Plasma Volume Management in Heart Failure
Summary
Plasma volume regulation lies at the heart of managing both acute and chronic manifestations of heart failure. Excess intravascular volume contributes to ventricular wall stress, pulmonary congestion and peripheral oedema, whereas inadequate volume status may compromise perfusion and renal function. Contemporary approaches combine direct and indirect measures of plasma volume to guide diuretic therapy, monitor decongestion and refine risk stratification. Estimated plasma volume status (ePVS), derived from routine haematological parameters, offers a convenient surrogate for intravascular fluid shifts. Emerging evidence emphasises the prognostic and therapeutic value of dynamic assessment of plasma volume, supporting individualised fluid management strategies that balance relief of congestion with preservation of end‐organ perfusion.
Research from Nature Portfolio
Recent studies have demonstrated that estimated plasma volume is an independent predictor of long‐term outcomes in patients with preserved ejection fraction, identifying those at high risk of hospitalisation and mortality through both baseline ePVS and its temporal variation. Further work in compensated chronic heart failure has evaluated the accuracy of common prediction formulas against direct measurement techniques, revealing that while certain algorithms modestly detect true volume excess, overall positive predictive value remains limited. Together, these investigations underscore the need for refined estimation methods and validation of instantaneous plasma volume derivatives to improve prognostic precision in diverse heart failure phenotypes.
Plasma Volume Management in Heart Failure publication trend
The graph below shows the total number of articles in plasma volume management in heart failure across all publications each year (not limited to Nature Index journals).
Technical terms
Estimated plasma volume status (ePVS): A calculated index of intravascular fluid derived from haemoglobin and haematocrit ratios to infer volume expansion or contraction.
Strauss formula: An algebraic method using serial haemoglobin and haematocrit measurements to estimate percentage change in plasma volume.
Haemoconcentration: An increase in blood cell concentration due to relative plasma volume reduction, often indicating effective decongestion.
Decongestion: The therapeutic process of removing excess intravascular and interstitial fluid to relieve symptoms in heart failure.
Left atrial diameter (LAD): Echocardiographic measurement reflecting chronic pressure and volume load on the left atrium, used as a marker of congestion.
References
- Long-term Prognostic Value of Estimated Plasma Volume in Heart Failure with Preserved Ejection Fraction. Scientific Reports (2019).
- Blood volume expansion, normovolemia, and clinical outcomes in chronic human heart failure: more is better. AJP Heart and Circulatory Physiology (2021).
- Estimated plasma volume status is a modest predictor of true plasma volume excess in compensated chronic heart failure patients. Scientific Reports (2021).
- Effect of estimated plasma volume status and left atrial diameter on prognosis of patients with acute heart failure. Frontiers in Cardiovascular Medicine (2023).
- Impact of Estimated Plasma Volume Status on Mortality in Right Heart Failure Patients: A Retrospective Cohort Study in Indonesia. Global Heart (2022).
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