Affiliation:
1. Department of Cardiovascular Diseases Mayo Clinic 200 First Street, SW Rochester MN USA
2. Department of Biomedical Statistics Mayo Clinic Rochester MN 55905 USA
3. Division of Diagnostic Radiology Mayo Clinic Rochester MN USA
Abstract
AbstractAimsTo identify different red blood cell mass (RBCM) profiles, separate from haemoglobin concentrations, and their impact on blood volume expansion and clinical outcomes in chronic heart failure.Methods and resultsRBCM was measured at hospital discharge using standardized nuclear medicine indicator‐dilution methodology in patients following diuretic treatment for clinical congestion. Individual RBCM phenotypes were prospectively identified and analysed for heart failure‐related mortality or first rehospitalization over 1 year.Of 132 patients, 42 (32%) demonstrated normal RBCM, 36 (27%) RBCM deficit (true anaemia), and 54 (41%) RBCM excess (erythrocythemia). Dilutional ‘anaemia’ defined by haemoglobin <12 g/dL with normal or an excess in RBCM with plasma volume expansion was identified in 37 (28%) patients. There were 61 composite outcome events, which included 38 deaths (29% of cohort) occurring over the 1 year follow‐up period [14/36 (39%) in RBCM deficit, 12/42 (29%) in normal RBCM, and 12/54 (22%) in RBCM excess subgroups]. By Kaplan–Meier and multivariate analyses, RBCM excess was independently associated with the best event‐free survival while RBCM deficit (true anaemia) the poorest outcomes; both compared with normal RBCM (P < 0.001). Dilutional ‘anaemia’ demonstrated a lower risk compared with true anaemia (P = 0.03).ConclusionsMarkedly different RBCM profiles are identifiable among comparably compensated heart failure patients, and this variability carries significant implications for post‐hospital outcomes. Novel to this analysis and in contrast to RBCM deficit is the independent association of RBCM excess with better event‐free survival compared with normal RBCM. The distinction of RBCM profiles to guide risk stratification and individualized patient management strategies warrants further study.
Subject
Cardiology and Cardiovascular Medicine
Cited by
3 articles.
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