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Fudim M, Kittipibul V, Molinger J, Yaranov DM, Miller WL. Patient Sex Impacts Volume Phenotypes and Hemodynamics in Chronic Heart Failure: A Multicenter Analysis. J Card Fail 2024:S1071-9164(24)00201-X. [PMID: 38880247 DOI: 10.1016/j.cardfail.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/22/2024] [Accepted: 05/13/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Quantitative methods have shown clinically significant heterogeneity in blood volume (BV) profiles in patients with chronic heart failure (HF). How patients' sex might impact this volume heterogeneity and its relationship to cardiac hemodynamics remains to be defined. METHODS Retrospective analysis of clinical and quantitative BV, plasma volume (PV) and red blood cell (RBC) mass data was undertaken across 3 medical centers. BV was quantitated using nuclear medicine I-131-labeled plasma albumin indicator-dilution methodology with cardiac hemodynamics obtained within 24 hours. RESULTS In an analysis of 149 males and 106 females, absolute BV was greater, on average, in males (6.9 ± 1.7 vs 5.0 ± 1.2 liters; P < 0.001); however, a wide range in BVs was demonstrated in both sexes (2.9-14.5 liters). Male sex was associated with higher prevalence of large (+ 25% of normal) BV and PV expansions (36% vs 15% and 51% vs 21%, respectively; both P < 0.001). In contrast, female sex was associated with higher prevalence of normal total BV (44% vs 27%; P = 0.005), PV (54% vs 27%; P < 0.001), hypovolemia (23% vs 11%; P = 0.005), and true anemia (42% vs 26%; P < 0.001). Cardiac hemodynamics differed by sex, but only modest associations were demonstrated between volume profiles and cardiac filling pressures. CONCLUSIONS Findings support unique intravascular volume profiles reflecting sex-specific differences in the prevalence and distributions of total BV, PV and RBC mass profiles in patients with chronic HF. This underscores the importance of recognizing patients' sex as a significant factor influencing volume homeostasis, which needs to be taken into account to individualize volume-management strategies effectively.
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Affiliation(s)
- Marat Fudim
- Department of Medicine, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC.
| | - Veraprapas Kittipibul
- Department of Medicine, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | - Jeroen Molinger
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Dmitry M Yaranov
- Department of Cardiology, Baptist Memorial Hospital, Memphis, TN
| | - Wayne L Miller
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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Miller WL, Grill DE, Mullan BP. Comparison of Blood Volume Profiles in Heart Failure With Preserved and Reduced Ejection Fractions: Sex Makes a Difference. Circ Heart Fail 2024; 17:e010906. [PMID: 38842508 DOI: 10.1161/circheartfailure.123.010906] [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: 05/22/2023] [Accepted: 04/10/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Blood volume (BV) profiles vary markedly in patients with heart failure (HF), but how HF phenotypes and patient sex impact volume profiles remain to be explored. The aim of the study was to differentiate BV, plasma volume, and red blood cell mass profiles by phenotypes of preserved and reduced left ventricular ejection fractions and assess the impact of patient sex on profile heterogeneity. METHODS Retrospective analysis of clinical and BV data was undertaken in patients with chronic New York Heart Association II-III heart failure. BV was quantitated using the nuclear medicine indicator-dilution methodology. RESULTS A total of 530 BV analyses (360 HF with reduced ejection fraction and 170 HF with preserved ejection fraction) were identified in 395 unique patients. Absolute BV was greater in HF with reduced ejection fraction (6.7±1.8 versus 5.9±1.6 liters: P<0.001); however, large variability in frequency distribution of volume profiles was observed in both phenotypes (-22% deficit to +109% excess relative to normal volumes). HF with reduced ejection fraction was characterized by a higher prevalence of BV expansion ≥+25% of normal (39% versus 26%; P=0.003), and HF with preserved ejection fraction was characterized a by more frequent normal BV (42% versus 24%; P<0.001). Male sex in both phenotypes was associated with a larger absolute BV (7.0±1.6 versus 5.1±1.3 liters; P<0.001) and higher frequency of large BV and plasma volume expansions above normal (both P<0.001), while females in both phenotypes demonstrated a higher prevalence of normal BV and plasma volume (both P<0.001). CONCLUSIONS Findings support significant differences in BV, plasma volume, and red blood cell mass profile distributions between heart failure phenotypes, driven in large part by sex-specific factors. This underscores the importance of identifying and distinguishing individual patient volume profiles to help guide volume management strategies.
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Affiliation(s)
- Wayne L Miller
- Department of Cardiovascular Medicine (W.L.M.), Mayo Clinic, Rochester, MN
| | - Diane E Grill
- Department of Biomedical Statistics and Informatics (D.E.G.), Mayo Clinic, Rochester, MN
| | - Brian P Mullan
- Division of Diagnostic Radiology and Nuclear Medicine (B.P.M.), Mayo Clinic, Rochester, MN
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Yaku H, Fudim M, Shah SJ. Role of splanchnic circulation in the pathogenesis of heart failure: State-of-the-art review. J Cardiol 2024; 83:330-337. [PMID: 38369183 DOI: 10.1016/j.jjcc.2024.02.004] [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: 11/07/2023] [Revised: 02/07/2024] [Accepted: 02/13/2024] [Indexed: 02/20/2024]
Abstract
A hallmark of heart failure (HF), whether it presents itself during rest or periods of physical exertion, is the excessive elevation of intracardiac filling pressures at rest or with exercise. Many mechanisms contribute to the elevated intracardiac filling pressures, and notably, the concept of volume redistribution has gained attention as a cause of the elevated intracardiac filling pressures in patients with HF, particularly HF with preserved ejection fraction, who often present without symptoms at rest, with shortness of breath and fatigue appearing only during exertion. This phenomenon suggests cardiopulmonary system non-compliance and inappropriate volume distribution between the stressed and unstressed blood volume components. A substantial proportion of the intravascular blood volume is in the splanchnic vascular compartment in the abdomen. Preclinical and clinical investigations support the critical role of the sympathetic nervous system in modulating the capacitance and compliance of the splanchnic vascular bed via modulation of the greater splanchnic nerve (GSN). The GSN activation by stressors such as exercise causes excessive splanchnic vasoconstriction, which may contribute to the decompensation of chronic HF via volume redistribution from the splanchnic vascular bed to the central compartment. Accordingly, for example, GSN ablation for volume management has been proposed as a potential therapeutic intervention to increase unstressed blood volume. Here we provide a comprehensive review of the role of splanchnic circulation in the pathogenesis of HF and potential novel treatment options for redistributing blood volume to improve symptoms and prognosis in patients with HF.
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Affiliation(s)
- Hidenori Yaku
- Division of Cardiology, Department of Medicine, and Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Marat Fudim
- Duke Clinical Research Institute, Durham, NC, USA; Division of Cardiology, Department of Internal Medicine, Duke University School of Medicine, Durham, NC, USA; Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, and Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Carry BJ, Miller WL. Blood volume phenotypes and patient sex in resistant hypertension. J Hypertens 2024; 42:917-921. [PMID: 38526133 DOI: 10.1097/hjh.0000000000003688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
The relationship of blood volume (BV) to systemic blood pressure (BP) is not well defined in resistant hypertension (RH). The goal of this study was to examine the extent to which systemic BP stratified by patient sex would impact BV phenotypes. A retrospective analysis of clinical and quantitative BV data was undertaken in a cohort of ambulatory patients with a history of controlled and uncontrolled RH. We analyzed 253 unique BVs with 54% of patients above goal BP of <150 mmHg. BV phenotypes were highly variable but no correlation of systolic BP to absolute BV or percentage deviation from normal volume was identified in either sex. Males demonstrated overall larger absolute BVs with higher prevalence of large plasma volume (PV) expansion; females were overall more hypovolemic by total BV but with a higher frequency of normal PV than males. Females trended towards more RBC mass deficit (true anemia) (49% vs. 38%. P = 0.084) while more males demonstrated RBC mass excess (erythrocythemia) (21% vs. 11%, P = 0.029). Importantly, a significant portion (52%) of patients with true anemia identified by BVA would go undetected by hemoglobin measurement alone. BV phenotypes are highly diverse in patients with RH. However, absolute BV or variability in BV phenotypes even when stratified by patient sex did not demonstrate an association with systemic BP. BV phenotyping provides a key to optimizing clinical management by identifying RBC mass profiles particularly distinguishing true anemia, dilutional anemia, and erythrocythemia and the contribution of PV expansion. Findings support the clinical utility of BV phenotyping in RH.
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Affiliation(s)
- Brendan J Carry
- Heart Institute, Geisinger Medical Center, Danville, Pennsylvania
| | - Wayne L Miller
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Miller WL, Silver MA. Serial blood volume measurements in patients with compensated chronic heart failure: How do volume profiles change over time? Am J Physiol Heart Circ Physiol 2023; 325:H578-H584. [PMID: 37505467 DOI: 10.1152/ajpheart.00364.2023] [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: 06/21/2023] [Revised: 07/10/2023] [Accepted: 07/21/2023] [Indexed: 07/29/2023]
Abstract
Among patients with chronic heart failure (HF) intravascular volume profiles vary significantly despite similar clinical compensation. However, little is known regarding changes in blood volume (BV) profiles over time. The objective of this analysis was to identify the extent and character of changes in volume profiles over time. A prospective analysis was undertaken in patients who were hospitalized and treated for fluid overload. Quantitative BV analyses were obtained in a compensated state at hospital discharge (baseline) and follow-up at 1, 3, and 6 mo. Data were available on 10 patients who remained stable without rehospitalization or medication change over a 6-mo period. Baseline BV profiles were highly variable at hospital discharge with an average deviation of +28% above normal in 6 patients and normal BV in 4 patients. Over the follow-up period, the median change in BV was -201 mL [-3% (-6, +3%)] from baseline with profiles remaining in the same volume category in 9 out of 10 patients. Crossover from normal BV to mild contraction (-13% of normal) occurred in one patient. Red blood cell mass demonstrated the largest change over 6 mo [median -275 (-410, +175) mL] with a deviation from normal of -14 (-20, +8) % (reflecting mild anemia). These findings suggest that BV profiles in clinically compensated patients with HF do not change substantially over a 6-mo period regardless of baseline expanded or normal BV. This lack of change in volume profiles particularly from an expanded BV has implications for long-term volume management, clinical outcomes, and also our understanding of volume homeostasis in HF.NEW & NOTEWORTHY The novel findings of this study demonstrate that blood volume profiles while highly variable in clinically compensated patients with HF on stable medical therapy do not change substantially over a 6-mo period regardless of baseline expanded or normal blood volumes. This lack of change in volume profiles particularly from an expanded blood volume has implications for long-term volume management and also for how we understand the pathophysiology of volume homeostasis in chronic HF.
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Affiliation(s)
- Wayne L Miller
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Marc A Silver
- The Advanced Heart Failure, Transplant and MCS Program, Banner University Medical Center-Phoenix, and University of Arizona-Phoenix, Phoenix, Arizona, United States
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Miller WL. Measurement of Blood Volume in Patients with Heart Failure: Clinical Relevance, Surrogates, Historical Background and Contemporary Methodology. Heart Int 2023; 17:36-43. [PMID: 37456346 PMCID: PMC10339432 DOI: 10.17925/hi.2023.17.1.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/22/2023] [Indexed: 07/18/2023] Open
Abstract
The development of clinical congestion resulting from volume overload, either by renal fluid retention or redistribution of blood volume from venous reservoirs, is a recurrent scenario in patients with chronic heart failure (HF). As a result, the treatment of congestion, most commonly by initiating aggressive diuretic therapy, is a front-line issue in the management of patients with HF. However, the association of clinical congestion and volume overload with physical signs and symptoms, as well as other surrogates of volume assessment, has limitations in accuracy and, therefore, reliability to direct appropriate interventions. The ability to quantitate intravascular volume and identify the variability in volume profiles among patients with HF can uniquely inform individualized volume management and aid in risk stratification. This tool is provided by contemporary nuclear medicine-based BVA-100 methodology, which uses the well-established indicator-dilution principle and is a requested topic for discussion in this review.
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Affiliation(s)
- Wayne L Miller
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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Miller WL, Fudim M, Mullan BP. Blood volume and chronic kidney disease in heart failure - Can volume expansion help balance the Cardio-Renal Axis for better clinical outcomes? Physiol Rep 2022; 10:e15526. [PMID: 36461656 PMCID: PMC9718939 DOI: 10.14814/phy2.15526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/07/2022] [Accepted: 11/13/2022] [Indexed: 06/17/2023] Open
Abstract
Intravascular volume is largely regulated by the kidneys but how differences in intravascular volume profiles interact with chronic kidney disease (CKD) to influence outcomes in chronic heart failure (HF) has not been explored. Our hypothesis was that a greater degree of volume expansion (VE) would moderate the impact of CKD on HF-related clinical outcomes. Quantitative blood volume (BV) data were available in 137 patients at the time of hospital discharge using a nuclear medicine radiolabeled albumin indicator-dilution technique. The study patients were stratified by the cohort median glomerular filtration rate (GFR, 44 ml/min/1.73 m2 ). An a priori cut-point of ≥+25% above normal BV was then used to further stratify the two GFR subgroups and prospectively analyzed for 1-year HF-related mortality or 1st re-hospitalization. Persistent BV expansions ≥+25% were present in 51% of the cohort. In the subgroup with GFR above the median (N = 68) greater or lesser BV expansion from +25% did not differentiate outcomes. However, in the subgroup with GFR below the median (N = 69), BV expansion-stratified risk (log-rank p = 0.022) with <+25% VE associated with poorer outcomes, while VE ≥ + 25% was associated with lower risk and comparable to GFR above the median. In patients with chronic HF, significant intravascular VE and CKD are common co-existing conditions. The presence of larger VE, however, appears to be a factor mitigating the impact of declining renal function on clinical outcomes, and as an element of volume pathophysiology warrants further study.
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Affiliation(s)
- Wayne L. Miller
- Department of Cardiovascular MedicineMayo ClinicRochesterMinnesotaUSA
| | - Marat Fudim
- Division of CardiologyDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Brian P. Mullan
- Division of Diagnostic Radiology and Nuclear MedicineMayo ClinicRochesterMinnesotaUSA
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Miller WL, Strobeck JE, Grill DE, Mullan BP. Blood volume expansion, normovolemia, and clinical outcomes in chronic human heart failure: more is better. Am J Physiol Heart Circ Physiol 2021; 321:H1074-H1082. [PMID: 34676782 PMCID: PMC9095049 DOI: 10.1152/ajpheart.00336.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Expansion in blood volume (BV) is a well-recognized response to arterial underfilling secondary to impaired cardiac output in heart failure (HF). However, the effectiveness of this response in terms of outcomes remains inadequately understood. Prospective analysis was undertaken in 110 patients with HF hospitalized and treated for fluid overload. BVs were measured in a compensated state at the hospital discharge using the indicator-dilution methodology. Data were analyzed for composite 1-year HF-related mortality/first rehospitalization. Despite uniform standard of care, marked heterogeneity in BVs was identified across the cohort. The cohort was stratified by BV expansion greater than or equal to +25% above normal (51% of cohort), mild-moderate expansion (22%), and normal BV (27%). Kaplan-Meier (K-M) survival estimates and regression analyses revealed BV expansion (greater than or equal to +25%) to be associated with better event-free survival relative to normal BV (P = 0.038). Increased red blood cell mass (RBCm; RBC polycythemia) was identified in 43% of the overall cohort and 70% in BV expansion greater than or equal to +25%. K-M analysis demonstrated polycythemia to be associated with better outcomes compared with normal RBCm (P < 0.002). Persistent BV expansion to include RBC polycythemia is common and, importantly, associated with better clinical outcomes compared with normal total BV or normal RBCm in patients with chronic HF. However, compensatory BV expansion is not a uniform physiological response to the insult of HF with marked variability in BV profiles despite uniform standard of care diuretic therapy. Therefore, recognizing the variability in volume regulation pathophysiology has implications not only for impact on clinical outcomes and risk stratification but also potential for informing individualized volume management strategies.NEW & NOTEWORTHY The novel findings of this study demonstrate that intravascular volume profiles among the patients with chronic heart failure (HF) vary substantially even with similar clinical compensation. Importantly, a profile of blood volume (BV) expansion (compared with a normal BV) is associated with lower HF mortality/morbidity. Furthermore, RBC polycythemia is common and independently associated with improved outcomes. These observations support BV expansion with RBC polycythemia as a compensatory mechanism in chronic HF.
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Affiliation(s)
- Wayne L Miller
- Department of Cardiovascular Medicine, Heart-Lung Center, Hawthorne, New Jersey
| | | | - Diane E Grill
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Brian P Mullan
- Division of Diagnostic Radiology, Mayo Clinic, Rochester, Minnesota
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9
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Ricci F, Khanji MY. Harnessing Artificial Intelligence for Quantitative Assessment of Hemodynamic Congestion and Predicting Outcomes. JACC Cardiovasc Imaging 2021; 14:2120-2122. [PMID: 34147449 DOI: 10.1016/j.jcmg.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/10/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Department of Clinical Sciences, Lund University, Malmö, Sweden; Casa di Cura Villa Serena, Città Sant'Angelo, Pescara, Italy.
| | - Mohammed Y Khanji
- Newham University Hospital, Barts Health NHS Trust, London, United Kingdom; Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
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Elhassan MG, Chao PW, Curiel A. The Conundrum of Volume Status Assessment: Revisiting Current and Future Tools Available for Physicians at the Bedside. Cureus 2021; 13:e15253. [PMID: 34188992 PMCID: PMC8231469 DOI: 10.7759/cureus.15253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Assessment of patients’ volume status at the bedside is a very important clinical skill that physicians need in many clinical scenarios. Hypovolemia with hypotension and tissue under-perfusion are usually more alarming to physicians, but hypervolemia is also associated with poor outcomes, making euvolemia a crucial goal in clinical practice. Nevertheless, the assessment of volume status can be challenging, especially in the absence of a gold standard test that is reliable and easily accessible to assist with clinical decision-making. Physicians need to have a broad knowledge of the individual non-invasive clinical tools available for them at the bedside to evaluate volume status. In this review, we will discuss the strengths and limitations of the traditional tools, which include careful history taking, physical examination, and basic laboratory tests, and also include the relatively new tool of point-of-care ultrasound.
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Affiliation(s)
| | - Peter W Chao
- Internal Medicine, Saint Agnes Medical Center, Fresno, USA
| | - Argenis Curiel
- Internal Medicine, Saint Agnes Medical Center, Fresno, USA
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Diuresis-Related Weight Loss Reflects Interstitial Compartment Decongestion with Minimal Impact on Intravascular Volume Expansion or Outcomes in Post-Acute Heart Failure: Metrics of Decongestion and Volume Status. J Card Fail 2021; 27:445-452. [PMID: 33347996 DOI: 10.1016/j.cardfail.2020.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/20/2020] [Accepted: 12/08/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Findings from heart failure (HF) studies linking diuresis-related weight loss to clinical decongestion and outcomes are mixed. Differential responses of interstitial and intravascular volume compartments to diuretic therapy and heterogeneity in volume profiles may confound the clinical interpretation of weight loss in patients with HF. METHODS AND RESULTS Data were prospectively collected in hospitalized patients requiring diuresis. Plasma volume (PV) was measured using I-131-labelled albumin indicator-dilution methodology. The cohort was stratified by tertiles of weight loss and analyzed for interstitial fluid loss relative to changes in PV and HF-related morality or first rehospitalization. Among 92 patients, the admission PV was expanded +42% (4.7 ± 1.2 L) above normal with significant variability (14% normal PV, 18% mild-moderate expansion, and 68% with large PV expansion [>+25% above normal]). With diuresis there were proportional decreases in interstitial volume (-6.5 ± 4.4%) and PV (-7.5 ± 11%); however, absolute decreases in the PV (-254 mL, interquartile range -11 to -583 mL) were less than 10% of interstitial volume loss (-5040 mL, interquartile range -2800 to -7989 mL); greater interstitial fluid loss did not translate into better outcomes (log-rank P = .430). CONCLUSIONS Diuresis-related decreases in weight reflect fluid loss from the interstitial compartment with only minor changes in the PV and without an impact on outcomes. Further, the degree of PV expansion at hospital admission does not drive the magnitude of the diuresis response, even with a wide spectrum of body weights; interstitial fluid overload is preferentially targeted and PV relatively preserved. Therefore, greater interstitial fluid loss reflects clinical decongestion, but not better outcomes, and a limited association with intravascular volume profiles potentially confounding weight loss as a prognostic metric in HF.
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Molitoris BA, George AG, Murray PT, Meier D, Reilly ES, Barreto E, Sandoval RM, Rizk DV, Shaw AD, Peacock WF. A Novel Fluorescent Clinical Method to Rapidly Quantify Plasma Volume. Cardiorenal Med 2019; 9:168-179. [PMID: 30844821 PMCID: PMC7175413 DOI: 10.1159/000496480] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/28/2018] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES To determine the performance of a rapid fluorescent indicator technique for measuring plasma volume (PV). METHODS This was an open-label, observational evaluation of a two-component intravenous visible fluorescent dye technique to rapidly measure PV in 16 healthy subjects and 16 subjects with chronic kidney disease (8 stage 3 and 8 stage 4 CKD), at 2 clinical research sites. The method consisted of a single intravenous injection of 12 mg of a large 150-kDa carboxy-methyl dextran conjugated to a fluorescent rhodamine-derived dye as the PV marker (PVM), and 35 mg of a small 5-kDa carboxy-methyl dextran conjugated to fluorescein, the renal clearance marker. Dye concentrations were quantified 15 min after the injections for initial PV measurements using the indicator-dilution principle. Additional samples were taken over 8 h to evaluate the stability of the PVM as a determinant of PV. Blood volumes (BV) were calculated based on PV and the subject's hematocrit. Pharmacokinetic parameters were calculated from the plasma concentration data taken over several days using noncompartmental methods (Phoenix WinNonlin®). Linear correlation and Bland-Altman plots were used to compare visible fluorescent injectate-measured PV compared to Nadler's formula for estimating PV. Finally, 8 healthy subjects received 350 mL infusion of a 5% albumin solution in normal saline over 30 min and a repeat PV determination was then carried out. RESULTS PV and BV varied according to weight and body surface area, with PV ranging from 2,115 to 6,234 mL and 28.6 to 41.9 mL/kg when weight adjusted. Both parameters were stable for > 6 h with repeated plasma measurements of the PVM. There was no difference between healthy subjects and CKD subjects. Overall, there was general agreement with Nadler's estimation formula for the mean PV in subjects. A 24-h repeat dose measurement in 8 healthy subjects showed PV variability of 98 ± 121 mL (mean = 3.8%). Additionally, following an intravenous bolus of 350 mL of a 5% albumin solution in normal saline in 8 healthy subjects, the mean (SD) measured increase in PV was 356 (±50.0) mL post-infusion. There were no serious adverse events reported during the study. CONCLUSIONS This minimally invasive fluorescent dye approach safely allowed for rapid, accurate, and reproducible determination of PV, BV, and dynamic monitoring of changes following fluid administration.
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Affiliation(s)
- Bruce A Molitoris
- Indiana University, Indianapolis, Indiana, USA,
- FAST BioMedical, Carmel, Indiana, USA,
| | - Anthony G George
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | | | - Ruben M Sandoval
- Indiana University, Indianapolis, Indiana, USA
- FAST BioMedical, Carmel, Indiana, USA
| | - Dana V Rizk
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andrew D Shaw
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada
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Malha L, Fattah H, Modersitzki F, Goldfarb DS. Blood volume analysis as a guide for dry weight determination in chronic hemodialysis patients: a crossover study. BMC Nephrol 2019; 20:47. [PMID: 30744587 PMCID: PMC6371522 DOI: 10.1186/s12882-019-1211-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Volume overload and depletion both lead to high morbidity and mortality. Achieving euvolemia is a challenge in patients with end stage kidney disease on hemodialysis (HD). Blood volume analysis (BVA) uses radiolabeled albumin to determine intravascular blood volume (BV). The measured BV is compared to an ideal BV (validated in healthy controls). We hypothesized that BVA could be used in HD to evaluate the adequacy of the current clinically prescribed "estimated dry weight" (EDW) and to titrate EDW in order to improve overall volume status. We were also interested in the reproducibility of BVA results in end stage kidney disease. METHODS Twelve adults on chronic HD were recruited; 10 completed the study. BVA (Daxor, New York, NY, USA) was used to measure BV at baseline. EDW was kept the same if the patient was deemed to be euvolemic by BVA otherwise, the prescribed EDW was changed with the aim that measured BV would match ideal BV. A second BVA measurement was done 1-3 months later in order to measure BV again. RESULTS Based on BVA, 6/10 patients were euvolemic at baseline and 5/10 were euvolemic at the second measurement. When comparing patients who had their prescribed EDW changed after the initial BVA to those who did not, both groups had similar differences between measured and ideal BV (P = 0.75). BV values were unchanged at the second measurement (P = 0.34) and there was no linear correlation between BV change and weight change (r2 = 0.08). CONCLUSIONS This pilot study is the first longitudinal measurement of BVA in HD patients. It revealed that changing weight did not proportionally change intravascular BV. BV remained stable for 1-3 months. BVA may not be helpful in clinically stable HD patients but studies on patients with hemodynamic instability and uncertain volume status are needed. TRIAL REGISTRATION ClinicalTrials.gov (NCT02717533), first registered February 4, 2015.
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Affiliation(s)
- Line Malha
- Nephrology and Hypertension Division, Weill-Cornell Medicine, 424 East 70th street, New York, NY, 10021, USA
| | - Hasan Fattah
- Nephrology Division, University of Kentucky, UK Transplant Center, 740 S. Limestone, 3rd fl, suite K348, Lexington, KY, 40536, USA
| | - Frank Modersitzki
- Nephrology Section, New York Harbor VA Healthcare System, Nephrology Section/111G, 423 East. 23 St., New York, NY, 10010, USA
| | - David S Goldfarb
- Nephrology Division, NYU School of Medicine and NYU Langone Medical Center, New York University School of Medicine, 423 E. 23 St., New York, NY, USA.
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Plasma Volume Is Normal but Heterogeneously Distributed, and True Anemia Is Highly Prevalent in Patients With Stable Heart Failure. J Card Fail 2017; 23:138-144. [DOI: 10.1016/j.cardfail.2016.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 08/03/2016] [Accepted: 08/19/2016] [Indexed: 11/20/2022]
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Kataoka H. Vascular expansion during worsening of heart failure: Effects on clinical features and its determinants. Int J Cardiol 2016; 230:556-561. [PMID: 28062134 DOI: 10.1016/j.ijcard.2016.12.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 11/11/2016] [Accepted: 12/16/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND This study investigated the relation of the changes in serum solutes/albumin to the level of vascular expansion and clinical features during worsening HF. METHODS Data from 47 patients with acute on chronic HF worsening were analyzed. Blood tests included hemoglobin, hematocrit, albumin, solutes (Na/K/Cl/BUN/Cr), and b-type natriuretic peptide (BNP). The relative change in the vascular expansion from stable to worsening HF was estimated based on changes in the plasma volume (%PV). RESULTS When divided into two groups based on the median %PV, the clinical features of the expansion group (11≤%PV [range 11% to 36%]; n=24) included a lower incidence of crackles (13% vs. 52%, p=0.005) and a tendency toward preserved renal function (83% vs. 57%, p=0.06) compared with the non-expansion group (%PV [range -19% to 11%]<11; n=23), whereas the increase in body weight and log BNP did not differ between groups. The expansion group had a greater increase in serum Na (3.58±4.43 vs. -0.11±3.31mEq/L, p=0.0016) and Cl (5.54±6.24 vs. -0.03±4.18mEq/L, p=0.0006), and a decrease in serum albumin (-0.37±0.3 vs. -0.16±0.3g/dL, p=0.04) and creatinine (-0.28±0.39 vs. -0.06±0.22mg/dL, p=0.027) from stability to worsening HF. Multivariate logistic regression analysis revealed an independent association between the increase in %PV and the increase in the serum Cl concentration from stability to worsening HF (odds ratio: 12.2, 95% confidence interval: 1.78-83.8, p=0.011). CONCLUSIONS Though this study is observational and does not allow for causal inference, it may nonetheless be speculated that a greater accumulation of Cl in the blood vessels acts to increase or maintain intravascular volume, which induces different clinical features of HF.
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Affiliation(s)
- Hajime Kataoka
- Internal Medicine, Nishida Hospital, Tsuruoka-Nishi-Machi 2-266, Saiki-City, Oita 876-0047, Japan..
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Saporito S, Dovancescu S, Herold IHF, van den Bosch HCM, van Assen HC, Aarts RM, Korsten HHM, Mischi M. Comparison of cardiac magnetic resonance imaging and bio-impedance spectroscopy for the assessment of fluid displacement induced by external leg compression. Physiol Meas 2016; 38:15-32. [DOI: 10.1088/1361-6579/38/1/15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Model-Based Characterization of the Transpulmonary Circulation by Dynamic Contrast-Enhanced Magnetic Resonance Imaging in Heart Failure and Healthy Volunteers. Invest Radiol 2016; 51:720-727. [DOI: 10.1097/rli.0000000000000304] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Miller WL. Assessment and Management of Volume Overload and Congestion in Chronic Heart Failure: Can Measuring Blood Volume Provide New Insights? KIDNEY DISEASES 2016; 2:164-169. [PMID: 28232933 DOI: 10.1159/000450526] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 09/01/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Volume overload and fluid congestion remain primary clinical challenges in the assessment and management of patients with chronic heart failure (HF). SUMMARY The pathophysiology of volume regulation is complex, and the simple concept of passive intravascular fluid accumulation is not adequate. The dynamics of interstitial and intravascular fluid compartment interactions and fluid redistribution from venous splanchnic beds to the central pulmonary circulation need to be taken into account in strategies of volume management. Clinical bedside evaluations and right heart hemodynamic assessments can alert of changes in volume status, but only the quantitative measurement of total blood volume can help identify the heterogeneity in plasma volume and red blood cell mass that are features of volume overload in chronic HF. The quantitative assessment of intravascular volume is an effective tool to help guide individualized, appropriate therapy. KEY MESSAGE Not all volume overload is the same, and the measurement of intravascular volume identifies heterogeneity to guide tailored therapy.
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Affiliation(s)
- Wayne L Miller
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn., USA
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Abstract
Volume regulation, assessment, and management remain basic issues in patients with heart failure. The discussion presented here is directed at opening a reassessment of the pathophysiology of congestion in congestive heart failure and the methods by which we determine volume overload status. Peer-reviewed historical and contemporary literatures are reviewed. Volume overload and fluid congestion remain primary issues for patients with chronic heart failure. The pathophysiology is complex, and the simple concept of intravascular fluid accumulation is not adequate. The dynamics of interstitial and intravascular fluid compartment interactions and fluid redistribution from venous splanchnic beds to central pulmonary circulation need to be taken into account in strategies of volume management. Clinical bedside evaluations and right heart hemodynamic assessments can alert clinicians of changes in volume status, but only the quantitative measurement of total blood volume can help identify the heterogeneity in plasma volume and red blood cell mass that are features of volume overload in patients with chronic heart failure and help guide individualized, appropriate therapy—not all volume overload is the same.
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Affiliation(s)
- Wayne L. Miller
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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Miller WL, Mullan BP. Volume Overload Profiles in Patients With Preserved and Reduced Ejection Fraction Chronic Heart Failure. JACC-HEART FAILURE 2016; 4:453-9. [DOI: 10.1016/j.jchf.2016.01.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/12/2016] [Accepted: 01/13/2016] [Indexed: 12/17/2022]
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Erpicum M, Dardenne N, Hans G, Larbuisson R, Defraigne JO. Prediction of the post-dilution hematocrit during cardiopulmonary bypass. Are new formulas needed? Perfusion 2015; 31:458-64. [PMID: 26685001 DOI: 10.1177/0267659115623357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Predicting the post-dilution hematocrit is an important tool to avoid preventable anemia or unnecessary transfusion. Simplified empirical formulas currently used for such a prediction may lead to large errors. We aimed to improve the accuracy of these formulas by a better estimation of the dilution volume and the patient circulatory blood volume. METHODS We compared the estimation accuracy of two formulas, using fixed (formula A) versus estimated (formula D) dilution volume and patient circulatory blood volume for 100 cardiac interventions. The difference between predicted and measured HctT1 was considered as "good" if less than 0.5%, "moderate" between 0.5 and 2% and "poor" if higher than 2%. The influence of the body mass index (BMI) on patient blood volume estimation was explored by categorized groups' comparison. RESULTS The mean difference between predicted and measured HctT1 differed significantly between formulas A and D. Formula A didn't differ from HctT1 (p=0.19, IC95% [-0.89-0.18]), but a significant and higher underestimation was observed in the BMI⩽25 group compared to the other BMI groups (p<0.001). Formula D overestimated HctT1 (p<0.001, IC95% [1.01-1.93]) without a difference between the BMI groups. No difference was observed in their overall proportions of good (11 vs 10%), moderate (44 vs 46%) and poor predictions (47 vs 44%) (p=0.117). CONCLUSIONS Formulas used for post-dilution hematocrit prediction lead to major estimation errors and a risk of inadequate transfusion practices. Estimations performed by experienced clinicians could not minimize these biases in all clinical cases as significant errors remain, with potential clinical impact. No estimation formula should be used as a hard tool for transfusing patients, but rather as a guide to predicting the probability of transfusion requirement.
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Affiliation(s)
- Marie Erpicum
- Department of Cardiovascular and Thoracic Surgery, University Hospital of Liege, Liege, Belgium
| | - Nadia Dardenne
- Support Unit in Epidemiology and Biostatistics, University of Liege, Liege, Belgium
| | - Grégory Hans
- Department of Anaesthesiology, University Hospital of Liege, Liege, Belgium
| | - Robert Larbuisson
- Department of Anaesthesiology, University Hospital of Liege, Liege, Belgium
| | - Jean-Olivier Defraigne
- Department of Cardiovascular and Thoracic Surgery, University Hospital of Liege, Liege, Belgium
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Miller WL, Mullan BP. Peripheral Venous Hemoglobin and Red Blood Cell Mass Mismatch in Volume Overload Systolic Heart Failure: Implications for Patient Management. J Cardiovasc Transl Res 2015; 8:404-10. [DOI: 10.1007/s12265-015-9650-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 08/27/2015] [Indexed: 10/23/2022]
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Saporito S, Herold IHF, Houthuizen P, van den Bosch HCM, Korsten HHM, van Assen HC, Mischi M. Automatic indicator dilution curve extraction in dynamic-contrast enhanced imaging using spectral clustering. Phys Med Biol 2015; 60:5225-40. [DOI: 10.1088/0031-9155/60/13/5225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Hilberath JN, Thomas ME, Smith T, Jara C, Fitzgerald DJ, Wilusz K, Liu X, Muehlschlegel JD. Blood volume measurement by hemodilution: association with valve disease and re-evaluation of the Allen Formula. Perfusion 2014; 30:305-11. [PMID: 25125291 DOI: 10.1177/0267659114547250] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Total blood volume (TBV) assessment is central to the management of cardiac surgical patients with cardiopulmonary bypass (CPB). The widely accepted Allen Formula lacks accuracy in estimating TBV in these patients. Moreover, the impact of commonly encountered cardiac disease states on TBV has not been systematically investigated. The aim of this study was to determine TBV by hemodilution (TBVHD) for patients with valve disease, compare TBVHD to algorithms frequently used during cardiac surgery and to modify the Allen Formula to better fit today's patient population. METHODS TBVHD was prospectively measured upon initiation of CPB. Ninety-six patients were grouped into 4 cohorts by preoperative diagnosis and compared to Allen and weight-based formulae in a univariate analysis: mitral regurgitation (MR), coronary artery disease requiring bypass surgery (CABG) and aortic stenosis (AS) ± CABG. The independent effects of height and weight on TBV were correlated to the original Allen Formula by multiple linear regression. RESULTS Patients with MR had significantly larger TBVHD compared to patients with AS, CABG or both. The smallest TBVHD was found in the patients with AS and CABG. The modified Allen Formula had an excellent model fit (R(2) = 0.88 and R(2) = 0.95 for males and females, respectively; p<0.001) while the classic formula overestimated TBV by 30% in males and females. For males, height impacted TBV calculations the most whereas weight was the predominant determinant in females. CONCLUSION Blood volume assessment via the Allen Formula or bodyweight overestimated TBV in cardiac surgical patients, with potential implications on their management. The assumption that MR frequently presents with increased intravascular volume was confirmed whereas AS patients with coronary disease had a relatively smaller TBV. Lastly, a modified Allen Formula to better reflect today's patient population was derived to reproducibly improve accuracy in mathematical estimates of TBV.
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Affiliation(s)
- J N Hilberath
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - M E Thomas
- Department of Anesthesiology, Warren Alpert School of Medicine, Rhode Island Hospital, Providence, USA
| | - T Smith
- Department of Cardiac Perfusion, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - C Jara
- Department of Cardiovascular Perfusion, Duke University Medical Center, Durham, USA
| | - D J Fitzgerald
- Department of Cardiac Perfusion, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - K Wilusz
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - X Liu
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - J D Muehlschlegel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
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Understanding the Heterogeneity in Volume Overload and Fluid Distribution in Decompensated Heart Failure Is Key to Optimal Volume Management. JACC-HEART FAILURE 2014; 2:298-305. [DOI: 10.1016/j.jchf.2014.02.007] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 01/28/2014] [Accepted: 02/03/2014] [Indexed: 11/22/2022]
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Brain-type natriuretic peptide and right ventricular end-diastolic volume index measurements are imprecise estimates of circulating blood volume in critically ill subjects. J Trauma Acute Care Surg 2014; 75:813-8. [PMID: 24158199 DOI: 10.1097/ta.0b013e3182a85f3a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Surrogate indicators have often been used to estimate intravascular volume to guide fluid management. Brain-type natriuretic peptide (BNP) has been used as a noninvasive adjunct in the diagnosis of fluid overload and as a marker of response to therapy, especially in individuals with congestive heart failure. Similarly, right ventricular end-diastolic volume index (RVEDVI) measurements represent another parameter used to guide fluid resuscitation. The aim of this study was to evaluate whether BNP and RVEDVI are clinically valuable parameters that can distinguish among hypovolemia, euvolemia, and hypervolemia, as measured by blood volume (BV) analysis in critically ill surgical subjects. METHODS This observational study was part of a prospective, randomized controlled trial. Subjects with pulmonary artery catheters for the treatment of traumatic injuries, severe sepsis/septic shock, cardiovascular collapse, adult respiratory distress syndrome, and postsurgical care were studied. Circulating BV was measured by a radioisotope dilution technique using the BVA-100 Analyzer (Daxor Corporation, New York, NY) within the first 24 hours of acute resuscitation. BV results were reported as percent deviation from the patient's ideal BV based on height and percent deviation from optimum weight. Hypovolemia was defined as less than 0%, euvolemia was defined as 0% to +16%, and hypervolemia was defined as greater than +16% deviation from ideal BV. RVEDVI was measured by continuous cardiac output pulmonary artery catheters (Edwards Lifesciences, Irvine, CA). BNP and RVEDVI measurements obtained with BV analysis were evaluated with Fisher's exact test and regression analysis. RESULTS In 81 subjects, there was no difference in BV status between those with BNP of 500 pg/mL or greater and BNP of less than 500 pg/mL (p = 0.82) or in those with RVEDVI of 140 mL/m or greater and RVEDVI of less than 140 mL/m (p = 0.43). No linear relationship existed between BV and these parameters. CONCLUSION In critically ill surgical patients, BNP and RVEDVI were not associated with intravascular volume status, although they may be useful as indices that reflect increased cardiac preload. LEVEL OF EVIDENCE Diagnostic study, level III.
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Abstract
The method for determining blood volume has evolved substantially since first attempts were made in the latter part of the nineteenth century with the exsanguination of animals. The now accepted methods are based on indicator dilution methodologies. First attempts utilized inert dyes such as Evans Blue and Cardiogreen. These were found to be impractical due, primarily, to their rapid clearance from the blood. For many years, the most accepted method for blood volume determination was the dual isotope technique. This procedure utilizes chromium 51 or 99mTc to label autologous red cells and radioiodine 125 or 131 to label human serum albumin (HSA). Plasma and red cell volumes are measured separately and the results "combined". The procedure requires on-site labeling of autologous red cells and HSA, and meticulous preparation of standards and doses. The complexity of this method leads to performance times of 6 to 8 hours. An FDA-approved single isotope method is now employed in over 60 major institutions. HSA is labeled with radioiodine 131 at an FDA radiopharmaceutical facility, and test doses and standards are provided to laboratories in kit form. The red cell volume is derived by a calculation utilizing the measured plasma volume and the value for the average whole-body hematocrit. All calculations are carried out by a dedicated microprocessor, and a final report is generated and printed. The results are compared with predicted normal values for male and female patients based on percentage deviation from normal weight. Preliminary results are available in 30 minutes and complete calculations in 90 minutes.
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Affiliation(s)
- Donald Margouleff
- Division of Nuclear Medicine, Department of Medicine, North Shore University Hospital, Manhasset, NY, USA.
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Henriksen UL, Henriksen JH, Bendtsen F, Møller S. 99mTc-labelled human serum albumin cannot replace125I-labelled human serum albumin to determine plasma volume in patients with liver disease. Clin Physiol Funct Imaging 2012; 33:211-7. [DOI: 10.1111/cpf.12015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 11/28/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Ulrik Lütken Henriksen
- Clinical Physiology and Nuclear Medicine 239; Center of Functional and Diagnostic Imaging and Research; Hvidovre Hospital; University of Copenhagen; Copenhagen; Denmark
| | - Jens H. Henriksen
- Clinical Physiology and Nuclear Medicine 239; Center of Functional and Diagnostic Imaging and Research; Hvidovre Hospital; University of Copenhagen; Copenhagen; Denmark
| | - Flemming Bendtsen
- Faculty of Health Sciences; Department of Gastroenterology 439; Hvidovre Hospital; University of Copenhagen; Copenhagen; Denmark
| | - Søren Møller
- Clinical Physiology and Nuclear Medicine 239; Center of Functional and Diagnostic Imaging and Research; Hvidovre Hospital; University of Copenhagen; Copenhagen; Denmark
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Wang H, Shi R, Mahler S, Gaspard J, Gorchynski J, D'Etienne J, Arnold T. Vascular pedicle width on chest radiograph as a measure of volume overload: meta-analysis. West J Emerg Med 2012; 12:426-32. [PMID: 22224132 PMCID: PMC3236159 DOI: 10.5811/westjem.2011.3.2023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 01/19/2011] [Accepted: 03/28/2011] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Vascular pedicle width (VPW), a measurement obtained from a chest radiograph (CR), is thought to be an indicator of circulating blood volume. To date there are only a handful of studies that demonstrate a correlation between high VPW and volume overload, each utilizing different VPW values and CR techniques. Our objective was to determine a mean VPW measurement from erect and supine CRs and to determine whether VPW correlates with volume overload. METHODS MEDLINE database, Web of Science, and the Cochrane Central Register of Controlled Trials were searched electronically for relevant articles. References from the original and review publications selected electronically were manually searched for additional relevant articles. Two investigators independently reviewed relevant articles for inclusion criteria and data extraction. Mean VPW measurements from both supine and erect CRs and their correlation with volume overload were calculated. RESULTS Data from 8 studies with a total of 363 subjects were included, resulting in mean VPW measurements of 71 mm (95% confidence interval [CI] 64.9-77.3) and 62 mm (95% CI 49.3-75.1) for supine and erect CRs, respectively. The correlation coefficients for volume overload and VPW were 0.81 (95% CI 0.74-0.86) for both CR techniques and 0.81 (95% CI 0.72-0.87) for supine CR and 0.80 (95% CI 0.69-0.87) for erect CR, respectively. CONCLUSION There is a clinical and statistical correlation between VPW and volume overload. VPW may be used to evaluate the volume status of a patient regardless of the CR technique used.
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Affiliation(s)
- Hao Wang
- JPS Health Network, Department of Emergency Medicine, Fort Worth, Texas
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Bonfils PK, Damgaard M, Stokholm KH, Nielsen SL. 99mTc-albumin can replace 125I-albumin to determine plasma volume repeatedly. Scandinavian Journal of Clinical and Laboratory Investigation 2012; 72:447-51. [PMID: 22646079 DOI: 10.3109/00365513.2012.688856] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Plasma volume assessment may be of importance in several disorders. The purpose of the present study was to compare the reliability of plasma volume measurements by technetium-labeled human serum albumin ((99m)Tc-HSA) with a simultaneously performed plasma volume determination with iodine-labeled human serum albumin ((125)I-HSA). MATERIALS AND METHODS In 15 healthy volunteers, simultaneous plasma volume measurements with (99m)Tc-HSA and (125)I-HSA were performed after ½ hour in the supine position. Blood samples were obtained 10, 15, 20, and 30 minutes after the injection for accurate retropolation from the plasma counts to time zero to correct for leakage of the isotopes from the circulation. RESULTS The mean difference (bias) between plasma volume measured with (125)I-albumin and (99m)Tc-albumin was 8 ml (0.1 ml/kg) with limits of agreement (bias ±1.96 SD) ranging from -181-196 ml (-2.3-2.5 ml/kg). The tracer disappearance rate was significantly higher with (99m)Tc-albumin (-23.1±7.1%/h) than with (125)I-albumin (-6.7±3.6%/h) (p <0.001). CONCLUSION This study demonstrates that (99m)Tc-HSA can replace (125)I-HSA for single measurements of plasma volume in healthy volunteers. It needs to be emphasized however, that repeated blood sampling for 1/2 hour after injection of the tracer is required to correct for the disappearance of (99m)Tc and (99m)Tc-HSA from the circulation.
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Affiliation(s)
- Peter K Bonfils
- Department of Clinical Physiology and Nuclear Medicine, Koege Hospital, Koege, Denmark. p_bonfi
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A prospective randomized trial using blood volume analysis in addition to pulmonary artery catheter, compared with pulmonary artery catheter alone, to guide shock resuscitation in critically ill surgical patients. Shock 2011; 35:220-8. [PMID: 20926981 DOI: 10.1097/shk.0b013e3181fc9178] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Measurement of blood volume (BV) may guide fluid and red blood cell management in critically ill patients when capillary leak from shock and fluid resuscitation makes assessment of intravascular volume difficult. This is a prospective randomized trial of critically ill surgical patients with septic shock, severe sepsis, severe respiratory failure, and/or cardiovascular collapse. The control group received fluid management based on pulmonary artery catheter parameters and red blood cell transfusions based on hematocrit values. The BV group received fluid and red blood cell transfusions based on BV analyses in addition to pulmonary artery catheter parameters. Blood volume was measured using the radioisotope tracer technique with iodine 131-labeled albumin. This allowed direct measurement of plasma volume and calculation of the red blood cell volume. The control group was blinded to the BV results. There were statistically significantly more times when the control group (compared with the BV group) demonstrated hypervolemia (48% vs. 37%) and red blood cell deficiency (33% vs. 16%). There was a delay in red blood cell transfusions administered to the control group by 1.5 +/- 2 days at which time the abnormality became clinically evident. Blood volume analyses provided additional information to the clinicians resulting in a change in treatment in 44% of the time to patients randomized to the BV group. The mortality rates were significantly different between the two groups (8% for the BV group and 24% in the control group; P = 0.03). Blood volume measurements allowed the physicians to promptly treat physiologic disturbances in both red blood cell volume and plasma volume, resulting in improved survival.
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Saugel B, Holzapfel K, Stollfuss J, Schuster T, Phillip V, Schultheiss C, Schmid RM, Huber W. Computed tomography to estimate cardiac preload and extravascular lung water. A retrospective analysis in critically ill patients. Scand J Trauma Resusc Emerg Med 2011; 19:31. [PMID: 21605380 PMCID: PMC3124413 DOI: 10.1186/1757-7241-19-31] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Accepted: 05/23/2011] [Indexed: 12/02/2022] Open
Abstract
Background In critically ill patients intravascular volume status and pulmonary edema need to be quantified as soon as possible. Many critically ill patients undergo a computed tomography (CT)-scan of the thorax after admission to the intensive care unit (ICU). This study investigates whether CT-based estimation of cardiac preload and pulmonary hydration can accurately assess volume status and can contribute to an early estimation of hemodynamics. Methods Thirty medical ICU patients. Global end-diastolic volume index (GEDVI) and extravascular lung water index (EVLWI) were assessed using transpulmonary thermodilution (TPTD) serving as reference method (with established GEDVI/EVLWI normal values). Central venous pressure (CVP) was determined. CT-based estimation of GEDVI/EVLWI/CVP by two different radiologists (R1, R2) without analyzing software. Primary endpoint: predictive capabilities of CT-based estimation of GEDVI/EVLWI/CVP compared to TPTD and measured CVP. Secondary endpoint: interobserver correlation and agreement between R1 and R2. Results Accuracy of CT-estimation of GEDVI (< 680, 680-800, > 800 mL/m2) was 33%(R1)/27%(R2). For R1 and R2 sensitivity for diagnosis of low GEDVI (< 680 mL/m2) was 0% (specificity 100%). Sensitivity for prediction of elevated GEDVI (> 800 mL/m2) was 86%(R1)/57%(R2) with a specificity of 57%(R1)/39%(R2) (positive predictive value 38%(R1)/22%(R2); negative predictive value 93%(R1)/75%(R2)). Estimated CT-GEDVI and TPTD-GEDVI were significantly different showing an overestimation of GEDVI by the radiologists (R1: mean difference ± standard error (SE): 191 ± 30 mL/m2, p < 0.001; R2: mean difference ± SE: 215 ± 37 mL/m2, p < 0.001). CT GEDVI and TPTD-GEDVI showed a very low Lin-concordance correlation coefficient (ccc) (R1: ccc = +0.20, 95% CI: +0.00 to +0.38, bias-correction factor (BCF) = 0.52; R2: ccc = -0.03, 95% CI: -0.19 to +0.12, BCF = 0.42). Accuracy of CT estimation in prediction of EVLWI (< 7, 7-10, > 10 mL/kg) was 30% for R1 and 40% for R2. CT-EVLWI and TPTD-EVLWI were significantly different (R1: mean difference ± SE: 3.3 ± 1.2 mL/kg, p = 0.013; R2: mean difference ± SE: 2.8 ± 1.1 mL/kg, p = 0.021). Again ccc was low with -0.02 (R1; 95% CI: -0.20 to +0.13, BCF = 0.44) and +0.14 (R2; 95% CI: -0.05 to +0.32, BCF = 0.53). GEDVI, EVLWI and CVP estimations of R1 and R2 showed a poor interobserver correlation (low ccc) and poor interobserver agreement (low kappa-values). Conclusions CT-based estimation of GEDVI/EVLWI is not accurate for predicting cardiac preload and extravascular lung water in critically ill patients when compared to invasive TPTD-assessment of these variables.
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Affiliation(s)
- Bernd Saugel
- Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Strasse 22, D-81675 München, Germany.
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Saugel B, Umgelter A, Martin F, Phillip V, Schmid RM, Huber W. Systemic Capillary Leak Syndrome associated with hypovolemic shock and compartment syndrome. Use of transpulmonary thermodilution technique for volume management. Scand J Trauma Resusc Emerg Med 2010; 18:38. [PMID: 20602755 PMCID: PMC2912233 DOI: 10.1186/1757-7241-18-38] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 07/05/2010] [Indexed: 12/21/2022] Open
Abstract
Systemic Capillary Leak Syndrome (SCLS) is a rare disorder characterized by increased capillary hyperpermeability leading to hypovolemic shock due to a markedly increased shift of fluid and protein from the intravascular to the interstitial space. Hemoconcentration, hypoalbuminemia and a monoclonal gammopathy are characteristic laboratory findings. Here we present a patient who suffered from SCLS with hypovolemic shock and compartment syndrome of both lower legs and thighs. Volume and catecholamine management was guided using transpulmonary thermodilution. Extended hemodynamic monitoring for volume and catecholamine management as well as monitoring of muscle compartment pressure is of crucial importance in SCLS patients.
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Affiliation(s)
- Bernd Saugel
- II Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str, 22, D-81675 München, Germany.
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Ganda A, Onat D, Demmer RT, Wan E, Vittorio TJ, Sabbah HN, Colombo PC. Venous congestion and endothelial cell activation in acute decompensated heart failure. Curr Heart Fail Rep 2010; 7:66-74. [PMID: 20424989 PMCID: PMC3874714 DOI: 10.1007/s11897-010-0009-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Despite accumulating clinical evidence supporting a key role for venous congestion in the development of acute decompensated heart failure (ADHF), there remain several gaps in our knowledge of the pathophysiology of ADHF. Specifically, the biomechanically driven effects of venous congestion on the vascular endothelium (the largest endocrine/paracrine organ of the body), on neurohormonal activation, and on renal and cardiac dysfunction remain largely unexplored. We propose that venous congestion is a fundamental, hemodynamic stimulus for vascular inflammation, which plays a key role in the development and possibly the resolution of ADHF through vascular, humoral, renal, and cardiac mechanisms. A better understanding of the role of venous congestion and endothelial activation in the pathophysiology of ADHF may provide a strong rationale for near-future testing of treatment strategies that target biomechanically driven inflammation. Targeting vascular and systemic inflammation before symptoms arise may prevent progression to overt clinical decompensation in the ADHF syndrome.
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Affiliation(s)
- Anjali Ganda
- Division of Nephrology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
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Cohen RS, Karlin P, Yushak M, Mancini D, Maurer MS. The effect of erythropoietin on exercise capacity, left ventricular remodeling, pressure-volume relationships, and quality of life in older patients with anemia and heart failure with preserved ejection fraction. CONGESTIVE HEART FAILURE (GREENWICH, CONN.) 2010; 16:96-103. [PMID: 20557328 PMCID: PMC3058381 DOI: 10.1111/j.1751-7133.2009.00135.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A prospective, open-label, 3-month study was conducted to evaluate the feasibility and short-term clinical effect of subcutaneous erythropoietin injections in patients with anemia and heart failure with preserved ejection fraction (ejection fraction, 55%+/-2%). Using a dose-adjusted algorithm to effect a rate of rise in hemoglobin not to exceed 0.4 g/dL /wk, hemoglobin (10.8+/-0.3 to 12.2+/-0.3 g/dL) and red blood cell volume (1187+/-55 to 1333+/-38 mL) increased with an average weekly dose of 3926 units. Functional measures increased from baseline (6-minute walk test [289+/-24 to 331+/-22 m], exercise time [432+/-62 to 571+/-51 s], and peak oxygen consumption [8.2+/-0.7 to 9.4+/-0.9 mL/kg/min], all P<.05). End-diastolic volume declined significantly (8% volumetric decrease, 108+/-3 to 100+/-3 mL, P =.03), but there were no significant changes in left ventricular mass or estimated left ventricular end-diastolic pressure. Pressure-volume analysis demonstrated a reduction in ventricular capacitance at an end-diastolic pressure of 30 mm Hg without significant changes in contractile state.
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Affiliation(s)
- Rose S Cohen
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY 10032, USA
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Gheorghiade M, Follath F, Ponikowski P, Barsuk JH, Blair JE, Cleland JG, Dickstein K, Drazner MH, Fonarow GC, Jaarsma T, Jondeau G, Sendon JL, Mebazaa A, Metra M, Nieminen M, Pang PS, Seferovic P, Stevenson LW, van Veldhuisen DJ, Zannad F, Anker SD, Rhodes A, McMurray JJ, Filippatos G. Assessing and grading congestion in acute heart failure: a scientific statement from the Acute Heart Failure Committee of the Heart Failure Association of the European Society of Cardiology and endorsed by the European Society of Intensive Care Medicine. Eur J Heart Fail 2010; 12:423-33. [DOI: 10.1093/eurjhf/hfq045] [Citation(s) in RCA: 513] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Mihai Gheorghiade
- Center for Cardiovascular Quality and Outcomes; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Ferenc Follath
- Department of Medicine; University Hospital; Zürich Switzerland
| | | | - Jeffrey H. Barsuk
- Division of Hospital Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - John E.A. Blair
- Department of Cardiology; Wilford Hall Medical Center; San Antonio TX USA
| | - John G. Cleland
- Department of Academic Cardiology; University of Hull, Castle Hill Hospital; Hull UK
| | - Kenneth Dickstein
- Stavanger University Hospital; Stavanger Norway
- Institute of Internal Medicine; University of Bergen; Bergen Norway
| | - Mark H. Drazner
- University of Texas Southwestern Medical Center; Dallas TX USA
| | - Gregg C. Fonarow
- Division of Cardiology; University of California Los Angeles David Geffen School of Medicine; Los Angeles CA USA
| | - Tiny Jaarsma
- Department of Cardiology; University Hospital Groningen; Groningen The Netherlands
| | | | | | - Alexander Mebazaa
- Hospital Lariboisière; Paris France
- U942 INSERM; University Paris Diderot; Paris France
| | - Marco Metra
- Department of Cardiology; University of Brescia; Brescia Italy
| | - Markku Nieminen
- Department of Medicine, Section of Cardiology; Helsinki University Central Hospital; Helsinki Finland
| | - Peter S. Pang
- Department of Emergency Medicine and Center for Cardiovascular Quality and Outcomes; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Petar Seferovic
- Department of Cardiology II; University Institute for Cardiovascular Diseases; Belgrade Serbia
| | | | | | - Faiez Zannad
- Department of Cardiology; Campus Virchow-Klinikum, Charité Universitätsmedizin; Berlin Germany
| | - Stefan D. Anker
- Department of Cardiology; Campus Virchow-Klinikum, Charité Universitätsmedizin; Berlin Germany
| | - Andrew Rhodes
- Department of Intensive Care Medicine; St George's Hospital; London UK
| | - John J.V. McMurray
- British Heart Foundation Cardiovascular Research Centre; University of Glasgow; Glasgow Scotland UK
| | - Gerasimos Filippatos
- Heart Failure Unit, Department of Cardiology; Athens University Hospital Attikon; Rimini 1 12461 Haidari Athens Greece
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Moralidis E, Papanastassiou E, Arsos G, Chilidis I, Gerasimou G, Gotzamani-Psarrakou A. A single measurement with51Cr-tagged red cells or125I-labeled human serum albumin in the prediction of fractional and whole blood volumes: an assessment of the limitations. Physiol Meas 2009; 30:559-71. [DOI: 10.1088/0967-3334/30/7/003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Tapolyai M, Uysal A, Maeweathers G, Bahta E, Dossabhoy NR. B-Type Natriuretic Peptide-Directed Ultrafiltration Improves Care in Acutely Hospitalized Dialysis Patients. ACTA ACUST UNITED AC 2009; 15:131-5. [DOI: 10.1111/j.1751-7133.2008.00045.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Huo Y, Kassab GS. A scaling law of vascular volume. Biophys J 2009; 96:347-53. [PMID: 19167288 DOI: 10.1016/j.bpj.2008.09.039] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Accepted: 09/17/2008] [Indexed: 01/17/2023] Open
Abstract
Vascular volume is of fundamental significance to the function of the cardiovascular system. An accurate prediction of blood volume in patients is physiologically and clinically significant. This study proposes what we believe is a novel volume scaling relation of the form: V(c)=K(v)D(s)(2/3)L(c), where V(c) and L(c) are cumulative vessel volume and length, respectively, in the tree, and D(s) is the diameter of the vessel segment. The scaling relation is validated in vascular trees of various organs including the heart, lung, mesentery, muscle, and eye of different species. Based on the minimum energy hypothesis and volume scaling relation, four structure-function scaling relations are predicted, including the diameter-length, volume-length, flow-diameter, and volume-diameter relations, with exponent values of 3/7, 1(2/7), 2(1/3), and 3, respectively. These four relations are validated in the various vascular trees, which further confirm the volume scaling relation. This scaling relation may serve as a control reference to estimate the blood volume in various organs and species. The deviation from the scaling relation may indicate hypovolemia or hypervolemia and aid diagnosis.
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Affiliation(s)
- Yunlong Huo
- Department of Biomedical Engineering, Surgery, and Cellular and Integrative Physiology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
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Ruaño G, Bernene J, Windemuth A, Bower B, Wencker D, Seip RL, Kocherla M, Holford TR, Petit WA, Hanks S. Physiogenomic comparison of edema and BMI in patients receiving rosiglitazone or pioglitazone. Clin Chim Acta 2009; 400:48-55. [DOI: 10.1016/j.cca.2008.10.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Revised: 09/16/2008] [Accepted: 10/07/2008] [Indexed: 12/15/2022]
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Schumacher YO, Ruthardt S, Schmidt M, Ahlgrim C, Roecker K, Pottgiesser T. Total haemoglobin mass but not cardiac volume adapts to long-term endurance exercise in highly trained spinal cord injured athletes. Eur J Appl Physiol 2009; 105:779-85. [PMID: 19125284 DOI: 10.1007/s00421-008-0963-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2008] [Indexed: 11/30/2022]
Abstract
The oxygen transport system is an important component in the limitation of endurance performance in able-bodied and paraplegic athletes. The aim of the present study was to investigate the total haemoglobin mass (tHb, carbon monoxide rebreathing method) and cardiac volume (HV, echocardiography) in 25 highly endurance trained male spinal cord injured (mainly paraplegic) athletes (SCI-TRAINED) and to compare the results with those of 10 untrained spinal cord injured controls (SCI-UNTRAINED) and in 25 able-bodied elite endurance athletes (TRAINED). tHb and tHb/kg were higher in SCI-TRAINED than in SCI-UNTRAINED (748 +/- 110 vs. 629 +/- 209 g (464 +/- 68 vs. 390 +/- 130 mmol) (mean +/- SD), P = 0.02 and 10.3 +/- 1.3 vs. 7.9 +/- 2.0 g/kg (6.4 +/- 0.8 vs. 4.9 +/- 1.2 mmol/kg), P < 0.0001), while HV and HV/kg showed no significant differences between the two groups (765 +/- 93 vs. 793 +/- 164 ml and 10.6 +/- 1.4 vs. 10.3 +/- 2.5 ml/kg). No difference between SCI-TRAINED and TRAINED was found for septal diameter (9.5 +/- 1.0 mm vs. 9.7 +/- 0.7 mm). However, tHb and tHb/kg in SCI-TRAINED was lower than in TRAINED [896 +/- 123 g (556 +/- 76 mmol), P = 0.0003 and 12.6 +/- 1.3 g/kg (7.8 +/- 0.8 mmol), P < 0.0001]. In spinal cord injured athletes, tHb but not HV adapts moderately to chronic endurance exercise, although tHb in spinal cord injured athletes does not reach the level of able-bodied-trained persons.
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Affiliation(s)
- Yorck Olaf Schumacher
- Department of Sports Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
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Takanishi DM, Yu M, Lurie F, Biuk-Aghai E, Yamauchi H, Ho HC, Chapital AD. Peripheral Blood Hematocrit in Critically Ill Surgical Patients: An Imprecise Surrogate of True Red Blood Cell Volume. Anesth Analg 2008; 106:1808-12. [DOI: 10.1213/ane.0b013e3181731d7c] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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