Total Blood Volume Profiles Differ Between Reduced and Preserved Ejection Fractions

A pilot study found that total blood volume (TBV) profiles differ between heart failure patients with preserved (HFpEF) and reduced (HFrEF) ejection fractions, according to data published in JACC: Heart Failure.

Researchers sought to examine the implications of volume management in decompensated HFpEF compared with HFrEF by characterizing volume profiles and their differences.

Researchers evaluated 20 HFpEF and 35 HFrEF patients upon hospital admission. They measured TBV and red blood cell mass (RBCM) using a standardized computer-based radiolabeled albumin dilution technique.

“The markedly different intravascular volume profiles including RBCM excess (polycythemia) and RBCM deficit (true anemia) with PV [plasma volume] expansion, and varied distribution of fluid overload in patients with HFpEF vs HFrEF should be identified before a plan of management is implemented,” the authors wrote.

“These differences have clinically significant implications for how to best establish a treatment regimen in the individual patient and avoid possible detrimental consequences.”

TBV was expanded by 27% ± 21% in HFpEF patients (range -5.2% to +77%; P=.002) and by +37 ± 25% in HFrEF patients (0% to 107%; P<.001) above normal volumes. There was normal RBCM in HFpEF patients (+8% ± 34%; P=.660) and expanded RBCM in HFrEF (+24% ± 31%; P=.004), although there was large variability observed in both groups. Excess RBCM was more prominent in HFrEF (63% vs 45%), and deficient RBCM was more prominent in HFpEF (35% vs 14%).

TBV levels decreased to +25% ± 20% (P=.029) in HFrEF patients with diuresis, but the levels were unchanged in HFpEF patients (+18% ± 20%; P=.173). Body weight also declined 6.6 ± 4.4 kg in HFrEF patients and 10.5 ± 8.3 kg (P=.026) in HFpEF, and interstitial fluid losses accounted for 85 ± 13% and 93 ± 6%  (P=.026) of the total volume removed.

The authors noted that the significance of different TBV volumes, including PV expansion and red blood cell mass among HFpEF and HFrEF patients, requires further study.

“One issue is identifying if the marked heterogeneity in volume expansion has clinical implications in terms of development of cardio-renal syndrome,” they wrote. “Analysis of these differences in extent of TBV expansion and the development of congestion may point toward clinical targets that may allow more tailored therapy in the individual patient and better outcomes, particularly with regard to readmission rates.”

Reference

Miller WL, Mullan BP. Volume overload profiles in patients with preserved (HFpEF) and reduced (HFrEF) ejection fraction chronic heart failure: are there differences? A pilot study. JACC Heart Fail. 2016; doi:10.1016/j.jchf.2016.01.005.