Diagnostic Test for Estimation of Plasma Volume on Assessment of Congestive Status in Acute Heart Failure Patients at Saiful Anwar General Hospital

Abstract

Background: Heart failure is a health issue with high mortality and morbidity rates globally, including in Indonesia. Congestion is the main symptom of acute heart failure. B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-pro BNP) are well-known markers to confirm the condition. Plasma volume estimation (ePVS) is one of the procedures currently being developed to assess a patient's congestive status at a lower cost. Objective: This study aims to evaluate the sensitivity and specificity value of ePVS to assess the congestive status in acute heart failure patients Methods: This is a descriptive observational research with a cross-sectional study method that included all patients with dyspneu that come to emergency room between May 2018-February 2023. Baseline characteristics, medication history, and echocardiography were also included in the statistical analysis. We used univariate and bivariate analysis to assess the effect of each variable on the patient's congestive condition. A diagnostic test of plasma volume estimation was carried out using Receiver Operating Characteristics (ROC) Analysis compared to NT pro-BNP as a diagnostic tool of congestive in acute heart failure based on guideline. Plasma volume estimation calculated using Strauss-Duarte formula. Result: A total of 506 subjects with dyspnea at ER Dr. Saiful Anwar Malang Hospital, who met the inclusion and exclusion criteria. The mean age was older in congestive patients with 51.3% being male. Patients with congestive conditions have a lower ejection fraction with a higher estimated right atrial pressure from echocardiography. The estimation plasma volume status was also higher in congestive conditions (4.90 vs 3.5). The ePVS from ROC analysis has a good diagnostic value at the reduced and mildly reduced EF. Conclusion: The estimation of plasma volume status has a good sensitivity and specificity value to assess congestive status in patients with acute heart failure who are fluid-overloaded. Keyword: Acute Heart Failure, Congestive, Plasma Volume Status.