Abstract 12177: Plasma Volume Status Predicts Mortality in Heart Failure Patients

Abstract

Background: The intravascular compartment is known as the plasma volume (PV). PV expansion plays an essential role in heart failure (HF), and large degrees of congestion relate to morbidity and mortality. Recently, it has been reported that PV is estimated by a simple formula based on hematocrit and body weight, not using radioisotope assays. We aimed to investigate the impact of PV status on prognosis of HF. Methods and Results: We calculated PV status as the following: Actual PV=(1-hematocrit)х[a+(bхbody weight)] (a=1530 in males and a=864 in females, b=41 in males and b=47.9 in females), Ideal PV=cхbody weight (c=39 in males and c=40 in females), and PV status=[(actual PV-ideal PV)/ideal PV]х100(%). We analyzed 1115 patients with HF who admitted to our hospital. These patients were divided into 3 groups based on the PV status: 1 st (PV status<41.9%, n=371), 2 nd (41.9%≤PV status<49.1%, n=372) and 3 rd tertiles (49.1%≤PV status, n=372). In the multiple regression analysis to determine PV status, among considerable clinical variables, B-type natriuretic peptide (BNP), sodium and estimated glomerular filtration rate (eGFR) were predictors of PV status (BNP: ß=0.280, P<0.001; sodium: ß=-0.197, P<0.001; and eGFR: ß=-0.214, P<0.001). In the average follow-up of 1007 days, 287 deaths (149 cardiac deaths and 138 non-cardiac deaths) occurred. In the Kaplan-Meier analysis, all-cause mortality progressively increased from 1 st to 2 nd and 3 rd groups (13.5%, 21.2% and 42.5%, P<0.001). In the Cox proportional hazard analysis, after adjusting for potential confounding factors including age, NYHA class, ejection fraction, BNP, sodium, eGFR, co-morbidities and medications, PV status was an independent predictor of all-cause mortality in HF patients (hazard ratio 1.420, 95% confidence interval 1.227-1.625, P<0.001). Conclusion: PV status, a marker of intravascular compartment and congestion, can identify high mortality in HF patients.