID: PMC9414864 DOI: 10.5334/gh.1136] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 07/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Plasma volume (PV) expansion hallmarks the syndrome of heart failure (HF) but is difficult to be quantified noninvasively. Estimated plasma volume status (ePVS) has marked prognostic utility in the failing left heart, however its use in right heart failure (RHF) remains unknown. This study aims to investigate the prognostic value of ePVS among isolated RHF patients. Methods: We retrospectively collected 208 patients admitted for RHF in our hospital from the electronic database from 2017 to 2019. ePVS was calculated using the Hakim formula. Patients were divided into low and high groups based on their PV value. Logistic regression was used to compare the odds of in-hospital mortality between these groups. Results: The overall in-hospital mortality was 12.5%, tripled from the low group to the high group (6.7% vs. 18.3%), within a median of 6 (3–19) days. High ePVS significantly predicted mortality in RHF, even after being adjusted for demographic, hemodynamic, chemistry, and medication variables (adjusted OR: 5.83, 95% CI: 1.62–20.95, p < 0.01). Conclusion: ePVS is associated with in-hospital mortality among isolated RHF patients. Given not only the wide accessibility of hemogram but also the low cost and the rapid quantification of relative PV, this simple tool can potentially aid in optimizing RHF management, especially in rural area, although further evaluation is warranted.
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Chouihed T, Bassand A, Duarte K, Jaeger D, Roth Y, Giacomin G, Delaruelle A, Duchanois C, Bannay A, Kobayashi M, Rossignol P, Girerd N. Head-to-head comparison of diagnostic scores for acute heart failure in the emergency department: results from the PARADISE cohort. Intern Emerg Med 2022; 17:1155-1163. [PMID: 34787803 DOI: 10.1007/s11739-021-02879-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 10/24/2021] [Indexed: 11/29/2022]
Abstract
BREST and PREDICA scores have recently emerged for the diagnosis of acute heart failure (AHF) in the emergency department (ED). This study aimed to perform a head-to-head comparison in a large contemporary cohort. BREST and PREDICA scores were calculated from, respectively, 11 and 8 routine clinical variables recorded in the ED in 1386 patients from the PArADIsE cohort. The diagnostic performance of the scores for adjudicated AHF diagnosis was assessed by the area under the ROC curve (AUC). Acute HF diagnosis was adjudicated according to the European Society of Cardiology criteria and BNP levels. A BREST score ≤ 3 or PREDICA score ≤ 1 was associated with low probabilities of AHF (5.7% and 2.6%, respectively). Conversely, a BREST score ≥ 9 or PREDICA score ≥ 5 was associated with a high risk of AHF diagnosis (77.3% and 66.9%, respectively) although more than half of the population was within the "gray zone" (4-8 and 2-4 for the BREST and PREDICA scores, respectively). Diagnostic performances of both scores were good (AUC 79.1%, [66.1-82.1] for the BREST score and 82.4%, [79.8-85.0] for the PREDICA score). PREDICA score had significantly higher diagnostic performance than BREST score (increase in AUC 3.3 [0.8-5.8], p = 0.009). Our study emphasizes the good diagnostic performance of both BREST and PREDICA scores, albeit with a significantly higher diagnostic performance of the PREDICA score. Yet, more than half of the population was classified within the "gray zone" by these scores; additional diagnostic tools are needed to ascertain AHF diagnosis in the ED in a majority of patients. Clinical trial registration: NCT02800122.
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Affiliation(s)
- Tahar Chouihed
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques - 1433, and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
- Emergency Department, University Hospital of Nancy, Vanvoeuvre-Les-Nancy, Nancy, France
| | - Adrien Bassand
- Emergency Department, University Hospital of Nancy, Vanvoeuvre-Les-Nancy, Nancy, France
| | - Kevin Duarte
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques - 1433, and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Déborah Jaeger
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques - 1433, and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
- Emergency Department, University Hospital of Nancy, Vanvoeuvre-Les-Nancy, Nancy, France
| | - Yann Roth
- Emergency Department, University Hospital of Nancy, Vanvoeuvre-Les-Nancy, Nancy, France
| | - Gaetan Giacomin
- Emergency Department, University Hospital of Nancy, Vanvoeuvre-Les-Nancy, Nancy, France
| | - Anne Delaruelle
- Emergency Department, University Hospital of Nancy, Vanvoeuvre-Les-Nancy, Nancy, France
| | - Charlène Duchanois
- Emergency Department, University Hospital of Nancy, Vanvoeuvre-Les-Nancy, Nancy, France
| | - Aurélie Bannay
- Université de Lorraine, CHRU-Nancy, Medical Information Department, CNRS, Inria, LORIA, 54000, Nancy, France
| | - Masatake Kobayashi
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques - 1433, and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Patrick Rossignol
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques - 1433, and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Nicolas Girerd
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques - 1433, and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France.
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Kim KH, Cho HJ, Kim SC, Lee J. Prognostic Value of Estimated Plasma Volume Status in Patients With Sepsis. J Korean Med Sci 2022; 37:e145. [PMID: 35535372 PMCID: PMC9091431 DOI: 10.3346/jkms.2022.37.e145] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/12/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In patients with sepsis, timely risk stratification is important to improve prognosis. Although several clinical scoring systems are currently being used to predict the outcome of sepsis, but they all have certain limitations. The objective of this study was to evaluate the prognostic value of estimated plasma volume status (ePVS) in patients admitted to the intensive care unit (ICU) with sepsis or septic shock. METHODS This single-center, prospective observational study, included 100 patients admitted to the ICU with sepsis or septic shock. Informed consent, blood samples, and co-morbidity data were obtained from the patients on admission, and the severity of sepsis was recorded. The primary outcome was in-hospital mortality and multivariable logistic regression analysis was used to adjust for confounding factors to determine the significant prognostic factor. RESULTS The in-hospital mortality was 47%. The ePVS was correlated with the amount of total fluids administered 24 hours before the ICU admission. The mean ePVS in patients who died was higher than in those who survived (7.7 ± 2.1 dL/g vs. 6.6 ± 1.6 dL/g, P = 0.003). To evaluate the utility of ePVS in predicting in-hospital mortality, a receiver operating characteristic curve was produced. Sensitivity and specificity were optimal at a cut-off point of 7.09 dL/g, with an area under the curve of 0.655. In the multivariate analysis, higher ePVS was significantly associated with higher in-hospital mortality (adjusted odds ratio, 1.39; 95% confidence interval, 1.04-1.85, P = 0.028). The Kaplan-Meier curve showed that an ePVS value above 7.09 was associated with an increased risk of in-hospital mortality compared with the rest of the population (P = 0.004). CONCLUSION The ePVS was correlated with the amount of intravenous fluid resuscitation and may be used as a simple and novel prognostic factor in patients with sepsis or septic shock who are admitted to the ICU.
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Affiliation(s)
- Kyung Hoon Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeong Jun Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok Chan Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jongmin Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Kataoka H. Mechanistic insights into chloride-related heart failure progression according to the plasma volume status. ESC Heart Fail 2022; 9:2044-2048. [PMID: 35384366 PMCID: PMC9065841 DOI: 10.1002/ehf2.13927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/04/2022] [Accepted: 03/28/2022] [Indexed: 11/11/2022] Open
Abstract
Aims Two types of heart failure (HF) progression were recently proposed on the basis of an increased vs. non‐increased serum chloride concentration. The applicability of this concept to real‐world HF pathophysiology requires further investigation. The present study evaluated the mechanisms of HF progression to a different type according to changes in the estimated plasma volume status (ePVS). Methods and results Data from 47 patients (32% men; 78.2 ± 9.7 years of age) with stable to worsening HF (37.5 ± 16 days) were analysed. Physical examination, standard blood tests, and b‐type natriuretic peptide (BNP) measurements were conducted. The ePVS was calculated as follows: ePVS (dL/g) = [100 − haematocrit (%)]/[haemoglobin (g/dL)]. For the study subjects as a whole (n = 47), changes in the ePVS correlated positively with changes in the serum chloride concentration from stable to worsening HF (r = 0.398, P = 0.0056). When divided into two groups of worsening HF with an increased (n = 31) vs. non‐increased serum chloride concentration (n = 16), no significant baseline differences in body weight, serum logBNP, or ePVS were detected between groups. Under worsening HF, the increase in body weight (2.34 ± 1.12 vs. 2.59 ± 1.56 kg, P = 0.57) and logBNP (0.39 ± 0.30 vs. 0.54 ± 0.31 pg/mL, P = 0.13) did not differ between groups, but the increase in the ePVS was smaller in the group with a non‐increased serum chloride concentration compared with that with an increased serum chloride concentration (0.292 ± 0.49 vs. 0.653 ± 0.60 dL/g, P = 0.044). An increase in the %change in ePVS ≥ 10% was less common in patients with a non‐increased chloride concentration (37% vs. 71%, P = 0.03). Patients with a non‐increased serum chloride concentration had more HF signs (3.31 ± 0.79 vs. 2.65 ± 0.71, P = 0.005) and a higher incidence of pulmonary rales (63% vs. 16%, P = 0.0024) than those with an increased serum chloride concentration. Conclusions According to the changes in the ePVS, HF progression may result from a difference between two HF types (i.e. increased vs. non‐increased serum chloride concentration) in the cardiac reserve in response to a given cardiac burden by modulating plasma volume status via the possible tonicity potential of chloride.
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Affiliation(s)
- Hajime Kataoka
- Department of Internal Medicine, Nishida Hospital, Tsuruoka-Nishi-Machi 2-266, Saiki, Oita, 876-0047, Japan
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Hasimbegovic E, Russo M, Andreas M, Werner P, Coti I, Wiedemann D, Kocher A, Laufer G, Hofer BS, Mach M. Deviations From the Ideal Plasma Volume and Isolated Tricuspid Valve Surgery—Paving the Way for New Risk Stratification Parameters. Front Cardiovasc Med 2022; 9:849972. [PMID: 35402525 PMCID: PMC8990912 DOI: 10.3389/fcvm.2022.849972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCongestion and plasma volume expansion are important features of heart failure, whose prognostic significance has been investigated in a range of surgical and non-surgical settings. The aim of this study was to evaluate the value of the estimated plasma volume status (ePVS) in patients undergoing isolated tricuspid valve surgery.MethodsThis study included patients who underwent isolated tricuspid valve surgery at the Vienna General Hospital (Austria) between July 2008 and November 2018. The PVS cut-off was calculated using ROC analysis and Youden's Index.ResultsEighty eight patients (median age: 58 [IQR: 35-70] years; 44.3% male; 75.6% NYHA III/IV; median EuroSCORE II 2.65 [IQR: 1.70-5.10]; 33.0% endocarditis-related regurgitation; 60.2% isolated repair; 39.8% isolated replacement) were included in this study. Patients who died within 1 year following surgery had significantly higher baseline ePVS values than survivors (median ePVS 5.29 [IQR: −1.55-13.55] vs. −3.68 [IQR: −10.92-4.22]; p = 0.005). During a median actuarial follow-up of 3.02 (IQR: 0.36-6.80) years, patients with a preoperative ePVS ≥ −4.17 had a significantly increased mortality (log-rank p = 0.006).ConclusionsePVS is an easily obtainable risk parameter for patients undergoing isolated tricuspid valve surgery capable of predicting mid- and long-term outcomes after isolated tricuspid valve surgery.
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Affiliation(s)
- Ena Hasimbegovic
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Marco Russo
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Andreas
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Paul Werner
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Iuliana Coti
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Dominik Wiedemann
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Alfred Kocher
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Günther Laufer
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Benedikt S. Hofer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Markus Mach
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
- *Correspondence: Markus Mach
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Shirakabe A, Okazaki H, Matsushita M, Shibata Y, Shigihara S, Nishigoori S, Sawatani T, Sasamoto N, Kiuchi K, Atsukawa M, Itokawa N, Arai T, Kobayashi N, Asai K. Type III procollagen peptide level can indicate liver dysfunction associated with volume overload in acute heart failure. ESC Heart Fail 2022; 9:1832-1843. [PMID: 35289118 PMCID: PMC9065836 DOI: 10.1002/ehf2.13878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/12/2022] [Accepted: 02/28/2022] [Indexed: 11/14/2022] Open
Abstract
Aim The role of serum type III procollagen peptide (P3P) level in the acute phase of acute heart failure (AHF) requires clarification. We hypothesized that serum P3P level is temporarily higher during the acute phase, reflecting liver dysfunction due to congestion. Methods and results A total of 800 AHF patients were screened, and data from 643 patients were analysed. Heart failure was diagnosed by the treating physician according to the European Society of Cardiology (ESC) guidelines, and included patients being treated with high‐concentration oxygen inhalation (including mechanical support) for orthopnea, inotrope administration, or mechanical support for low blood pressure, and various types of diuretics for peripheral or pulmonary oedema. In all cases, diuretics or vasodilators were administered to treat AHF. The patients were divided into three groups according to their quartile (Q) serum P3P level: low‐P3P (Q1, P3P ≤ 0.6 U/mL), mid‐P3P (Q2/Q3, 0.6 < P3P <1.2 U/mL), and high‐P3P (Q4, P3P ≥ 1.2 U/mL). The plasma volume status (PVS) was calculated using the following formula: ([actual PV − ideal PV]/ideal PV) × 100 (%). The primary endpoint was 365 day mortality. A Kaplan–Meier curve analysis showed that prognoses, including all‐cause mortality and heart failure events within 365 days, were significantly (P < 0.001) worse in the high‐P3P group when compared with the mid‐P3P and low‐P3P groups. A multivariate logistic regression analysis showed that high PVS (Q4, odds ratio [OR]: 4.702, 95% CI: 2.012–20.989, P < 0.001), high fibrosis‐4 index (Q4, OR: 2.627, 95% CI: 1.311–5.261, P = 0.006), and low estimated glomerular filtration rate per 10 mL/min/1.73 m2 decrease (OR: 1.996, 95% CI: 1.718–2.326, P < 0.001) were associated with high P3P values. The Kaplan–Meier curve analysis demonstrated a significantly lower survival rate, as well as a higher rate of heart failure events, in the high‐P3P and high‐PVS groups when compared with the other groups. A multivariate Cox regression model identified high P3P level and high PVS as an independent predictor of 365 day all‐cause mortality (hazard ratio [HR]: 2.249; 95% CI: 1.081–3.356; P = 0.026) and heart failure events (HR: 1.586, 95% CI: 1.005–2.503, P = 0.048). Conclusion A high P3P level during the acute phase of AHF served as a comprehensive biomarker of liver dysfunction with volume overload (i.e. liver congestion) and renal dysfunction. A high P3P level at admission may be able to predict adverse outcomes in AHF patients.
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Affiliation(s)
- Akihiro Shirakabe
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Hirotake Okazaki
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Masato Matsushita
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Yusaku Shibata
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Shota Shigihara
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Suguru Nishigoori
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Tomofumi Sawatani
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Nozomi Sasamoto
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Kazutaka Kiuchi
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Masanori Atsukawa
- Division of Gastroenterology and Hepatology, Nippon Medical School, Tokyo, Japan
| | - Norio Itokawa
- Division of Gastroenterology and Hepatology, Nippon Medical School, Tokyo, Japan
| | - Taeang Arai
- Division of Gastroenterology and Hepatology, Nippon Medical School, Tokyo, Japan
| | - Nobuaki Kobayashi
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Kuniya Asai
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
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11
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Kobayashi M, Douair A, Coiro S, Giacomin G, Bassand A, Jaeger D, Duarte K, Huttin O, Zannad F, Rossignol P, Chouihed T, Girerd N. A Combination of Chest Radiography and Estimated Plasma Volume May Predict In-Hospital Mortality in Acute Heart Failure. Front Cardiovasc Med 2022; 8:752915. [PMID: 35087878 PMCID: PMC8787280 DOI: 10.3389/fcvm.2021.752915] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/16/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Patients with heart failure (HF) often display dyspnea associated with pulmonary congestion, along with intravascular congestion, both may result in urgent hospitalization and subsequent death. A combination of radiographic pulmonary congestion and plasma volume might screen patients with a high risk of in-hospital mortality in the emergency department (ED). Methods: In the pathway of dyspneic patients in emergency (PARADISE) cohort, patients admitted for acute HF were stratified into 4 groups based on high or low congestion score index (CSI, ranging from 0 to 3, high value indicating severe congestion) and estimated plasma volume status (ePVS) calculated from hemoglobin/hematocrit. Results: In a total of 252 patients (mean age, 81.9 years; male, 46.8%), CSI and ePVS were not correlated (Spearman rho <0 .10, p > 0.10). High CSI/high ePVS was associated with poorer renal function, but clinical congestion markers (i.e., natriuretic peptide) were comparable across CSI/ePVS categories. High CSI/high ePVS was associated with a four-fold higher risk of in-hospital mortality (adjusted-OR, 95%CI = 4.20, 1.10-19.67) compared with low CSI/low ePVS, whereas neither high CSI nor ePVS alone was associated with poor prognosis (all-p-value > 0.10; Pinteraction = 0.03). High CSI/high ePVS improved a routine risk model (i.e., natriuretic peptide and lactate)(NRI = 46.9%, p = 0.02), resulting in high prediction of risk of in-hospital mortality (AUC = 0.85, 0.82-0.89). Conclusion: In patients hospitalized for acute HF with relatively old age and comorbidity burdens, a combination of CSI and ePVS was associated with a risk of in-hospital death, and improved prognostic performance on top of a conventional risk model.
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Affiliation(s)
- Masatake Kobayashi
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, INSERM 1116, Nancy, France
- F-CRIN INI-CRCT Cardiovascular and Renal Clinical Trialists Network, Nancy, France
- CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | - Amine Douair
- Emergency Department, University Hospital of Nancy, Nancy, France
| | - Stefano Coiro
- Division of Cardiology, University of Perugia, Perugia, Italy
| | - Gaetan Giacomin
- Emergency Department, University Hospital of Nancy, Nancy, France
| | - Adrien Bassand
- Emergency Department, University Hospital of Nancy, Nancy, France
| | - Déborah Jaeger
- Emergency Department, University Hospital of Nancy, Nancy, France
| | - Kevin Duarte
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, INSERM 1116, Nancy, France
- F-CRIN INI-CRCT Cardiovascular and Renal Clinical Trialists Network, Nancy, France
- CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Olivier Huttin
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, INSERM 1116, Nancy, France
- F-CRIN INI-CRCT Cardiovascular and Renal Clinical Trialists Network, Nancy, France
- CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Faiez Zannad
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, INSERM 1116, Nancy, France
- F-CRIN INI-CRCT Cardiovascular and Renal Clinical Trialists Network, Nancy, France
- CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Patrick Rossignol
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, INSERM 1116, Nancy, France
- F-CRIN INI-CRCT Cardiovascular and Renal Clinical Trialists Network, Nancy, France
- CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Tahar Chouihed
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, INSERM 1116, Nancy, France
- F-CRIN INI-CRCT Cardiovascular and Renal Clinical Trialists Network, Nancy, France
- CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
- Emergency Department, University Hospital of Nancy, Nancy, France
| | - Nicolas Girerd
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, INSERM 1116, Nancy, France
- F-CRIN INI-CRCT Cardiovascular and Renal Clinical Trialists Network, Nancy, France
- CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
- *Correspondence: Nicolas Girerd
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12
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Chen J, Shen J, Cai D, Wei T, Qian R, Zeng C, Lyu L. Estimated plasma volume status (ePVS) is a predictor for acute myocardial infarction in-hospital mortality: analysis based on MIMIC-III database. BMC Cardiovasc Disord 2021; 21:530. [PMID: 34749646 PMCID: PMC8573972 DOI: 10.1186/s12872-021-02338-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/20/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Estimated plasma volume status (ePVS) has been reported that associated with poor prognosis in heart failure patients. However, no researchinvestigated the association of ePVS and prognosis in patients with acute myocardial infarction (AMI). Therefore, we aimed to determine the association between ePVS and in-hospital mortality in AMI patients. METHODS AND RESULTS We extracted AMI patients data from MIMIC-III database. A generalized additive model and logistic regression model were used to demonstrate the association between ePVS levels and in-hospital mortality in AMI patients. Kaplan-Meier survival analysis was used to pooled the in-hospital mortality between the various group. ROC curve analysis were used to assessed the discrimination of ePVS for predicting in-hospital mortality. 1534 eligible subjects (1004 males and 530 females) with an average age of 67.36 ± 0.36 years old were included in our study finally. 136 patients (73 males and 63 females) died in hospital, with the prevalence of in-hospital mortality was 8.9%. The result of the Kaplan-Meier analysis showed that the high-ePVS group (ePVS ≥ 5.28 mL/g) had significant lower survival possibility in-hospital admission compared with the low-ePVS group (ePVS < 5.28 mL/g). In the unadjusted model, high-level of ePVS was associated with higher OR (1.09; 95% CI 1.06-1.12; P < 0.001) compared with low-level of ePVS. After adjusted the vital signs data, laboratory data, and treatment, high-level of ePVS were also associated with increased OR of in-hospital mortality, 1.06 (95% CI 1.03-1.09; P < 0.001), 1.05 (95% CI 1.01-1.08; P = 0.009), 1.04 (95% CI 1.01-1.07; P = 0.023), respectively. The ROC curve indicated that ePVS has acceptable discrimination for predicting in-hospital mortality. The AUC value was found to be 0.667 (95% CI 0.653-0.681). CONCLUSION Higher ePVS values, calculated simply from Duarte's formula (based on hemoglobin/hematocrit) was associated with poor prognosis in AMI patients. EPVS is a predictor for predicting in-hospital mortality of AMI, and could help refine risk stratification.
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Affiliation(s)
- Jun Chen
- Zhejiang Chinese Medical University, Hangzhou, 310000 Zhejiang China
| | - Jiayi Shen
- Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, 323000 Zhejiang China
| | - Dongsheng Cai
- Zhejiang University of Medical College, Hangzhou, 310000 Zhejiang China
| | - Tiemin Wei
- Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, 323000 Zhejiang China
| | - Renyi Qian
- Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, 323000 Zhejiang China
| | - Chunlai Zeng
- Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, 323000 Zhejiang China
| | - Lingchun Lyu
- Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, 323000 Zhejiang China
- Department of Cardiology, Lishui Central Hospital and The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, 323000 China
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13
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Niedermeyer SE, Stephens RS, Kim BS, Metkus TS. Calculated Plasma Volume Status Is Associated With Mortality in Acute Respiratory Distress Syndrome. Crit Care Explor 2021; 3:e0534. [PMID: 34514428 PMCID: PMC8423381 DOI: 10.1097/cce.0000000000000534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Supplemental Digital Content is available in the text. The optimal method to assess fluid overload in acute respiratory distress syndrome is not known, and current techniques have limitations. Plasma volume status has emerged as a noninvasive method to assess volume status and is defined as the percentage alteration from ideal plasma volume. We hypothesized that plasma volume status would suggest the presence of significant excess volume and therefore correlate with mortality in acute respiratory distress syndrome.
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Affiliation(s)
- Shannon E Niedermeyer
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - R Scott Stephens
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bo Soo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Thomas S Metkus
- Divisions of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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14
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Shirakabe A, Okazaki H, Matsushita M, Shibata Y, Shigihara S, Nishigoori S, Sawatani T, Tani K, Kiuchi K, Otsuka Y, Atsukawa M, Itokawa N, Arai T, Kobayashi N, Asai K, Shimizu W. Clinical Significance of the Fibrosis-4 Index in Patients with Acute Heart Failure Requiring Intensive Care. Int Heart J 2021; 62:858-865. [PMID: 34276014 DOI: 10.1536/ihj.20-793] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The Fibrosis-4 (FIB4) index could indicate the liver fibrosis in patients with chronic hepatic diseases. It was calculated using the following formula: (age × aspartate aminotransferase [U/L]) / (platelet count [103/μL] × √alanine aminotransferase [U/L]). However, the clinical impact of the FIB4 index in the acute phase of acute heart failure (AHF) has not been sufficiently investigated.A total 1,468 AHF patients were analyzed. The median FIB4 index was 2.71 [1.85-4.22]. The patients were divided into three groups according to the quartiles of their FIB4 index (low-FIB4 [Q1, ≤ 1.847], middle-FIB4 [Q2/Q3, 1.848-4.216], and high-FIB4 [Q4, ≥ 4.216] groups). A Kaplan-Meier curve analysis showed that the prognosis, such as all-cause mortality and HF events within 365 days, was significantly poorer in the high-FIB4 group than in the middle-FIB4 and low-FIB4 groups. A multivariate Cox regression model identified high FIB4 index as an independent predictor of 365-day all-cause death (hazard ratio (HR): 1.660, 95% CI: 1.136-2.427) and HF events (HR: 1.505, 95% CI: 1.145-1.978). The multivariate logistic regression analysis showed that the high plasma volume status (PVS) (Q4, odds ratio [OR]: 2.099, 95% CI: 1.429-3.082), low systolic blood pressure (SBP) (< 100 mmHg, OR: 3.825, 95% CI: 2.504-5.840), and low left ventricular ejection fraction (< 40%, OR: 1.321, 95% CI: 1.002-1.741) were associated with a high FIB4 index.A high FIB4 index can predict adverse outcomes in AHF patients, which indicate that congestive liver and liver hypoperfusion occur due to low cardiac output in the acute phase of AHF.
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Affiliation(s)
- Akihiro Shirakabe
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Hirotake Okazaki
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Masato Matsushita
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Yusaku Shibata
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Shota Shigihara
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Suguru Nishigoori
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Tomofumi Sawatani
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Kenichi Tani
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Kazutaka Kiuchi
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Yusuke Otsuka
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | | | - Norio Itokawa
- Division of Gastroenterology and Hepatology, Nippon Medical School
| | - Taeang Arai
- Division of Gastroenterology and Hepatology, Nippon Medical School
| | - Nobuaki Kobayashi
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Kuniya Asai
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
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15
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Kawai T, Nakatani D, Yamada T, Sakata Y, Hikoso S, Mizuno H, Suna S, Kitamura T, Okada K, Dohi T, Kojima T, Oeun B, Sunaga A, Kida H, Sato H, Hori M, Komuro I, Tamaki S, Morita T, Fukunami M, Sakata Y. Clinical impact of estimated plasma volume status and its additive effect with the GRACE risk score on in-hospital and long-term mortality for acute myocardial infarction. IJC HEART & VASCULATURE 2021; 33:100748. [PMID: 33748402 PMCID: PMC7957089 DOI: 10.1016/j.ijcha.2021.100748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 02/06/2021] [Accepted: 02/20/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Estimated plasma volume status (ePVS) is a well-validated prognostic indicator in heart failure. However, it remains unclear whether ePVS has prognostic significance in patients with acute myocardial infarction (AMI). Moreover, there is no available information on its additive effect with the Global Registry of Acute Coronary Events (GRACE) risk score in AMI patients. METHODS Data were obtained from the Osaka Acute Coronary Insufficiency Study (OACIS) registry database. Patients whose data were available for ePVS derived from Hakim's formula and the GRACE risk score were studied. The primary endpoints were in-hospital and 5-year mortality. RESULTS Of 3930 patients, 206 and 200 patients died during hospitalization and 5 years after discharge, respectively. After adjustment, ePVS remained an independent predictor of in-hospital death (OR:1.02, 95% CI: 1.00-1.04, p = 0.036), and 5-year mortality(HR:1.03, 95% CI: 1.01-1.04, p < 0.001). An additive effect of ePVS with the GRACE risk score was observed in predicting the 5-year mortality with an area under the receiver operating characteristic curve (AUC) from 0.744 to 0.763 (p = 0.026), but not in-hospital mortality (the AUC changed from 0.875 to 0.875, p = 0.529). The incremental predictive value of combining ePVS and the GRACE risk score for 5-year mortality was significantly improved, as shown by the net reclassification improvement (NRI:0.378, p < 0.001) and integrated discrimination improvement (IDI:0.014, p < 0.001). CONCLUSIONS In patients with AMI, ePVS independently predicted in-hospital and long-term mortality. In addition, ePVS had an additive effect with the GRACE risk score on long-term mortality. Therefore, ePVS may be useful for identifying high-risk subjects for intensive treatment.
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Affiliation(s)
- Tsutomu Kawai
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takahisa Yamada
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Yasuhiko Sakata
- Department of Evidence-Based Cardiovascular Medicine and Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroya Mizuno
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shinichiro Suna
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoharu Dohi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takayuki Kojima
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Bolrathanak Oeun
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akihiro Sunaga
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hirota Kida
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroshi Sato
- School of Human Welfare Studies, Kwansei Gakuin University, Nishinomiya, Japan
| | - Masatsugu Hori
- Osaka Prefectural Hospital Organization Osaka International Cancer Institute, Osaka, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Shunsuke Tamaki
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Takashi Morita
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | | | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - on behalf of the Osaka Acute Coronary Insufficiency Study (OACIS) Investigators
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Evidence-Based Cardiovascular Medicine and Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
- School of Human Welfare Studies, Kwansei Gakuin University, Nishinomiya, Japan
- Osaka Prefectural Hospital Organization Osaka International Cancer Institute, Osaka, Japan
- Department of Cardiovascular Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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16
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Kobayashi M, Girerd N, Duarte K, Chouihed T, Chikamori T, Pitt B, Zannad F, Rossignol P. Estimated plasma volume status in heart failure: clinical implications and future directions. Clin Res Cardiol 2021; 110:1159-1172. [PMID: 33409701 DOI: 10.1007/s00392-020-01794-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/10/2020] [Indexed: 01/02/2023]
Abstract
Congestion is one of the main predictors of poor outcome in patients with heart failure (HF). Assessing and monitoring congestion is essential for optimizing HF therapy. Among the various available methods, serial measurements of estimated plasma volume (ePVS) using routine blood count and/or body weight (e.g., the Strauss, Duarte, Hakim formulas) may be useful in HF management. Further prospective study is warranted to determine whether ePVS can help optimize decongestion therapy (loop diuretics, mineralocorticoid receptor antagonists, SGLT2i) in various HF settings. This narrative review summarizes the recent evidence supporting the association of ePVS with clinical congestion and outcome(s) and discusses future directions for monitoring ePVS in HF.
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Affiliation(s)
- Masatake Kobayashi
- Centre d'Investigations Cliniques Plurithématique, INSERM 1433, CHRU de Nancy, Inserm 1116 and INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Université de Lorraine, Nancy, France
| | - Nicolas Girerd
- Centre d'Investigations Cliniques Plurithématique, INSERM 1433, CHRU de Nancy, Inserm 1116 and INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Université de Lorraine, Nancy, France
| | - Kevin Duarte
- Centre d'Investigations Cliniques Plurithématique, INSERM 1433, CHRU de Nancy, Inserm 1116 and INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Université de Lorraine, Nancy, France
| | - Tahar Chouihed
- Centre d'Investigations Cliniques Plurithématique, INSERM 1433, CHRU de Nancy, Inserm 1116 and INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Université de Lorraine, Nancy, France
| | | | - Bertram Pitt
- University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Faiez Zannad
- Centre d'Investigations Cliniques Plurithématique, INSERM 1433, CHRU de Nancy, Inserm 1116 and INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Université de Lorraine, Nancy, France
| | - Patrick Rossignol
- Centre d'Investigations Cliniques Plurithématique, INSERM 1433, CHRU de Nancy, Inserm 1116 and INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Université de Lorraine, Nancy, France.
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Kobayashi M, Douair A, Duarte K, Jaeger D, Giacomin G, Bassand A, Jeangeorges V, Vuillaume LA, Preud'homme G, Huttin O, Zannad F, Rossignol P, Chouihed T, Girerd N. Diagnostic performance of congestion score index evaluated from chest radiography for acute heart failure in the emergency department: A retrospective analysis from the PARADISE cohort. PLoS Med 2020; 17:e1003419. [PMID: 33175832 PMCID: PMC7657510 DOI: 10.1371/journal.pmed.1003419] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 10/14/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Congestion score index (CSI), a semiquantitative evaluation of congestion on chest radiography (CXR), is associated with outcome in patients with heart failure (HF). However, its diagnostic value in patients admitted for acute dyspnea has yet to be evaluated. METHODS AND FINDINGS The diagnostic value of CSI for acute HF (AHF; adjudicated from patients' discharge files) was studied in the Pathway of dyspneic patients in Emergency (PARADISE) cohort, including patients aged 18 years or older admitted for acute dyspnea in the emergency department (ED) of the Nancy University Hospital (France) between January 1, 2015 and December 31, 2015. CSI (ranging from 0 to 3) was evaluated using a semiquantitative method on CXR in consecutive patients admitted for acute dyspnea in the ED. Results were validated in independent cohorts (N = 224). Of 1,333 patients, mean (standard deviation [SD]) age was 72.0 (18.5) years, 686 (51.5%) were men, and mean (SD) CSI was 1.42 (0.79). Patients with higher CSI had more cardiovascular comorbidities, more severe congestion, higher b-type natriuretic peptide (BNP), poorer renal function, and more respiratory acidosis. AHF was diagnosed in 289 (21.7%) patients. CSI was significantly associated with AHF diagnosis (adjusted odds ratio [OR] for 0.1 unit CSI increase 1.19, 95% CI 1.16-1.22, p < 0.001) after adjustment for clinical-based diagnostic score including age, comorbidity burden, dyspnea, and clinical congestion. The diagnostic accuracy of CSI for AHF was >0.80, whether alone (area under the receiver operating characteristic curve [AUROC] 0.84, 95% CI 0.82-0.86) or in addition to the clinical model (AUROC 0.87, 95% CI 0.85-0.90). CSI improved diagnostic accuracy on top of clinical variables (net reclassification improvement [NRI] = 94.9%) and clinical variables plus BNP (NRI = 55.0%). Similar diagnostic accuracy was observed in the validation cohorts (AUROC 0.75, 95% CI 0.68-0.82). The key limitation of our derivation cohort was its single-center and retrospective nature, which was counterbalanced by the validation in the independent cohorts. CONCLUSIONS In this study, we observed that a systematic semiquantified assessment of radiographic pulmonary congestion showed high diagnostic value for AHF in dyspneic patients. Better use of CXR may provide an inexpensive, widely, and readily available method for AHF triage in the ED.
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Affiliation(s)
- Masatake Kobayashi
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Amine Douair
- Emergency Department, University Hospital of Nancy, Vandoeuvre-les-Nancy, France
| | - Kevin Duarte
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Déborah Jaeger
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
- Emergency Department, University Hospital of Nancy, Vandoeuvre-les-Nancy, France
| | - Gaetan Giacomin
- Emergency Department, University Hospital of Nancy, Vandoeuvre-les-Nancy, France
| | - Adrien Bassand
- Emergency Department, University Hospital of Nancy, Vandoeuvre-les-Nancy, France
| | - Victor Jeangeorges
- Emergency Department, University Hospital of Nancy, Vandoeuvre-les-Nancy, France
| | | | - Gregoire Preud'homme
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Olivier Huttin
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Faiez Zannad
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Patrick Rossignol
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Tahar Chouihed
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
- Emergency Department, University Hospital of Nancy, Vandoeuvre-les-Nancy, France
| | - Nicolas Girerd
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
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18
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Fudim M, Lerman JB, Page C, Alhanti B, Califf RM, Ezekowitz JA, Girerd N, Grodin JL, Miller WL, Pandey A, Rossignol P, Starling RC, Tang WHW, Zannad F, Hernandez AF, O'connor CM, Mentz RJ. Plasma Volume Status and Its Association With In-Hospital and Postdischarge Outcomes in Decompensated Heart Failure. J Card Fail 2020; 27:297-308. [PMID: 33038532 DOI: 10.1016/j.cardfail.2020.09.478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/27/2020] [Accepted: 09/23/2020] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Marat Fudim
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Joseph B Lerman
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Courtney Page
- Duke Clinical Research Institute, Durham, North Carolina
| | - Brooke Alhanti
- Duke Clinical Research Institute, Durham, North Carolina
| | | | | | - Nicolas Girerd
- Université de Lorraine, Centre d'Investigation Clinique Plurithématique 1433, INSERM U1116, CHRU de Nancy, FCRIN INI-CRCT, Nancy, France
| | - Justin L Grodin
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Wayne L Miller
- Division of Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Patrick Rossignol
- Université de Lorraine, Centre d'Investigation Clinique Plurithématique 1433, INSERM U1116, CHRU de Nancy, FCRIN INI-CRCT, Nancy, France
| | | | | | - Faiez Zannad
- Université de Lorraine, Centre d'Investigation Clinique Plurithématique 1433, INSERM U1116, CHRU de Nancy, FCRIN INI-CRCT, Nancy, France
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | | | - Robert J Mentz
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
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Almufleh A, Desai AS, Fay R, Ferreira JP, Buckley LF, Mehra MR, Rossignol P, Zannad F. Correlation of laboratory haemoconcentration measures with filling pressures obtained via pulmonary arterial pressure sensors in ambulatory heart failure patients. Eur J Heart Fail 2020; 22:1907-1911. [PMID: 32353199 DOI: 10.1002/ejhf.1848] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 12/28/2022] Open
Abstract
AIMS Laboratory measures of haemoconcentration correlate with invasive haemodynamics and clinical outcomes in hospitalized heart failure (HF) patients. We aimed to determine the association between haemoconcentration and haemodynamic measures in ambulatory HF patients with implantable pulmonary arterial pressure (PAP) sensors. METHODS AND RESULTS We reviewed ambulatory HF patients (n = 23) managed at the Brigham and Women's Hospital with implantable PAP sensors (CardioMEMS™, Abbott, Atlanta, GA, USA) who had sufficient data for serial haemodynamic-haemoconcentration correlation. The primary measures of interest were the absolute changes in haemoglobin and diastolic PAP at follow-up compared to baseline values (obtained at implantation). In 23 patients (median age 64 years, 57% with HF with preserved ejection fraction), 518 paired laboratory-haemodynamic measurements were evaluated. At a median follow-up of 27 (interquartile range 13-42) months, 17 (74%) patients had at least one hospitalization (59 total hospitalizations including 30 HF hospitalizations). For the population as a whole, diastolic PAP was negatively correlated with haemoglobin level (r = -0.09, P = 0.053). This negative correlation was more apparent when changes in haemoglobin and diastolic PAP were evaluated at the time of HF hospitalization compared to baseline values (r = -0.40, P = 0.029). The mean rise in diastolic PAP of 3.6 mmHg at HF hospitalization corresponded to a numerical decline of 0.6 g/dL in haemoglobin (P = 0.20). CONCLUSION Change in haemoglobin was correlated with change in diastolic PAP in ambulatory HF patients, especially at the time of HF hospitalization. These findings support the potential for investigation into the role of ambulatory monitoring of haemoglobin as an inexpensive, non-invasive tool to guide de-congestion strategies and potentially prevent HF hospitalizations.
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Affiliation(s)
- Aws Almufleh
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Renaud Fay
- Université de Lorraine, Inserm Clinical Investigation Center 1433, CHRU Nancy, Inserm U1116, FCRIN INI-CRCT, Nancy, France
| | - Joao Pedro Ferreira
- Université de Lorraine, Inserm Clinical Investigation Center 1433, CHRU Nancy, Inserm U1116, FCRIN INI-CRCT, Nancy, France
| | - Leo F Buckley
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Mandeep R Mehra
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Patrick Rossignol
- Université de Lorraine, Inserm Clinical Investigation Center 1433, CHRU Nancy, Inserm U1116, FCRIN INI-CRCT, Nancy, France
| | - Faiez Zannad
- Université de Lorraine, Inserm Clinical Investigation Center 1433, CHRU Nancy, Inserm U1116, FCRIN INI-CRCT, Nancy, France
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20
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Adedinsewo D, Carter RE, Attia Z, Johnson P, Kashou AH, Dugan JL, Albus M, Sheele JM, Bellolio F, Friedman PA, Lopez-Jimenez F, Noseworthy PA. Artificial Intelligence-Enabled ECG Algorithm to Identify Patients With Left Ventricular Systolic Dysfunction Presenting to the Emergency Department With Dyspnea. Circ Arrhythm Electrophysiol 2020; 13:e008437. [PMID: 32986471 DOI: 10.1161/circep.120.008437] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Identification of systolic heart failure among patients presenting to the emergency department (ED) with acute dyspnea is challenging. The reasons for dyspnea are often multifactorial. A focused physical evaluation and diagnostic testing can lack sensitivity and specificity. The objective of this study was to assess the accuracy of an artificial intelligence-enabled ECG to identify patients presenting with dyspnea who have left ventricular systolic dysfunction (LVSD). METHODS We retrospectively applied a validated artificial intelligence-enabled ECG algorithm for the identification of LVSD (defined as LV ejection fraction ≤35%) to a cohort of patients aged ≥18 years who were evaluated in the ED at a Mayo Clinic site with dyspnea. Patients were included if they had at least one standard 12-lead ECG acquired on the date of the ED visit and an echocardiogram performed within 30 days of presentation. Patients with prior LVSD were excluded. We assessed the model performance using area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity. RESULTS A total of 1606 patients were included. Median time from ECG to echocardiogram was 1 day (Q1: 1, Q3: 2). The artificial intelligence-enabled ECG algorithm identified LVSD with an area under the receiver operating characteristic curve of 0.89 (95% CI, 0.86-0.91) and accuracy of 85.9%. Sensitivity, specificity, negative predictive value, and positive predictive value were 74%, 87%, 97%, and 40%, respectively. To identify an ejection fraction <50%, the area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity were 0.85 (95% CI, 0.83-0.88), 86%, 63%, and 91%, respectively. NT-proBNP (N-terminal pro-B-type natriuretic peptide) alone at a cutoff of >800 identified LVSD with an area under the receiver operating characteristic curve of 0.80 (95% CI, 0.76-0.84). CONCLUSIONS The ECG is an inexpensive, ubiquitous, painless test which can be quickly obtained in the ED. It effectively identifies LVSD in selected patients presenting to the ED with dyspnea when analyzed with artificial intelligence and outperforms NT-proBNP. Graphic Abstract: A graphic abstract is available for this article.
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Affiliation(s)
| | - Rickey E Carter
- Department of Health Sciences Research (R.E.C., P.J.), Mayo Clinic, Jacksonville, FL
| | - Zachi Attia
- Division of Cardiovascular Medicine (Z.A., J.L.D., P.A.F., F.L.-J., P.A.N.), Mayo Clinic, Rochester, MN
| | - Patrick Johnson
- Department of Health Sciences Research (R.E.C., P.J.), Mayo Clinic, Jacksonville, FL
| | | | - Jennifer L Dugan
- Division of Cardiovascular Medicine (Z.A., J.L.D., P.A.F., F.L.-J., P.A.N.), Mayo Clinic, Rochester, MN
| | - Michael Albus
- Department of Emergency Medicine (M.A., J.M.S.), Mayo Clinic, Jacksonville, FL
| | - Johnathan M Sheele
- Department of Emergency Medicine (M.A., J.M.S.), Mayo Clinic, Jacksonville, FL
| | | | - Paul A Friedman
- Division of Cardiovascular Medicine (Z.A., J.L.D., P.A.F., F.L.-J., P.A.N.), Mayo Clinic, Rochester, MN
| | - Francisco Lopez-Jimenez
- Division of Cardiovascular Medicine (Z.A., J.L.D., P.A.F., F.L.-J., P.A.N.), Mayo Clinic, Rochester, MN
| | - Peter A Noseworthy
- Division of Cardiovascular Medicine (Z.A., J.L.D., P.A.F., F.L.-J., P.A.N.), Mayo Clinic, Rochester, MN
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Abensur Vuillaume L, Ferreira JP, Asseray N, Trombert-Paviot B, Montassier E, Legrand M, Girerd N, Boivin JM, Chouihed T, Rossignol P. Hypokalemia is frequent and has prognostic implications in stable patients attending the emergency department. PLoS One 2020; 15:e0236934. [PMID: 32750075 PMCID: PMC7402484 DOI: 10.1371/journal.pone.0236934] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 07/16/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Potassium disturbances are associated with adverse prognosis in patients with chronic conditions. Its prognostic implications in stable patients attending the emergency department (ED) is poorly described. AIMS This study aimed to assess the prevalence of dyskalemia, describe its predisposing factors and prognostic associations in a population presenting the ED without unstable medical illness. METHODS Post-hoc analysis of a prospective, cross-sectional, multicenter study in the ED of 11 French academic hospitals over a period of 8 weeks. All adults presenting to the ED during this period were included, except instances of self-drug poisoning, inability to complete self-medication questionnaire, presence of an unstable medical illness and decline to participate in the study. All-cause hospitalization or deaths were assessed. RESULTS A total of 1242 patients were included. The mean age was 57.2±22.3 years, 51% were female. The distribution according to potassium concentrations was: hypokalemia<4mmol/L(n = 620, 49.9%), normokalemia 4-5mmol/L(n = 549, 44.2%) and hyperkalemia >5mmol/L(n = 73, 0,6%). The proportion of patients with a kalemia<3.5mmol/L was 8% (n = 101). Renal insufficiency (OR [95% CI] = 3.56[1.94-6.52], p-value <0.001) and hemoglobin <12g/dl (OR [95% CI] = 2.62[1.50-4.60], p-value = 0.001) were associated with hyperkalemia. Female sex (OR [95% CI] = 1.31[1.03-1.66], p-value = 0.029), age <45years (OR [95% CI] = 1.69 [1.20-2.37], p-value = 0.002) and the use of thiazide diuretics (OR [95% CI] = 2.04 [1.28-3.32], p-value = 0.003), were associated with hypokalemia<4mmol/l. Two patients died in the ED and 629 (52.7%) were hospitalized. Hypokalemia <3.5mmol/L was independently associated with increased odds of hospitalization or death (OR [95% CI] = 1.47 [1.00-2.15], p-value = 0.048). CONCLUSIONS Hypokalemia is frequently found in the ED and was associated with worse outcomes in a low-risk ED population.
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Affiliation(s)
- Laure Abensur Vuillaume
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques- Plurithématique 1433, and Inserm U1116, CHRU, Nancy, France
- Emergency Departement, Regional Hospital Metz-Thionville, Metz, France
- F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France
| | - João Pedro Ferreira
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques- Plurithématique 1433, and Inserm U1116, CHRU, Nancy, France
- F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France
| | - Nathalie Asseray
- Infectious Diseases Department, Nantes University Hospital and CIC 1413, INSERM, Nantes, France
| | - Béatrice Trombert-Paviot
- Department of Public Health and Medical Informatics, University Hospital of Saint Etienne and Host Research Team SNA-EPIS, PRES Lyon, Jean Monnet University, Lyon, France
| | - Emmanuel Montassier
- F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France
- Department of Emergency Medicine, Nantes University Hospital; MiHAR lab, Université de Nantes, Nantes, France
| | - Matthieu Legrand
- APHP, Department of Anaesthesiology, Critical Care Medicine and Burn Unit, Saint Louis University Hospital, INSERM UMR-S942, INI-CRCT network and Univ Paris Diderot, Paris, France
| | - Nicolas Girerd
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques- Plurithématique 1433, and Inserm U1116, CHRU, Nancy, France
- F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France
| | - Jean-Marc Boivin
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques- Plurithématique 1433, and Inserm U1116, CHRU, Nancy, France
- F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France
| | - Tahar Chouihed
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques- Plurithématique 1433, and Inserm U1116, CHRU, Nancy, France
- F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France
- Emergency Departement, University Regional Hospital, Nancy, France
| | - Patrick Rossignol
- Université de Lorraine, Inserm, Centre d’Investigations Cliniques- Plurithématique 1433, and Inserm U1116, CHRU, Nancy, France
- F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France
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Tsioufis K, Chrysohoou C, Kariori M, Leontsinis I, Dalakouras I, Papanikolaou A, Charalambus G, Sambatakou H, Siasos G, Panagiotakos D, Tousoulis D. The mystery of "missing" visits in an emergency cardiology department, in the era of COVID-19.; a time-series analysis in a tertiary Greek General Hospital. Clin Res Cardiol 2020; 109:1483-1489. [PMID: 32506198 PMCID: PMC7275652 DOI: 10.1007/s00392-020-01682-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/28/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the era of the current COVID-19 health crisis, the aim of the present study was to explore population behavior as regards the visits in the Εmergency Cardiology department (ECD) of a tertiary General Hospital that does not hospitalize SARS-CoV-2 infected patients METHODS AND RESULTS: Daily number of visits at the EDC and admissions to Cardiology Wards and Intensive Care Unit of a tertiary General Hospital, in Athens, Greece, were retrieved from hospital's database (January 1st-April 30th 2018, 2019 and 2020). A highly significant reduction in the visits at ECD of the hospital during March and April 2020 was observed as compared with January and February of the same year (p for linear trend < ·001); in particular the number of visits was 41.1% lower in March 2020 and 32.7% lower in April 2020, as compared to January 2020. As the number of confirmed COVID-19 cases throughout the country increased (i.e., from February 26th to April 2nd) the number of visits at ECD decreased (p = 0.01), whereas, the opposite was observed in the period afterwards (p = 0.01).The number of acute Myocardial infarctions (MI) cases in March 2020 was the lowest compared to the entire three year period (p < 0·001); however, the number of acute MI cases in April 2020 was doubled as compared to March 2020, but still was lower than the preceding years (p < 0·001). CONCLUSIONS It is hard to explain the mystery of the "missing" emergency hospital visits. However, if this decline in cardiovascular disease related hospital visits is "true", it is something that needs to be rigorously studied, to learn how to keep these rates down.
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Affiliation(s)
- Konstantinos Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vass Sofias Ave, 11527, Athens, Greece.
| | - Christina Chrysohoou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vass Sofias Ave, 11527, Athens, Greece
| | - Maria Kariori
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vass Sofias Ave, 11527, Athens, Greece
| | - Ioannis Leontsinis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vass Sofias Ave, 11527, Athens, Greece
| | - Ioannis Dalakouras
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vass Sofias Ave, 11527, Athens, Greece
| | - Angelos Papanikolaou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vass Sofias Ave, 11527, Athens, Greece
| | | | - Helen Sambatakou
- 2nd Department of Internal Medicine, HIV Unit, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Gerasimos Siasos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vass Sofias Ave, 11527, Athens, Greece
| | | | - Dimitrios Tousoulis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vass Sofias Ave, 11527, Athens, Greece
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Turcato G, Zaboli A, Ciccariello L, Pfeifer N. Estimated plasma volume status (ePVS) could be an easy-to-use clinical tool to determine the risk of sepsis or death in patients with fever. J Crit Care 2020; 58:106-112. [PMID: 32422322 DOI: 10.1016/j.jcrc.2020.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/27/2020] [Accepted: 05/03/2020] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Capillary permeability can be increased in patients with sepsis. Indirect estimation of plasma volume status (ePVS) could identify more severely ill patients with fever. METHODS 1502 patients evaluated for fever at the Emergency Department (ED) of Merano General Hospital (Italy) between June 1, 2018 and May 30, 2019. The ePVS value registered on ED admission and derived from complete blood count was considered. Associations between the ePVS value and the two outcomes of the study (30-day mortality and sepsis diagnosis) were studied. RESULTS Fifty-one of 1502 patients (3.4%) died at 30 days and 5.3% (80/1502) had a diagnosis of sepsis. The median ePVS in patients who died was higher than in those who survived (6.01 dL/g vs 4.49 dL/g, p < .001). In the multivariate analysis, ePVS higher than 4.52 dL/g presented an OR of 2.717 (CI95% 1.103-6.692, p = .020) for 30-day mortality and 1.824 (CI95% 1.055-3.154, p = .030) for the diagnosis of sepsis. ePVS presented a significant improvement in reclassification of the usual evaluation of patients with fever (NRI 21.6% for 30-day mortality and NRI 19.7 for sepsis diagnosis, p < .001). CONCLUSION The ePVS value was a useful additional predictive tool to assess the severity of illness in patients with fever.
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Affiliation(s)
- Gianni Turcato
- Department of Emergency Medicine, Franz Tappeiner General Hospital of Merano, Azienda Sanitaria dell'Alto Adige, Merano, Italy.
| | - Arian Zaboli
- Department of Emergency Medicine, Franz Tappeiner General Hospital of Merano, Azienda Sanitaria dell'Alto Adige, Merano, Italy
| | - Laura Ciccariello
- Department of Emergency Medicine, Franz Tappeiner General Hospital of Merano, Azienda Sanitaria dell'Alto Adige, Merano, Italy
| | - Norbert Pfeifer
- Department of Emergency Medicine, Franz Tappeiner General Hospital of Merano, Azienda Sanitaria dell'Alto Adige, Merano, Italy
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Palazzuoli A, Ruocco G, Franci B, Evangelista I, Lucani B, Nuti R, Pellicori P. Ultrasound indices of congestion in patients with acute heart failure according to body mass index. Clin Res Cardiol 2020; 109:1423-1433. [PMID: 32296972 DOI: 10.1007/s00392-020-01642-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/02/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The inverse relationship between body mass index (BMI) and natriuretic peptide levels complicates the diagnosis of heart failure (HF) in obese patients. Assessment of congestion with ultrasound could facilitate HF diagnosis but it is unclear if any relationship exists amongst BMI, inferior vena cava (IVC) diameter and the number of B-lines. METHODS We performed a comprehensive echocardiographic evaluation within 24 h from hospital admission in patients with HF, including lung B-lines and IVC diameter, and studied their relationship with BMI and outcome. RESULTS 216 patients (median age 81 (77-86) years) were enrolled. Median number of B-lines was 31 (IQR 26-38), median IVC diameter was 23 (22-25) mm and median BNP 991 (727-1601) pg/mL. BMI was inversely correlated with B-lines (r = - 0.50, p < 0.001), but not with IVC diameter (r = - 0.04, p = 0.58). Compared to overweight patients (BMI 25-29.9 kg/m2; n = 100) or with a normal BMI (BMI < 25 kg/m2; n = 59), obese patients (BMI ≥ 30 kg/m2; n = 57) had lower B-lines [28 (24-33) vs 30 (26-35), and vs 38 (32-42), respectively; p < 0.001] but similar IVC diameter. During the first 60 days of follow-up, there were 53 primary events: 29 patients died and 24 had a HF-related hospitalisation. B-lines and IVC diameter were independently associated with an increased risk. However, B-lines were less likely to predict outcome in the subgroup of patients with a BMI ≥ 30 kg/m2. CONCLUSIONS Assessment of IVC diameter or B-lines in patients admitted with AHF identifies those at greater risk of death or HF readmission. However, assessment of B-lines might be influenced by BMI.
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Affiliation(s)
- Alberto Palazzuoli
- Department of Internal Medicine and Metabolic Diseases, Cardiology Section, Le Scotte Hospital, Viale Bracci, 53100, Siena, Italy.
| | - Gaetano Ruocco
- Department of Internal Medicine and Metabolic Diseases, Cardiology Section, Le Scotte Hospital, Viale Bracci, 53100, Siena, Italy.,Division of Cardiology, Regina Montis Regalis Hospital, Mondovì, Cuneo, Italy
| | - Beatrice Franci
- Department of Internal Medicine and Metabolic Diseases, Cardiology Section, Le Scotte Hospital, Viale Bracci, 53100, Siena, Italy
| | - Isabella Evangelista
- Department of Internal Medicine and Metabolic Diseases, Cardiology Section, Le Scotte Hospital, Viale Bracci, 53100, Siena, Italy
| | - Barbara Lucani
- Department of Internal Medicine and Metabolic Diseases, Cardiology Section, Le Scotte Hospital, Viale Bracci, 53100, Siena, Italy
| | - Ranuccio Nuti
- Department of Internal Medicine and Metabolic Diseases, Cardiology Section, Le Scotte Hospital, Viale Bracci, 53100, Siena, Italy
| | - Pierpaolo Pellicori
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK
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Rossignol P, Fay R, Girerd N, Zannad F. Daily home monitoring of potassium, creatinine, and estimated plasma volume in heart failure post-discharge. ESC Heart Fail 2020; 7:1257-1263. [PMID: 32274878 PMCID: PMC7261583 DOI: 10.1002/ehf2.12642] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/05/2020] [Accepted: 01/22/2020] [Indexed: 01/10/2023] Open
Abstract
Aims Congestive status, serum potassium, and renal function are major determinants of outcomes as well as critical elements for adjusting drug therapy in heart failure (HF) patients. This study aimed at describing the daily variations in estimated plasma volume (ePV, a surrogate of congestion computed from haemoglobin and haematocrit), blood potassium, and estimated glomerular filtration rate during 2 months post‐hospitalization for decompensated HF with reduced ejection fraction. Methods and results The study was conducted in a single tertiary referral centre. Capillary blood samples were drawn by study nurses at home (7–12 am), and haematocrit, blood haemoglobin, creatinine, and potassium were measured using an approved home‐based device (ABOTT i‐STAT) (http://ClinicalTrials.gov: NCT01655134). Among the 15 home‐monitored patients, two patients died (one suddenly), and one was readmitted for ischaemic acute pulmonary oedema, with a subsequent acute coronary syndrome, and did not have a complete 2‐month follow‐up. The 5‐day‐a‐week biological home monitoring revealed an ePV >5.5 mL/g Hb, suggestive of undiagnosed residual congestion at discharge in 3 out the 15 patients. It was possible to document a number of episodes of hyperkalaemia (>5: mean ± standard deviation: 2.2 ± 2.2 or 5.5: 1.7 ± 1.6 mmol/L), hypokalaemia (<4: 1.9 ± 2.4 or 3.5: 0.5 ± 1.2 mmol/L), worsening renal function (drop in estimated glomerular filtration rate > 20%: 1.3 ± 1.8 or 30%: 0.7 ± 1.2) and recongestion (ePV rise above 10%: 1.4 ± 1.5, 15%: 2.3 ± 2.4, 5.5 mL/g Hb: 1.8 ± 2.6) episodes indicative of clinically relevant and potentially actionable cardiorenal and electrolytic patterns. Conclusions Our findings demonstrate that a 5‐day‐a‐week home monitoring combining haemoglobin/haematocrit, potassium, and creatinine measurements was able to capture a substantial number of clinically relevant cardiorenal and electrolyte events which are frequently overlooked and potentially actionable. Whether acting on these events may help optimizing renin angiotensin aldosterone system inhibitors and diuretic therapy warrants further dedicated testing. The ongoing HERMES HF study (NCT04050904) is assessing the short‐term feasibility and safety of such a monitoring strategy, complemented by a decision support system, and generating recommendations based on ESC clinical guidelines in patients discharged after an episode of worsening heart failure with reduced ejection fraction.
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Affiliation(s)
- Patrick Rossignol
- Centre d'Investigations Cliniques-1433, Université de Lorraine, Inserm, Inserm U1116, CHU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Renaud Fay
- Centre d'Investigations Cliniques-1433, Université de Lorraine, Inserm, Inserm U1116, CHU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Nicolas Girerd
- Centre d'Investigations Cliniques-1433, Université de Lorraine, Inserm, Inserm U1116, CHU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Faiez Zannad
- Centre d'Investigations Cliniques-1433, Université de Lorraine, Inserm, Inserm U1116, CHU Nancy, F-CRIN INI-CRCT, Nancy, France
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Prognostic impact of plasma volume estimated from hemoglobin and hematocrit in heart failure with preserved ejection fraction. Clin Res Cardiol 2020; 109:1392-1401. [PMID: 32253507 DOI: 10.1007/s00392-020-01639-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/24/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Plasma volume (PV) estimated from Duarte's formula (based on hemoglobin/hematocrit) has been associated with poor prognosis in patients with heart failure (HF). There are, however, limited data regarding the association of estimated PV status (ePVS) derived from hemoglobin/hematocrit with clinical profiles and study outcomes in patients with HF and preserved ejection fraction (HFpEF). METHODS AND RESULTS Patients from North and South America enrolled in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial (TOPCAT) with available hemoglobin/hematocrit data were studied. The association between ePVS (Duarte formula and Hakim formula) and the composite of cardiovascular mortality, HF hospitalization, or aborted cardiac arrest was assessed. Among 1747 patients (age 71.6 years; males 50.1%), mean ePVS derived from Duarte formula was 4.9 ± 1.0 mL/g. Higher Duarte-derived ePVS was associated with prior HF admission, diabetes, more severe congestion, poor renal function, higher natriuretic peptide level, and E/e'. After adjustment for potential covariates including natriuretic peptide, higher Duarte-derived ePVS was associated with an increased rate of the primary outcome [highest vs. lowest ePVS quartile: adjusted-HR (95%CI) = 1.79 (1.28-2.50), p < 0.001]. Duarte-derived ePVS improved prognostic performance on top of clinical and routine variables (including natriuretic peptides) (NRI = 11, p < 0.001), whereas Hakim-derived ePVS did not (p = 0.59). The prognostic value of Duarte-derived ePVS was not modified by renal function (P interaction > 0.10 for all outcomes). CONCLUSION ePVS from Duarte's formula was associated with congestion status and improved risk stratification regardless of renal function. Our findings suggest that Duarte-derived ePVS is a useful congestion variable in patients with HFpEF.
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Scicchitano P, Massari F. Bioimpedance vector analysis in the evaluation of congestion in heart failure. Biomark Med 2020; 14:81-85. [PMID: 32053026 DOI: 10.2217/bmm-2019-0429] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Pietro Scicchitano
- Department of Cardiology, Hospital 'F. Perinei' Altamura, Altamura, Apulia, Italy.,Department of Cardiology, University 'A. Moro' Bari, Bari, Apulia, Italy
| | - Francesco Massari
- Department of Cardiology, Hospital 'F. Perinei' Altamura, Altamura, Apulia, Italy
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Estimated plasma volume and mortality: analysis from NHANES 1999-2014. Clin Res Cardiol 2020; 109:1148-1154. [PMID: 32025836 DOI: 10.1007/s00392-020-01606-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 01/20/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND While estimated plasma volume (ePV) has been studied in some diseases, such as heart failure, the relationship between ePV and all-cause or cause-specific mortality remains unexplored. Therefore, we investigated the association between ePV and all-cause, cardiovascular (CV), and cancer-related mortality among adults in the US. METHOD We used the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014 and included participants older than 18 years. Mortality data were obtained from the National Death Index and matched to the NHANES participants. ePV was derived using Strauss formula. Cox proportional hazard models were fit to estimate hazard ratios for all-cause and cause-specific mortality without and with adjustment for potential confounders. RESULTS Of the 42,705 participants, 5194 died (1121 CV deaths) during mean follow-up of 8.0 (range 0-16.7) years. Mean ± SD age and ePV of the participants were 47.2 ± 19.4 years and 4.2 ± 0.84, respectively. In unadjusted models, 1 unit increase in ePV was associated with 29%, 32%, and 16% increased risk in all-cause (HR 1.29; 95% CI 1.24, 1.35), CV (HR 1.32; 95% CI 1.22, 1.43), and cancer-related (HR 1.16; 95% CI 1.05, 1.27) mortality. Risk remained high in adjusted models (all-cause HR 1.24; 95% CI 1.18, 1.30; CV HR 1.22; 95% CI 1.11, 1.34; cancer-specific HR 1.24; 95% CI 1.10, 1.39). When comparing the highest and lowest ePV quartiles, similar results were noted (adjusted all-cause HR 1.64; 95% CI 1.45, 1.86; CV HR 1.52; 95% CI 1.19, 1.93; cancer HR 1.85; 95% CI 1.38, 2.49). CONCLUSION An increase in ePV was associated with increased all-cause and cause-specific mortality. Further studies are needed to explore the mechanism of this relationship and translation into a better outcome.
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Association of estimated plasma volume status with hemodynamic and echocardiographic parameters. Clin Res Cardiol 2020; 109:1060-1069. [PMID: 32006155 DOI: 10.1007/s00392-020-01599-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/14/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Estimated plasma volume status (ePVS) has diagnostic and prognostic value in patients with heart failure (HF). However, it remains unclear which congestion markers (i.e., biological, imaging, and hemodynamic markers) are preferentially associated with ePVS. In addition, there is evidence of sex differences in both the hematopoietic process and myocardial structure/function. METHOD AND RESULTS Patients with significant dyspnea (NYHA ≥ 2) underwent echocardiography and lung ultrasound within 4 h prior to cardiac catheterization. Patients were divided according to tertiles based on sex-specific ePVS thresholds calculated from hemoglobin and hematocrit measurements using Duarte's formula. Among the 78 included patients (median age 74.5 years; males 69.2%; HF 48.7%), median ePVS was 4.1 (percentile25-75 = 3.7-4.9) mL/g in males (N = 54) and 4.8 (4.4-5.3) mL/g in females (N = 24). Patients with the highest ePVS had more frequently HF, higher NT-proBNP, larger left atrial volume, and higher E/e' (all p values < 0.05), but no difference in inferior vena cava diameter or pulmonary congestion assessed by lung ultrasound (all p values > 0.10). In multivariable analysis, higher E/e' and lower diastolic blood pressure were significantly associated with increased ePVS. The association between ePVS and congestion variables was not sex-dependent except for left-ventricular end-diastolic pressure, which was only correlated with ePVS in females (Spearman Rho = 0.53, p < 0.01 in females and Spearman Rho = - 0.04, p = 0.76 in males; pinteraction = 0.08). CONCLUSION ePVS is associated with E/e' regardless of sex, while only associated with invasively measured left-ventricular end-diastolic pressure in females. These results suggest that ePVS is preferably associated with left-sided hemodynamic markers of congestion.
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Kobayashi M, Bercker M, Huttin O, Pierre S, Sadoul N, Bozec E, Chouihed T, Ferreira JP, Zannad F, Rossignol P, Girerd N. Chest X-ray quantification of admission lung congestion as a prognostic factor in patients admitted for worsening heart failure from the ICALOR cohort study. Int J Cardiol 2020; 299:192-198. [DOI: 10.1016/j.ijcard.2019.06.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/24/2019] [Accepted: 06/24/2019] [Indexed: 12/27/2022]
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Multiparametric approach to congestion for predicting long-term survival in heart failure. J Cardiol 2020; 75:47-52. [PMID: 31326239 DOI: 10.1016/j.jjcc.2019.05.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/27/2019] [Accepted: 05/31/2019] [Indexed: 01/30/2023]
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Shirakabe A, Asai K, Kobayashi N, Okazaki H, Matsushita M, Shibata Y, Goda H, Shigihara S, Asano K, Tani K, Kiuchi K, Hata N, Shimizu W. Prognostic Value of Both Plasma Volume Status and Nutritional Status in Patients With Severely Decompensated Acute Heart Failure. CJC Open 2019; 1:305-315. [PMID: 32159125 PMCID: PMC7063636 DOI: 10.1016/j.cjco.2019.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 10/03/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Plasma volume status (PVS) has been evaluated recently as a prognostic marker of acute heart failure (AHF). However, whether evaluating PVS alone is sufficient remains unclear. METHODS Of 675 patients with AHF screened, 601 were enrolled. The PVS, prognostic nutritional index (PNI) (lower = worse), and Controlling Nutritional Status (CONUT) score (higher = worse) were evaluated. Patients were divided into 2 groups according to PVS value (low- or high-PVS group) and were further subdivided into 4 groups (low- or high-PVS/CONUT group and low- or high-PVS/PNI group). RESULTS A Kaplan-Meier curve showed a significantly lower survival rate in the high-PVS group than in the low-PVS group, the high-PVS/high-CONUT group than in the high-PVS/low-CONUT group, and the high-PVS/low-PNI group than in the high-PVS/high-PNI group. A multivariate Cox regression model showed that high PVS (hazard ratio [HR], 1.642; 95% confidence interval [CI], 1.049-2.570) and high PVS/high CONUT (HR, 2.076; 95% CI, 1.147-3.757) and high PVS/low PNI (HR, 2.094; 95% CI, 1.166-3.761) were independent predictors of 365-day mortality. CONCLUSIONS An adverse outcome was predicted by the evaluation of PVS; furthermore, a malnutrition status with a high PVS leads to an adverse outcome. The simultaneous evaluation of nutrition status and PVS is essential to predict an AHF outcome.
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Affiliation(s)
- Akihiro Shirakabe
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Kuniya Asai
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Nobuaki Kobayashi
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Hirotake Okazaki
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Masato Matsushita
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Yusaku Shibata
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Hiroki Goda
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Shota Shigihara
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Kazuhiro Asano
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Kenichi Tani
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Kazutaka Kiuchi
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Noritake Hata
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
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The unit of Estimated Plasma Volume in Patients with Heart Failure using the Strauss-derived Duarte formula is not liter but dL/g. J Card Fail 2019; 25:140. [DOI: 10.1016/j.cardfail.2018.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/11/2018] [Indexed: 11/17/2022]
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