Cardiovascular Volume Reserve in Patients with Heart Failure and Reduced Ejection Fraction

Cardiovascular Volume Reserve in Patients with Heart Failure and Reduced Ejection Fraction:

Abstract

This study aimed to investigate the relationship between intravascular volume and intracardiac filling pressures in stable HF patients with reduced ejection fraction (HFrEF). A total of 40 HFrEF patients (LVEF 36 ± 10%) (10 subjects with a pulmonary artery catheter) underwent intravascular volume expansion with 1 L hydroxyl-ethyl-starch over 3 h with coinciding intravascular volume measurements (technetium (99 tc)-labeled red blood cell technique). Intravascular blood volume increased from 5.0 ± 1.0 L to 5.7 ± 1.0 L (p < 0.0001). No change in clinical status, echocardiographic indices, or cardiac filling pressures was noticed. Invasively measured right atrial pressure and pulmonary arterial wedge pressure increased significantly immediately after start of infusion (4 ± 2 mmHg to 8 ± 4 mmHg; p = 0.01 and 10 ± 3 mmHg to 15 ± 6 mmHg; p = 0.01, respectively), decreased afterwards, and remained stable for 3 h (6 ± 2 mmHg and 14 ± 4 mmHg, respectively). The accuracy of cardiac filling pressure estimates to predict intravascular volume expansion was low (all AUC < 0.65).