Abstract 4138901: Estimated Plasma Volume Status Reflected Changes In Hemodynamic Parameters On Echocardiogram After Treatment In Patients With Heart Failure With Preserved Ejection Fraction.

Introduction: Estimated plasma volume status (ePVS) is an index of changes in plasma volume and may play a significant role in the management of heart failure (HF). Research questions: Whether does ePVS reflect the hemodynamic changes after treatment in patients with HF? Aims: The aim of this study was to investigate the relationship between ePVS and changes in echocardiographic parameters after treatment in patients with HF with preserved ejection fraction (HFpEF). Methods: We retrospectively analyzed data from 1226 patients (81±9 years, 55.2 % female) registered in the PURSUIT-HFpEF (Prospective, Multicenter, Observational Study of Patients with Heart Failure with Preserved Ejection Fraction) study, a multicenter registry of patients hospitalized for acute decompensated HFpEF. We collected blood samples and performed echocardiography on admission and shortly before discharge. We calculated ePVS based on the Strauss formula using hemoglobin (Hb) and hematocrit (Hct) values as 100 x [(Hb(discharge)/Hb(admission) x (1 - Hct(admission)) / (1 – Hct(discharge))] – 100 (%), and investigated the correlations between ePVS and changes in echocardiographic parameters. Patients were followed for median of 708 days (IQR 365, 1086 days) to observe all-cause death and major adverse cardiovascular events (MACE; death, HF hospitalization and stroke). Results: The median value of ePVS was -0.97 (IQR -1.10, -0.86), indicating successful volume reduction during hospitalization. The decrease of inferior vena cava (IVC) diameter was correlated with ePVS (p<0.0001). Whereas ePVS was not correlated with left ventricular (LV) end-systolic diameter, it was correlated with decreases in LV diastolic diameter (p=0.007), LV ejection fraction (p=0.01), time-velocity integral of LV outflow (TVI LVO , p<0.0001), LV mass (p=0.01) and left atrial diameter (p=0.0002). Among diastolic parameters, ePVS was correlated with decrease in E velocity (p<0.0001) and e’ velocity (p=0.002) but not with E/e’ ratio. Change in tricuspid regurgitation pressure gradient was inversely correlated with ePVS. A stepwise multivariate regression analysis revealed that ePVS was associated with changes in IVC diameter, E velocity and TVI LVO . A Cox proportional hazard model showed that ePVs was a predictor for both all-cause death and MACE. Conclusion: EPVs was correlated with changes in echocardiographic parameters relevant to hemodynamics after HF treatment and predicted prognosis in patients with HFpEF.