Expansion in blood volume (BV) is a well-recognized response to arterial under-filling secondary to impaired cardiac output in heart failure (HF). However, the effectiveness of this response in terms of outcomes remains inadequately understood. Prospective analysis was undertaken in 110 HF patients hospitalized and treated for fluid overload. BVs were measured in a compensated state at hospital discharge using indicator-dilution methodology. Data were analyzed for composite 1-year HF-related mortality/1^st re-hospitalization. Despite uniform standard of care marked heterogeneity in BVs was identified across the cohort. The cohort was stratified by BV expansion ≥+25% above normal (51% of cohort), mild-moderate expansion (22%), and normal BV (27%). Kaplan-Meier (K-M) survival estimates and regression analyses revealed BV expansion (≥+25%) to be associated with better event-free survival relative to normal BV (p=0.038). Increased red blood cell mass (RBCm) (RBC polycythemia) was identified in 43% of the overall cohort, and 70% in BV expansion ≥+25%. K-M analysis demonstrated polycythemia to be associated with better outcomes compared with normal RBCm (p<0.002). Persistent BV expansion to include RBC polycythemia is common and, importantly, associated with better clinical outcomes compared to normal total BV or normal RBCm in patients with chronic HF. However, compensatory BV expansion is not a uniform physiologic response to the insult of HF with marked variability in BV profiles despite uniform standard of care diuretic therapy. Therefore, recognizing the variability in volume regulation pathophysiology has implications not only for impact on clinical outcomes and risk stratification, but also potential for informing individualized volume management strategies.

中文翻译：

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慢性人类心力衰竭的血容量扩张、血容量正常和临床结果 - 越多越好

血容量 (BV) 的扩张是公认的对继发于心力衰竭 (HF) 心输出量受损的动脉欠充盈的反应。然而，这种反应在结果方面的有效性仍然没有得到充分理解。对 110 名因液体超负荷住院和接受治疗的 HF 患者进行了前瞻性分析。在出院时使用指示剂稀释法在补偿状态下测量 BV。数据分析了复合 1 年 HF 相关死亡率/1 ^st再次住院。尽管在整个队列中发现了统一的护理标准，但在 BV 中存在明显的异质性。队列按 BV 扩展超过正常值≥+25%（队列的 51%）、轻度中度扩展（22%）和正常 BV（27%）进行分层。Kaplan-Meier (KM) 生存估计和回归分析显示，与正常 BV 相比，BV 扩张 (≥+25%) 与更好的无事件生存相关 (p=0.038)。整个队列中有 43% 的人发现红细胞量 (RBCm) 增加（RBC 红细胞增多症），而 BV 扩增≥+25% 的人为 70%。KM 分析表明，与正常 RBCm 相比，红细胞增多症与更好的结果相关（p<0.002）。持续的 BV 扩张包括红细胞红细胞增多症是常见的，重要的是，与慢性 HF 患者的正常总 BV 或正常 RBCm 相比，临床结果更好。然而，代偿性 BV 扩张并不是对 HF 损伤的统一生理反应，尽管有统一的利尿剂治疗标准，但 BV 曲线存在显着差异。因此，认识到容量调节病理生理学的变异性不仅对临床结果和风险分层的影响具有影响，而且还可能为个体化容量管理策略提供信息。