• Circ Heart Fail · May 2015

    Multicenter Study Comparative Study Observational Study

    Effect of estimated plasma volume reduction on renal function for acute heart failure differs between patients with preserved and reduced ejection fraction.

    • Makoto Takei, Shun Kohsaka, Yasuyuki Shiraishi, Ayumi Goda, Yuki Izumi, Mayuko Yagawa, Atsushi Mizuno, Mitsuaki Sawano, Taku Inohara, Takashi Kohno, Keiichi Fukuda, Tsutomu Yoshikawa, and West Tokyo Heart Failure Registry Investigators.
    • From the Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan (M.T., S.K., Y.S., M.S., T.I., T.K., K.F.); Department of Cardiology, St. Luke's International Hospital, Chuouku, Tokyo, Japan (A.M.); Second Department of Internal Medicine, Division of Cardiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan (A.G.); and Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan (Y.I., M.Y., T.Y.).
    • Circ Heart Fail. 2015 May 1; 8 (3): 527-32.

    BackgroundThe prognostic relevance of plasma volume reduction (PVR) in acute heart failure patients remains unclear because of the confounding hemodynamic effect of left ventricular ejection fraction impairment on kidney function.Methods And ResultsSubjects enrolled in the West Tokyo Heart Failure Registry were examined. The PV at admission and discharge was estimated from the subjects' body weight and its deviation from the ideal body weight. Patients in the top tertile of estimated PVR were classified as PVR+. Of the 381 patients with acute heart failure, 181 (47.5%) had heart failure with preserved ejection fraction (HFpEF). Estimated PVR was associated with worsening renal function in the HFpEF (odds ratio, 3.28; 95% confidence interval, 1.55-6.96; P=0.002) but not in the heart failure with reduced ejection fraction cohort (odds ratio, 1.22; 95% confidence interval, 0.61-2.42; P=0.57). This association in the HFpEF cohort remained significant after adjusting for a history of hypertension and diabetes mellitus and the estimated glomerular filtration rate (odds ratio, 3.34; 95% confidence interval, 1.52-7.33; P=0.003). The use of intravenous diuretics was a significant predictor of PVR in the HFpEF and heart failure with reduced ejection fraction groups.ConclusionsThe effect of estimated PVR differs by HF type, and the estimated PVR during hospitalization is a predictor of worsening renal function in patients with HFpEF but not in heart failure with reduced ejection fraction.Clinical Trial RegistrationURL: http://www.umin.ac.jp/ctr/index-j.html. Unique identifier: UMIN000001549.© 2015 American Heart Association, Inc.

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