Prognostic impact of plasma volume estimated from hemoglobin and hematocrit in heart failure with preserved ejection fra
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ORIGINAL PAPER
Prognostic impact of plasma volume estimated from hemoglobin and hematocrit in heart failure with preserved ejection fraction Masatake Kobayashi1 · Nicolas Girerd1 · Kevin Duarte1 · Gregoire Preud’homme1 · Bertram Pitt2 · Patrick Rossignol1 Received: 29 January 2020 / Accepted: 24 March 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Plasma volume (PV) estimated from Duarte’s formula (based on hemoglobin/hematocrit) has been associated with poor prognosis in patients with heart failure (HF). There are, however, limited data regarding the association of estimated PV status (ePVS) derived from hemoglobin/hematocrit with clinical profiles and study outcomes in patients with HF and preserved ejection fraction (HFpEF). Methods and results Patients from North and South America enrolled in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial (TOPCAT) with available hemoglobin/hematocrit data were studied. The association between ePVS (Duarte formula and Hakim formula) and the composite of cardiovascular mortality, HF hospitalization, or aborted cardiac arrest was assessed. Among 1747 patients (age 71.6 years; males 50.1%), mean ePVS derived from Duarte formula was 4.9 ± 1.0 mL/g. Higher Duarte-derived ePVS was associated with prior HF admission, diabetes, more severe congestion, poor renal function, higher natriuretic peptide level, and E/e’. After adjustment for potential covariates including natriuretic peptide, higher Duarte-derived ePVS was associated with an increased rate of the primary outcome [highest vs. lowest ePVS quartile: adjusted-HR (95%CI) = 1.79 (1.28–2.50), p 1 sign and at least one symptom of HF, left-ventricular ejection fraction (LVEF) ≥ 45%, controlled systolic blood pressure, and serum potassium 0%) was significantly associated with a higher incidence of the primary outcome. However, given the well-known regional differences in the TOPCAT trial [24], analyzing the individuals enrolled in the Americas has proven to be more informative. In this latter subset, and contrary to the results herein using the Duarte-derived formula, higher ePVS was not significantly associated with study outcomes in multivariable Cox models adjusted for natriuretic peptide [e.g.,
Clinical Research in Cardiology Table 1 Baseline characteristics according to quartiles of Duarte-derived estimated plasma volume status ePVS quartiles Quartile 1, 5.50 (N = 435)
p value
Adjusted P value*
Age, years
70.2 ± 9.5
71.9 ± 9.7
72.3 ± 9.5
72.0 ± 9.8
Female gender, N (%)
Body mass index, kg/m2
145 (33.1%)
219 (50.1%)
238 (54.5%)
270 (62.1%)
33.8 ± 7.5
33.1 ± 7.4
33.9 ± 8.8
34.2 ± 8.6
Obesity, N (%)
283 (65.1%)
278 (63.8%)
276 (63.2%)
284 (65.7%)
Hypertension
389 (88.8%)
391 (89.5%)
393 (90.1%)
Diabetes
142 (32.4%)
181 (41.4%)
208 (47.7%)
Atrial fibrillation
206 (47.0%)
185 (42.3%)
190 (43.6%)
156 (35.9%)
Myocardial infarction
89 (20.3%)
83 (19.0%)
86 (19.7%)
100 (23.0%)
Prior HF hospitaliza
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