111 - Plasma Volume is Normal but Heterogeneously Distributed and True Anemia is Highly Prevalent in Patients with Stable Heart Failure

Abstract

Background: Both intravascular volume overload and depletion as well as anemia are associated with increased hospital admissions and mortality in patients with heart failure. The purpose of this study was to accurately measure plasma volume and red cell mass (RCM) in stable patients with chronic heart failure with reduced ejection fraction (HFrEF) and gain more insight into plasma volume regulation and anemia in stable conditions of HFrEF. Methods and Results: Plasma volume and RCM measurement based on 99Tc-labeled red blood cells, venous blood samples and clinical parameters were obtained in 24 stable HFrEF patients under optimal medical therapy. Measured plasma volume values were compared with predicted values based on body surface area. Plasma volume was on average normal (99,98% of predicted) but heterogeneously distributed (variations of 81% up to 133%). Neurohumoral activation and medication use were not associated with plasma volume status. Furthermore, anemia based on measurement of RCM was more prevalent than anemia based on hemoglobin concentration and present in up to 75% of subjects, but exceptional dilutional. Conclusion: In stable chronic HFrEF patients under optimal medical therapy, plasma volume is overall normal but heterogeneously distributed. Anticipated factors such as neurohumoral activation and heart failure medication were not associated with plasma volume status. Furthermore, anemia is more common than assessed by hemoglobin.View Large Image Figure ViewerDownload Hi-res image Download (PPT)