Kévin Duarte1, Jean-Marie Monnez1, Eliane Albuisson2, Bertram Pitt3, Faiez Zannad4, Patrick Rossignol5. 1. Université de Lorraine, Institut Elie Cartan de Lorraine, Unité Mixte de Recherche 7502, Vandoeuvre-lès-Nancy, France; Centre National de la Recherche Scientifique, Institut Elie Cartan de Lorraine, Unité Mixte de Recherche 7502, Vandoeuvre-lès-Nancy, France; INRIA, Project-Team BIGS, Villers-lès-Nancy, France. 2. Université de Lorraine, Institut Elie Cartan de Lorraine, Unité Mixte de Recherche 7502, Vandoeuvre-lès-Nancy, France; Centre National de la Recherche Scientifique, Institut Elie Cartan de Lorraine, Unité Mixte de Recherche 7502, Vandoeuvre-lès-Nancy, France; CHU Nancy, Pôle S(2)R, PARC, ESPRI-BIOBASE, Vandoeuvre-lès-Nancy, France; INSERM, Centre d'Investigations Cliniques-Plurithématique 1433, Vandoeuvre-lès-Nancy, France; Université de Lorraine, Faculté de Médecine, SPI-EAO, Vandoeuvre-lès-Nancy, France. 3. University of Michigan School of Medicine, Ann Arbor, Michigan. 4. INSERM, Centre d'Investigations Cliniques-Plurithématique 1433, Vandoeuvre-lès-Nancy, France; INSERM U1116, Nancy, France; Université de Lorraine, Nancy, France; CHU Nancy, Pôle de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre-lès-Nancy, France; F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France. 5. INSERM, Centre d'Investigations Cliniques-Plurithématique 1433, Vandoeuvre-lès-Nancy, France; INSERM U1116, Nancy, France; Université de Lorraine, Nancy, France; F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France. Electronic address: p.rossignol@chu-nancy.fr.
Abstract
OBJECTIVES: The purpose of this study was to assess the prognostic value of the estimation of plasma volume or of its variation beyond clinical examination in a post-hoc analysis of EPHESUS (Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study). BACKGROUND: Assessing congestion after discharge is challenging but of paramount importance to optimize patient management and to prevent hospital readmissions. METHODS: The present analysis was performed in a subset of 4,957 patients with available data (within a full dataset of 6,632 patients). The study endpoint was cardiovascular death or hospitalization for heart failure (HF) between months 1 and 3 after post-acute myocardial infarction HF. Estimated plasma volume variation (ΔePVS) between baseline and month 1 was estimated by the Strauss formula, which includes hemoglobin and hematocrit ratios. Other potential predictors, including congestion surrogates, hemodynamic and renal variables, and medical history variables, were tested. An instantaneous estimation of plasma volume at month 1 was defined and also tested. RESULTS: Multivariate analysis was performed with stepwise logistic regression. ΔePVS was selected in the model (odds ratio: 1.01; p = 0.004). The corresponding prognostic gain measured by integrated discrimination improvement was significant (7.57%; p = 0.01). Nevertheless, instantaneous estimation of plasma volume at month 1 was found to be a better predictor than ΔePVS. CONCLUSIONS: In HF complicating myocardial infarction, congestion as assessed by the Strauss formula and an instantaneous derived measurement of plasma volume provided a predictive value of early cardiovascular events beyond routine clinical assessment. Prospective trials to assess congestion management guided by this simple tool to monitor plasma volume are warranted.
OBJECTIVES: The purpose of this study was to assess the prognostic value of the estimation of plasma volume or of its variation beyond clinical examination in a post-hoc analysis of EPHESUS (Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study). BACKGROUND: Assessing congestion after discharge is challenging but of paramount importance to optimize patient management and to prevent hospital readmissions. METHODS: The present analysis was performed in a subset of 4,957 patients with available data (within a full dataset of 6,632 patients). The study endpoint was cardiovascular death or hospitalization for heart failure (HF) between months 1 and 3 after post-acute myocardial infarction HF. Estimated plasma volume variation (ΔePVS) between baseline and month 1 was estimated by the Strauss formula, which includes hemoglobin and hematocrit ratios. Other potential predictors, including congestion surrogates, hemodynamic and renal variables, and medical history variables, were tested. An instantaneous estimation of plasma volume at month 1 was defined and also tested. RESULTS: Multivariate analysis was performed with stepwise logistic regression. ΔePVS was selected in the model (odds ratio: 1.01; p = 0.004). The corresponding prognostic gain measured by integrated discrimination improvement was significant (7.57%; p = 0.01). Nevertheless, instantaneous estimation of plasma volume at month 1 was found to be a better predictor than ΔePVS. CONCLUSIONS: In HF complicating myocardial infarction, congestion as assessed by the Strauss formula and an instantaneous derived measurement of plasma volume provided a predictive value of early cardiovascular events beyond routine clinical assessment. Prospective trials to assess congestion management guided by this simple tool to monitor plasma volume are warranted.
Authors: Ulrich Fischer-Rasokat; Matthias Renker; Christoph Liebetrau; Maren Weferling; Andreas Rieth; Andreas Rolf; Yeong-Hoon Choi; Christian W Hamm; Won-Keun Kim Journal: Cardiovasc Diagn Ther Date: 2021-10
Authors: Kenneth C Bilchick; Nathaniel Chishinga; Alex M Parker; David X Zhuo; Mitchell H Rosner; LaVone A Smith; Hunter Mwansa; Jacob N Blackwell; Peter A McCullough; Sula Mazimba Journal: Cardiorenal Med Date: 2017-11-03 Impact factor: 2.041