Diagnostic Test for Estimation of Plasma Volume on Assessment of Congestive Status in Acute Heart Failure Patients at Saiful Anwar General Hospital

Oktafin Srywati Pamuna, Indra Prasetya, Tri Astiawati, Mohammad Saifur Rohman, Novi Kurnianingsih



Heart failure is a severe health issue with high death and morbidity rates globally, including in Indonesia. Congestion is the main symptom of acute heart failure. B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-pro BNP) are well-known markers to confirm the condition. Plasma volume estimation (ePVS)is one of the procedures currently being developed to assess a patient's congestive status at a lower cost.



This is descriptive observational research with a cross-sectional study method that included all patients with acute heart failure between May 2019-February 2022. Baseline characteristics, medication history, and echocardiography were also included in the statistical analysis. We used univariate and multivariate analysis to assess the effect of each variable on the patient's congestive condition. A diagnostic test of plasma volume estimation was carried out using Receiver Operating Characteristics (ROC) Analysis compared to NT pro-BNP as the gold standard.  



 A total of 506 subjects were diagnosed with acute heart failure at Dr. Saiful Anwar Malang Hospital, who met the inclusion and exclusion criteria. The mean age was older in congestive patients with 62.5% being male. Patients with congestive conditions have a lower ejection fraction with a higher estimated right atrial pressure from echocardiography. The estimation plasma volume status was also higher in congestive conditions (6,90 vs 3,5). The ePVS from ROC analysis has a good diagnostic value with a sensitivity of 91, 7% and specificity of 92,6%.



The estimation of plasma volume status has a good sensitivity and specificity value to assess congestive status in patients with acute heart failure who are fluid-overloaded. 


acute heart failure, congestive, plasma volume status

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McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021;42(36):3599–726. 10.1093/eurheartj/ehab368

Ziaeian B, Fonarow GC. Epidemiology and aetiology of heart failure. Nat Rev Cardiol 2016;13(6):368–78. 10.1038/nrcardio.2016.25

Ural D, Çavuşoğlu Y, Eren M, et al. Akut kalp yetersizliği tanı ve tedavisi. Anatol J Cardiol 2015;15(11):860–89. 10.5152/AnatolJCardiol.2015.6567

Greenberg BH. Heart failure epidemic. Curr Cardiol Rep 2002;4(3):185. 10.1007/s11886-002-0048-y

Groenewegen A, Rutten FH, Mosterd A, Hoes AW. Epidemiology of heart failure. Eur J Heart Fail 2020;22(8):1342–56. 10.1002/ejhf.1858

Kemenkes RI. Situasi kesehatan jantung. Pus data dan Inf Kementeri Kesehat RI 2014;3. http://www.depkes.go.id/download.php?file=download/pusdatin/infodatin/infodatin-jantung.pdf. 10.1017/CBO9781107415324.004

Tsukada YT, Katoh YK, Seino Y. Home-based management in patients with chronic heart failure. Nippon rinsho Japanese J Clin Med 2007;65 Suppl 5:323–8.

Tubaro M, Vranckx P, Price S. Oxford Medicine Online The ESC Textbook of Intensive and Acute Cardiovascular Care. 2016. 10.1093/med/9780199687039.001.0001

Dickstein K, Cohen-Solal A, Filippatos G, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. Eur Heart J 2008;29(19):2388–442. 10.1093/eurheartj/ehn309

Cerlinskaite K, Javanainen T, Cinotti R, Mebazaa A. Acute heart failure management. Korean Circ J 2018;48(6):463–80. 10.4070/kcj.2018.0125

Strobeck JE, Feldschuh J, Miller WL. Heart Failure Outcomes With Volume-Guided Management. JACC Hear Fail 2018;6(11):940–8. 10.1016/j.jchf.2018.06.017

Gaggin HK, Januzzi JL. Biomarkers and diagnostics in heart failure. Biochim Biophys Acta - Mol Basis Dis 2013;1832(12):2442–50. http://dx.doi.org/10.1016/j.bbadis.2012.12.014. 10.1016/j.bbadis.2012.12.014

Sakka SG. Hemodynamic monitoring in the critically ill patient - current status and perspective. Front Med 2015;2(AUG):1–6. 10.3389/fmed.2015.00044

Sciomer S, Moscucci F, Salvioni E, et al. Role of gender, age and BMI in prognosis of heart failure. Eur J Prev Cardiol 2020;27(2_suppl):46–51. 10.1177/2047487320961980

Nohria A, Tsang SW, Fang JC, et al. Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure. J Am Coll Cardiol 2003;41(10):1797–804. http://dx.doi.org/10.1016/S0735-1097(03)00309-7. 10.1016/S0735-1097(03)00309-7

Kocabaş U, Sinan ÜY, Aruğaslan E, et al. Clinical characteristics and in-hospital outcomes of acute decompensated heart failure patients with and without atrial fibrillation. Anatol J Cardiol 2020;23(5):260–7. 10.14744/AnatolJCardiol.2020.94884

Crousillat DR, Ibrahim NE. Sex Differences in the Management of Advanced Heart Failure. Curr Treat Options Cardiovasc Med 2018;20(11). 10.1007/s11936-018-0687-y

Zafrir B, Salman N, Crespo-Leiro MG, et al. Body surface area as a prognostic marker in chronic heart failure patients: results from the Heart Failure Registry of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2016;18(7):859–68. 10.1002/ejhf.551

Mentz RJ, Kjeldsen K, Rossi GP, et al. Decongestion in acute heart failure. Eur J Heart Fail 2014;16(5):471–82. 10.1002/ejhf.74

Miller WL. Fluid volume overload and congestion in heart failure. Circ Hear Fail 2016;9(8):1–9. 10.1161/CIRCHEARTFAILURE.115.002922

Nadar SK, Shaikh MM. Biomarkers in Routine Heart Failure Clinical Care. Card Fail Rev 2019;5(1):50–6. 10.15420/cfr.2018.27.2

Ibrahim NE, Gaggin HK, Konstam MA, Januzzi JL. Established and emerging roles of biomarkers in heart failure clinical trials. Circ Hear Fail 2016;9(9):1–10. 10.1161/CIRCHEARTFAILURE.115.002528

Kobayashi M, Girerd N, Duarte K, et al. Estimated plasma volume status in heart failure: clinical implications and future directions. Clin Res Cardiol 2021;110(8):1159–72. 10.1007/s00392-020-01794-8

Roumelioti M-E, Glew RH, Khitan ZJ, et al. Fluid balance concepts in medicine: Principles and practice. World J Nephrol 2018;7(1):1–28. 10.5527/wjn.v7.i1.1

Kobayashi M, Girerd N, Duarte K, Preud’homme G, Pitt B, Rossignol P. Prognostic impact of plasma volume estimated from hemoglobin and hematocrit in heart failure with preserved ejection fraction. Clin Res Cardiol 2020;109(11):1392–401. https://doi.org/10.1007/s00392-020-01639-4. 10.1007/s00392-020-01639-4

Martens P, Nijst P, Dupont M, Mullens W. The Optimal Plasma Volume Status in Heart Failure in Relation to Clinical Outcome. J Card Fail 2019;25(4):240–8. https://doi.org/10.1016/j.cardfail.2018.11.019. 10.1016/j.cardfail.2018.11.019

Duarte K, Monnez JM, Albuisson E, Pitt B, Zannad F, Rossignol P. Prognostic Value of Estimated Plasma Volume in Heart Failure. JACC Hear Fail 2015;3(11):886–93. 10.1016/j.jchf.2015.06.014

Zile MR, Bennett TD, St. John Sutton M, et al. Transition from chronic compensated to acute d compensated heart failure: Pathophysiological insights obtained from continuous monitoring of intracardiac pressures. Circulation 2008;118(14):1433–41. 10.1161/CIRCULATIONAHA.108.783910

Knudsen NN, Kjærulff TM, Ward LC, Sæbye D, Holst C, Heitmann BL. Body water distribution and risk of cardiovascular morbidity and mortality in a healthy population: A prospective cohort study. PLoS One 2014;9(2):1–7. 10.1371/journal.pone.0087466

McKie PM, Burnett JC. NT-proBNP: The Gold Standard Biomarker in Heart Failure. J Am Coll Cardiol 2016;68(22):2437–9. 10.1016/j.jacc.2016.10.001

DOI: https://doi.org/10.21776/ub.hsj.2023.004.04.3


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