Vascular expansion during worsening of heart failure: Effects on clinical features and its determinants

This study investigated the relation of the changes in serum solutes/albumin to the level of vascular expansion and clinical features during worsening HF.

Data from 47 patients with acute on chronic HF worsening were analyzed. Blood tests included hemoglobin, hematocrit, albumin, solutes (Na/K/Cl/BUN/Cr), and b-type natriuretic peptide (BNP). The relative change in the vascular expansion from stable to worsening HF was estimated based on changes in the plasma volume (%PV).

When divided into two groups based on the median %PV, the clinical features of the expansion group (11≤%PV [range 11% to 36%]; n=24) included a lower incidence of crackles (13% vs. 52%, p=0.005) and a tendency toward preserved renal function (83% vs. 57%, p=0.06) compared with the non-expansion group (%PV [range -19% to 11%]<11; n=23), whereas the increase in body weight and log BNP did not differ between groups. The expansion group had a greater increase in serum Na (3.58±4.43 vs. -0.11±3.31mEq/L, p=0.0016) and Cl (5.54±6.24 vs. -0.03±4.18mEq/L, p=0.0006), and a decrease in serum albumin (-0.37±0.3 vs. -0.16±0.3g/dL, p=0.04) and creatinine (-0.28±0.39 vs. -0.06±0.22mg/dL, p=0.027) from stability to worsening HF. Multivariate logistic regression analysis revealed an independent association between the increase in %PV and the increase in the serum Cl concentration from stability to worsening HF (odds ratio: 12.2, 95% confidence interval: 1.78-83.8, p=0.011).

Though this study is observational and does not allow for causal inference, it may nonetheless be speculated that a greater accumulation of Cl in the blood vessels acts to increase or maintain intravascular volume, which induces different clinical features of HF.