Estimated Plasma Volume and Heart Failure-Related Events in Hospitalized Patients With Stage A-D Heart Failure

Heart failure (HF) is associated with poor clinical outcomes and is classified into Stages A-D. Estimated plasma volume (ePV) is a marker of plasma volume expansion. Prognostic markers applicable across all HF stages may enable the early identification of patients at high risk of adverse clinical outcomes. This study evaluated the impact of ePV on clinical outcomes in patients with Stage A-D HF.

ePV was measured using the PRIME Plus analyzer in 494 patients with HF (Stage A, n=78; Stage B, n=274; Stage C/D, n=142) admitted to our hospital in 2022. Over a median follow-up of 3 years, 95 HF-related events, defined as HF rehospitalization and deaths, and 43 all-cause deaths occurred. Kaplan-Meier analysis demonstrated that patients in the highest ePV tertile had the greatest risk of HF-related events and all-cause deaths. Multivariable Cox proportional hazards regression analysis identified ePV as an independent predictor of HF-related events (hazard ratio [HR] 1.48; 95% confidence interval [CI] 1.26-1.73; P<0.0001) and all-cause deaths (HR 1.35; 95% CI 1.06-1.73; P=0.0158). The addition of ePV to established cardiovascular risk factors significantly improved the C-statistic (0.7009 vs. 0.7415; P=0.0260), net reclassification index, and integrated discrimination index.

This study demonstrates that ePV is a feasible prognostic marker for HF-related events and all-cause deaths in patients with Stage A-D HF.