Discordance Between Hemoconcentration and Clinical Assessment of Decongestion in Acute Heart Failure

Darawsha, Wisam; Chirmicci, Stefan; Solomonica, Amir; Wattad, Malak; Kaplan, Marielle; Makhoul, Badira F.; Abassi, Zaid; Azzam, Zaher S.; Aronson, Doron

doi:10.1016/j.cardfail.2016.04.005

Cited by 22 publications

(10 citation statements)

References 35 publications

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“…Aggressive decongestion as documented by a decrease in PV and hemoconcentration, improves clinical outcomes in patients with HF 12-14, 58, 59 . Incident hemoconcentration, across a large range of definitions, is frequently associated with worsening renal function 12-14, 58, 60-63 (Supplementary table 1), which has little negative prognostic influence 61,64,65 . In contrast, worsening renal function without hemoconcentration, i.e.…”

Section: Hemoconcentration and Worsening Renal Functionmentioning

confidence: 99%

Estimated plasma volume status in heart failure: clinical implications and future directions

et al. 2021

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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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Section: Hemoconcentration and Worsening Renal Functionmentioning

confidence: 99%

Estimated plasma volume status in heart failure: clinical implications and future directions

et al. 2021

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“…For instance, anemia in HF is common and is associated with poor outcomes [8,9], as is hemodilution [10]. There are however other studies reporting conflicting effects of hemoconcentration on survival in HF [11,12,13]. …”

Section: Introductionmentioning

confidence: 99%

Plasma Volume and Renal Function Predict Six-Month Survival after Hospitalization for Acute Decompensated Heart Failure

et al. 2017

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Background: Plasma volume (PV) is contracted in stable patients with heart failure (HF) due to decongestion strategies. On the other hand, increased PV can adversely affect the trajectory of HF. We therefore examined the effects of increased percentage change in PV (%ΔPV), blood urea nitrogen (BUN), and %ΔPV stratified by BUN and glomerular filtration rate (GFR) on survival after discharge in patients hospitalized for acute decompensated HF (ADHF). Methods: We used the Strauss-Davis-Rosenbaum formula to calculate the %ΔPV between baseline and hospital discharge in a cohort from the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness trial (ESCAPE). Kaplan-Meier curves were constructed for survival over 6 months. Cox proportional hazards regression was used to obtain adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) for the associations between survival after discharge and %ΔPV, BUN, and %ΔPV stratified by BUN and GFR. Results: Of the 324 patients included in our study (age 56.1 ± 13.6 years, 26.5% female), those with increased or no %ΔPV at discharge were less likely to survive at 6 months compared with those having reduced %ΔPV (log rank, p = 0.0093). Increased %ΔPV (HR 1.08 per 10% increase; 95% CI: 1.02-1.14) and increased BUN at discharge (HR 1.02 per mg/dL; 95% CI: 1.01-1.03) were independently associated with worse survival. Decreasing %ΔPV had a greater association with improved survival in patients with discharge BUN <31 mg/dL (p = 0.02) and discharge GFR >40 mL/min/1.73 m² (p = 0.047). Conclusions: Increased %ΔPV and BUN at discharge predicted worse 6-month survival in patients with ADHF. Decreased %ΔPV with low BUN or high GFR at discharge was associated with improved survival.

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“…In the current issue of the Journal, Darawsha and colleagues studied the relationship between hemoconcentration (defined as an increase in both hemoglobin and hematocrit between baseline and pre-discharge) and decongestion (defined as improvement in a 9-point congestion score between baseline and pre-discharge), and their impact on post-discharge outcomes (8).…”

Section: Evaluation Study Of Congestive Heart Failure and Pulmonary Amentioning

confidence: 99%

Measuring Congestion in Acute Heart Failure: The “Holy Grail” Still Awaits

Murad

Dunlap

2016

Journal of Cardiac Failure

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Discordance Between Hemoconcentration and Clinical Assessment of Decongestion in Acute Heart Failure

Cited by 22 publications

References 35 publications

Estimated plasma volume status in heart failure: clinical implications and future directions

Estimated plasma volume status in heart failure: clinical implications and future directions

Plasma Volume and Renal Function Predict Six-Month Survival after Hospitalization for Acute Decompensated Heart Failure

Measuring Congestion in Acute Heart Failure: The “Holy Grail” Still Awaits

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