Study On The Value Of Plasma Volume Estimated By Hemoglobin And Hematocrit In The Diagnosis Of Volume Load Of Heart Failure With Preserved Ejection Fraction

Objective:Discuss the diagnostic value of plasma volume estimated by hemoglobin and hematocrit for volume load of heart failure with preserved ejection fraction(HFp EF).Methods:A retrospective analysis of 200 inpatients in the cardiology department of our hospital from September 2017 to August 2020 were divided into non-heart failure(HF)group 50 cases,HF group was divided into HFp EF group 50 cases according to left ventricular ejection fraction(LVEF),50 cases in the HF with median ejection fraction(HFm EF)group and 50 cases in the HF with reduced ejection fraction(HFr EF)group.Collect clinical data,including age,gender,combined atrial fibrillation,hypertension,coronary heart disease,diabetes,and stroke.Biochemical indicators are venous blood test indicators drawn the day after admission,including: hemoglobin(Hb),hematocrit(HCT),BNP,cholesterol,triglycerides,high-density lipoprotein,low-density lipoprotein,and cardiac color Doppler ultrasound results,including left ventricular end diastolic diameter(LVEDd),left atrial inner diameter(LAD),LVEF,etc.Use Duarte formula to estimate plasma volume(ePVS)based on Hb and HCT.Use SPSS25.0 software for statistical analysis,ANOVA compares the basic data and ePVS between the four groups to find statistically significant indicators;use multivariate binary Logistic regression to analyze whether the statistically significant indicators are risk factors for HFp EF,HFm EF and HFr EF.Draw a receiver operating characteristic curve(ROC)to evaluate the diagnostic value of ePVS for the volume load of the three types of HF patients.Results:1.1.A total of 200 patients were enrolled in this study,with an average age of67.66±12.56 years old,including 126(63.0%)males and 74(37.0%)females.Patients with hypertension,coronary heart disease,diabetes,and stroke were respectively 98 cases(49.0%),87 cases(43.5%),47 cases(23.5%),38 cases(19.0%).Among the four groups,there was no statistical difference in gender,coronary heart disease,diabetes,stroke,total cholesterol,triglycerides,high-density lipoprotein,low-density lipoprotein,potassium ion,sodium ion,etc.(P>0.05);Age,combined with hypertension,BNP,LAD,LVEDd,ePVS are statistically different(P<0.05);compared with the non-HF group,the combination of HFp EF and coronary heart disease,combined with diabetes,BNP,LAD,LVEDd,ePVS is statistically significant Difference(P<0.05);BNP,LAD,LVEDd,ePVS in the HFm EF group were statistically different(P<0.05);age,BNP,LAD,LVEDd,ePVS in the HFr EF group were statistically different(P<0.05);Compared with the HFr EF group In comparison,the proportion of women in the HFp EF group,the age of onset,and the ePVS value were higher(all P<0.05);compared with the HFp EF group,the values of BNP and LVEDd the HFr EF group were higher(P<0.05).2.Multivariate binary logistic regression analysis,after adjusting for related factors,coronary heart disease,LVEDd,and ePVS were independent risk factors for HFp EF(OR=3.579,95%CI: 1.246-10.382,P=0.018;OR=1.565,95%CI: 1.237～1.981,P<0.001;OR=3.233,95%CI: 1.737～5.980,P<0.001);LAD and LVEDd are independent risk factors for HFm EF(OR=1.095,95%CI: 1.012～ 1.185,P=0.023;OR=1.119,95%CI: 1.025～1.222,P=0.012);ePVS is not an independent risk factor for HFm EF(OR=1.118,95%CI:0.725～1.724,P=0.614);combined Diabetes,LVEDd,and ePVS were independent risk factors for HFr EF(OR=4.683,95%CI: 1.324-16.569,P=0.017;OR=1.708,95%CI:1.261～2.315,P=0.001;OR=1.533,95 %CI: 1.031～2.280,P=0.035).3.The area under the curve(AUC)for the diagnosis of HFp EF by ePVS is 74.9(95%CI:0.654～0.845,P<0.05),the cutoff value is 5.09 ml/g,the sensitivity and specificity are 0.460 and 0.94 respectively;There is no diagnostic value in patients with HFm EF and HFr EF(P>0.05).Conclusion:1.ePVS is an independent risk factor for HFp EF patients;2.ePVS≥5.09 ml/g can be used as an indicator of the volume load of HFp EF patients,helping clinicians to judge the volume load early before the appearance of clinical symptoms,and intervene early to avoid the occurrence of symptomatic decompensated HFp EF.