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Kittipibul V, Novelli A, Yaranov D, Swavely A, Ferreira LF, Molinger J, Jefferies JL, Miller WL, Fudim M. Relationship of red blood cell mass profiles and anemia type to outcomes and cardiopulmonary exercise performance in chronic heart failure. Am Heart J 2025; 288:131-139. [PMID: 40306395 DOI: 10.1016/j.ahj.2025.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Revised: 04/19/2025] [Accepted: 04/22/2025] [Indexed: 05/02/2025]
Abstract
BACKGROUND Blood volume analysis (BVA) allows direct measurement of red blood cell mass (RBCM) and differentiation of true and dilutional anemia in heart failure (HF). This study aimed to characterize the relationships of RBCM profiles and anemia types to HF outcomes and cardiopulmonary exercise test (CPET) parameters. METHODS Chronic stable HF patients were prospectively enrolled. All patients underwent BVA; a subset underwent supine invasive CPET within 24 hours of BVA. RBCM profiles were defined using RBCM %deviation (deficit: <-10%, normal: -10 to 10%, excess: >10%). Anemia defined by World Health Organization criteria alone was categorized using RBCM %deviation (<-10% true anemia, ≥-10% dilutional pseudo-anemia). HF hospitalization at 6 months and CPET parameters were compared among RBCM profiles and anemia types. RESULTS One-hundred twenty patients (58 years, 40% female, 41% Black, 63% HFrEF) were enrolled. Forty percent had RBCM deficit, 37.5% had normal RBCM, and 22.5% had excess RBCM. Fifty-eight patients (48%) were anemic: 60% true anemia and 40% dilutional pseudo-anemia. Patients with dilutional pseudo-anemia had a higher incidence of HF hospitalization (44.8%) compared to no anemia (22.7%) and true anemia (20.6%) (P = .040). There was no difference in HF hospitalization among RBCM profiles (P = .99). There was a nonsignificant trend toward worse peak VO2 in RBCM deficit and true anemia, with no differences in other CPET parameters. CONCLUSIONS Dilutional pseudo-anemia demonstrated higher HF hospitalizations compared to true anemia, while true anemia had a trend towards worse peak VO2. The implications of BVA-identified RBCM profiles and anemia types for clinical management warrant further investigation.
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Affiliation(s)
- Veraprapas Kittipibul
- Division of Cardiology, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | - Alexandra Novelli
- Department of Internal Medicine, Duke University School of Medicine, Durham, NC
| | - Dmitry Yaranov
- Department of Cardiology, Baptist Memorial Hospital, Memphis, TN
| | - Ashley Swavely
- Division of Cardiology, Duke University Medical Center, Durham, NC
| | | | - Jeroen Molinger
- Division of Cardiology, Duke University Medical Center, Durham, NC
| | | | - Wayne L Miller
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Marat Fudim
- Division of Cardiology, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC.
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2
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Cumpston P. A robust analysis of alternate methods for estimating blood volume. Perfusion 2025:2676591251328856. [PMID: 40221826 DOI: 10.1177/02676591251328856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2025]
Abstract
AimThis study evaluates the accuracy of a newly derived blood volume estimation formula based on the Boer equation for lean body mass, comparing its performance against the Nadler, Allen and Lemmens-Bernstein-Brodsky formulas.MethodsBlood volume estimation was evaluated using two datasets: the Retzlaff dataset, based on 78 healthy individuals, and the Allen dataset, derived from 81 subjects, two of European descent, the remainder Chinese 'medical, nursing and pedagogic students, technicians, clerks and family members' and one young Chinese physician. The formulas were compared using robust statistical methods, including the Wilcoxon Signed-Rank Test, permutation tests, Bland-Altman analysis, and Proportion Within Range.ResultsAcross all methods, the formula derived from the Boer equation showed the narrowest limits of agreement and smallest variability in most metrics, highlighting its potential as the most accurate and clinically useful tool for blood volume estimation. The Nadler formula also performed well but with slightly larger errors and bias.ConclusionThis study highlights the limitations of the Allen formula and demonstrates the superior performance of the Boer formula, which is derived from lean body mass. While the Allen formula performed well on its original dataset, it showed higher variability and less accuracy on more modern data. Both the Nadler and Boer formulas exhibited greater precision, with the Boer formula showing slightly lower variability. The study emphasizes the importance of using independent data sets for validation and addresses a critical gap in blood volume assessment by using robust techniques for analysis.
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Affiliation(s)
- Philip Cumpston
- The Greenslopes Private Hospital, Greenslopes, QLD, Australia
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3
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Hinkle GH. 51Cr Red Blood Cells in the Study of Hematologic Disease: A Historical Review. J Nucl Med Technol 2024; 52:299-305. [PMID: 39137978 DOI: 10.2967/jnmt.124.267702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/19/2024] [Indexed: 08/15/2024] Open
Abstract
The early years of nuclear medicine included the development and clinical use of several in vitro or nonimaging procedures. The use of radionuclides as replacements for nonradioactive dyes brought improved accuracies and less subjective measurements to indicator dilution studies of body compartments such as the gastrointestinal system, lungs, urinary system, and vascular space. A popular nuclear medicine procedure was the radionuclide dilution method for quantitation of whole-blood volume or red blood cell volume or mass using 51Cr-labeled red blood cells-an important diagnostic element in patients suspected of having polycythemia vera, congestive heart failure, hypertension, shock, syncope, and other abnormal blood volume disorders. The radionuclide dilution method led to improved evaluation of red blood cell survival, which is important for clinical treatment planning in anemia and confirmation of splenic sequestration of damaged red blood cells. Although it was discovered that 51Cr was a chemically stable radiolabel of red blood cells after binding to intracellular hemoglobin, few nuclear medicine departments offered the clinical study for referring physicians because it required laboratory expertise for technologists, patient coordination, and a time-consuming procedure. The introduction of improved methods that are less time-consuming and have clinically acceptable results, along with the discontinuation of the sodium chromate 51Cr injection radiopharmaceutical by manufacturers, has consigned 51Cr red blood cells for red blood cell volume, mass, or survival evaluation to the list of retired nuclear medicine studies.
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Sohal S, Uppal D, Mathai SV, Wats K, Uppal NN. Acute Cardiorenal Syndrome: An Update. Cardiol Rev 2024; 32:489-498. [PMID: 36883827 DOI: 10.1097/crd.0000000000000532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
The complex dynamic pathophysiological interplay between the heart and kidney causes a vicious cycle of worsening renal and/or cardiovascular function. Acute decompensated heart failure causing worsening renal function defines Type 1 cardiorenal syndrome (CRS). Altered hemodynamics coupled with a multitude of nonhemodynamic factors namely pathological activation of the renin angiotensin aldosterone system and systemic inflammatory pathways mechanistically incite CRS type 1. A multipronged diagnostic approach utilizing laboratory markers, noninvasive and/or invasive modalities must be implemented to enable timely initiation of effective treatment strategies. In this review, we discuss the pathophysiology, diagnosis, and emerging treatment options for CRS type 1.
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Affiliation(s)
- Sumit Sohal
- From the Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, Newark, NJ
| | - Dipan Uppal
- Department of Cardiovascular Diseases, Cleveland Clinic Florida, Weston, FL
| | | | - Karan Wats
- Division of Cardiovascular Diseases, Department of Medicine, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Nupur N Uppal
- Division of Kidney Diseases and Hypertension, Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY
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Jefferies JL, Stavish CA, Silver MA, Butler J, Humes HD, Strobeck J. Blood Volume Analysis and Cardiorenal Syndrome: From Bench to Bedside. Cardiorenal Med 2024; 14:483-497. [PMID: 39033745 DOI: 10.1159/000540497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 05/09/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND This review delves into the intricate landscape of cardiorenal syndrome (CRS) and highlights the pivotal role of blood volume analysis (BVA) in improving patient care and outcomes. SUMMARY BVA offers a direct and highly accurate quantification of intravascular volume, red blood cell volume, and plasma volume, complete with patient-specific norms. This diagnostic tool enhances the precision of diuretic and red cell therapies, significantly elevating the effectiveness of conventional care. KEY MESSAGES Our objectives encompass a comprehensive understanding of how BVA informs the evaluation and treatment of CRS, including its subtypes, pathophysiology, and clinical significance. We delve into BVA principles, techniques, and measurements, elucidating its diagnostic potential and advantages compared to commonly used surrogate measures. We dissect the clinical relevance of BVA in various CRS scenarios, emphasizing its unique contributions to each subtype. By assessing the tangible impact of BVA on patient outcomes through meticulous analysis of relevant clinical studies, we unveil its potential to enhance health outcomes and optimize resource utilization. Acknowledging the challenges and limitations associated with BVA's clinical implementation, we underscore the importance of multidisciplinary collaboration among cardiologists, nephrologists, and other clinicians. Finally, we identify research gaps and propose future directions for BVA and CRS, contributing to ongoing advancements in this field and patients affected by this complicated clinical syndrome.
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Affiliation(s)
| | | | - Marc A Silver
- University of Arizona-Phoenix, Department of Medicine, Phoenix, Arizona, USA
| | - Javed Butler
- University of Mississippi, Department of Medicine, Jackson, Mississippi, USA
| | - Harvey David Humes
- University of Michigan Health, Division of Nephrology, Internal Medicine, Ann Arbor, Michigan, USA
| | - John Strobeck
- Heart-Lung Center Consultants, New Milford, New Jersey, USA
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DiNuzzo M, Dienel GA, Behar KL, Petroff OA, Benveniste H, Hyder F, Giove F, Michaeli S, Mangia S, Herculano-Houzel S, Rothman DL. Neurovascular coupling is optimized to compensate for the increase in proton production from nonoxidative glycolysis and glycogenolysis during brain activation and maintain homeostasis of pH, pCO 2, and pO 2. J Neurochem 2024; 168:632-662. [PMID: 37150946 PMCID: PMC10628336 DOI: 10.1111/jnc.15839] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 04/22/2023] [Accepted: 05/02/2023] [Indexed: 05/09/2023]
Abstract
During transient brain activation cerebral blood flow (CBF) increases substantially more than cerebral metabolic rate of oxygen consumption (CMRO2) resulting in blood hyperoxygenation, the basis of BOLD-fMRI contrast. Explanations for the high CBF versus CMRO2 slope, termed neurovascular coupling (NVC) constant, focused on maintenance of tissue oxygenation to support mitochondrial ATP production. However, paradoxically the brain has a 3-fold lower oxygen extraction fraction (OEF) than other organs with high energy requirements, like heart and muscle during exercise. Here, we hypothesize that the NVC constant and the capillary oxygen mass transfer coefficient (which in combination determine OEF) are co-regulated during activation to maintain simultaneous homeostasis of pH and partial pressure of CO2 and O2 (pCO2 and pO2). To test our hypothesis, we developed an arteriovenous flux balance model for calculating blood and brain pH, pCO2, and pO2 as a function of baseline OEF (OEF0), CBF, CMRO2, and proton production by nonoxidative metabolism coupled to ATP hydrolysis. Our model was validated against published brain arteriovenous difference studies and then used to calculate pH, pCO2, and pO2 in activated human cortex from published calibrated fMRI and PET measurements. In agreement with our hypothesis, calculated pH, pCO2, and pO2 remained close to constant independently of CMRO2 in correspondence to experimental measurements of NVC and OEF0. We also found that the optimum values of the NVC constant and OEF0 that ensure simultaneous homeostasis of pH, pCO2, and pO2 were remarkably similar to their experimental values. Thus, the high NVC constant is overall determined by proton removal by CBF due to increases in nonoxidative glycolysis and glycogenolysis. These findings resolve the paradox of the brain's high CBF yet low OEF during activation, and may contribute to explaining the vulnerability of brain function to reductions in blood flow and capillary density with aging and neurovascular disease.
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Affiliation(s)
| | - Gerald A Dienel
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205 USA
- Department of Cell Biology and Physiology, University of New Mexico School of Medicine, Albuquerque, NM, 87131 USA
| | - Kevin L Behar
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06511 USA
| | - Ognen A Petroff
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06511 USA
| | - Helene Benveniste
- Department of Anesthesiology, Yale University, New Haven, CT, 06520 USA
- Department of Biomedical Engineering, Yale University, New Haven, CT, 06520 USA
| | - Fahmeed Hyder
- Department of Biomedical Engineering, Yale University, New Haven, CT, 06520 USA
- Department of Radiology, Magnetic Resonance Research Center (MRRC), Yale University, New Haven, CT, 06520 USA
| | - Federico Giove
- Centro Ricerche Enrico Fermi, Rome, RM, 00184 Italy
- Fondazione Santa Lucia IRCCS, Rome, RM, 00179 Italy
| | - Shalom Michaeli
- Department of Radiology, Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, MN, 55455 USA
| | - Silvia Mangia
- Department of Radiology, Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, MN, 55455 USA
| | - Suzana Herculano-Houzel
- Department of Psychology, Vanderbilt University, Nashville, TN
- Department of Biological Sciences, Vanderbilt University, Nashville, TN
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN
| | - Douglas L Rothman
- Department of Biomedical Engineering, Yale University, New Haven, CT, 06520 USA
- Department of Radiology, Magnetic Resonance Research Center (MRRC), Yale University, New Haven, CT, 06520 USA
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Deniau B, Costanzo MR, Sliwa K, Asakage A, Mullens W, Mebazaa A. Acute heart failure: current pharmacological treatment and perspectives. Eur Heart J 2023; 44:4634-4649. [PMID: 37850661 DOI: 10.1093/eurheartj/ehad617] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 08/23/2023] [Accepted: 09/08/2023] [Indexed: 10/19/2023] Open
Abstract
Acute heart failure (AHF) represents the most frequent cause of unplanned hospital admission in patients older than 65 years. Symptoms and clinical signs of AHF (e.g. dyspnoea, orthopnoea, oedema, jugular vein distension, and variation of body weight) are mostly related to systemic venous congestion secondary to various mechanisms including extracellular fluids, increased ventricular filling pressures, and/or auto-transfusion of blood from the splanchnic into the pulmonary circulation. Thus, the initial management of AHF patients should be mostly based on decongestive therapies on admission followed, before discharge, by rapid implementation of guideline-directed oral medical therapies for heart failure. The therapeutic management of AHF requires the identification and rapid diagnosis of the disease, the diagnosis of the cause (or triggering factor), the evaluation of severity, the presence of comorbidities, and, finally, the initiation of a rapid treatment. The most recent guidelines from ESC and ACC/AHA/HFSA have provided updated recommendations on AHF management. Recommended pharmacological treatment for AHF includes diuretic therapy aiming to relieve congestion and achieve optimal fluid status, early and rapid initiation of oral therapies before discharge combined with a close follow-up. Non-pharmacological AHF management requires risk stratification in the emergency department and non-invasive ventilation in case of respiratory failure. Vasodilators should be considered as initial therapy in AHF precipitated by hypertension. On the background of recent large randomized clinical trials and international guidelines, this state-of-the-art review describes current pharmacological treatments and potential directions for future research in AHF.
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Affiliation(s)
- Benjamin Deniau
- Department of Anesthesia, Burn and Critical Care, University Hospitals Saint-Louis-Lariboisière, AP-HP, 2 rue Ambroise Paré, 75010 Paris, France
- UMR-S 942, INSERM, MASCOT, Université de Paris Cité, Paris, France
- Université de Paris Cité, Paris, France
- FHU PROMICE, France
| | | | - Karen Sliwa
- Cape Heart Institute, Department of Cardiology and Medicine, Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, South Africa
| | - Ayu Asakage
- UMR-S 942, INSERM, MASCOT, Université de Paris Cité, Paris, France
| | - Wilfried Mullens
- Ziekenhuis Oost-Limburg A.V., Genk, Belgium
- Hasselt University, Diepenbeek/Hasselt, Belgium
| | - Alexandre Mebazaa
- Department of Anesthesia, Burn and Critical Care, University Hospitals Saint-Louis-Lariboisière, AP-HP, 2 rue Ambroise Paré, 75010 Paris, France
- UMR-S 942, INSERM, MASCOT, Université de Paris Cité, Paris, France
- Université de Paris Cité, Paris, France
- FHU PROMICE, France
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Fan Y, Guo L, Wang R, Xu J, Fang Y, Wang W, Lv J, Tang W, Wang H, Xu DX, Tao L, Huang Y. Low transplacental transfer of PFASs in the small-for-gestational-age (SGA) new-borns: Evidence from a Chinese birth cohort. CHEMOSPHERE 2023; 340:139964. [PMID: 37633609 DOI: 10.1016/j.chemosphere.2023.139964] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 08/28/2023]
Abstract
Early life in utero exposure to per- and polyfluoroalkyl substances (PFASs) and infiltration through the placenta into cord blood pose significant risk to fetal development. Accumulating knowledge suggests that PFASs pass through the placenta in multiple transportation ways, not limiting to passive transport but also active transport or facilitated diffusion. Therefore, we propose that the transplacental transfer efficiency (TTE) could be re-evaluated as traditional cord to maternal ratio-based method might overlook certain biological or health information from the mother and fetus. In this study, we investigated 30 PFAS chemicals in paired maternal and cord serum from 195 births classified as small-for-gestational-age (SGA) and matched appropriate-for-gestational-age (AGA). PFASs were ubiquitously detected in the maternal and serum samples, with PFOA, PFOS, 6:2 Cl-PFESA and other dominant compounds. We adopted a modified TTE estimation method (TTEm), taking into consideration of the total burden mass of PFASs in the blood from mother to fetus. Using the modified TTEm, a significant (p < 0.05) decrease was observed in the PFAS transplacental transfer potential in SGA (1.6%-11.3%) compared to AGA (2.3%-21.1%), suggesting a reverse association between TTE and SGA birth risk. This is the first study attempted to re-evaluate the TTE of PFAS and indicates that TTEm might be more advantageous to reflect the transplacental transfer potency of chemicals particularly when transportation mechanisms are multi-faceted.
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Affiliation(s)
- Yijun Fan
- Department of Toxicology, School of Public Health; Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China; Department of Gynecology and Obstetrics, the Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Liyan Guo
- Department of Toxicology, School of Public Health; Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Ruolan Wang
- Department of Toxicology, School of Public Health; Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China; Department of Gynecology and Obstetrics, the Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jingjing Xu
- Department of Toxicology, School of Public Health; Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Yuanyuan Fang
- Department of Toxicology, School of Public Health; Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China; Department of Gynecology and Obstetrics, the Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wenxin Wang
- Department of Toxicology, School of Public Health; Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China; Department of Gynecology and Obstetrics, the Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jia Lv
- Department of Toxicology, School of Public Health; Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Weitian Tang
- Department of Toxicology, School of Public Health; Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Hua Wang
- Department of Toxicology, School of Public Health; Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - De-Xiang Xu
- Department of Toxicology, School of Public Health; Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Lin Tao
- Department of Toxicology, School of Public Health; Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China.
| | - Yichao Huang
- Department of Toxicology, School of Public Health; Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China.
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Cumpston P. Blood volume estimation in cardiac surgery - A comparative analysis. Perfusion 2023; 38:455-463. [PMID: 35345934 DOI: 10.1177/02676591211069920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION This paper seeks to identify which of three published formulas used for estimating the blood volume of normal human subjects correlates most closely with blood volumes measured in a published study where erythrocyte volume was determined by a method using 51Cr and a nonradioactive dye was used to determine the plasma volume. METHODS Blood volumes predicted by three published algorithms were compared with blood volume estimates from a study by Retzlaff et al. using the two-tailed Wilcoxon signed rank test and a robust version of the Bland-Altman test. RESULTS When applied to a sample of normal subjects selected from Mayo Clinic personnel and patients, the Nadler formula correlated more closely with blood volume measured using a radio nucleotide technique than did the Allen formula or one based on a saline haemodilution technique. CONCLUSIONS The Nadler formula correlated more closely with blood volume measurements derived from Retzlaff's study than the other formulas for estimating blood volume in a population with height and weight distribution more consistent with that seen in North America. It should be used in preference to the Allen formula for estimating blood volume in adult patients currently undergoing cardiac surgical procedures. Saline haemodilution techniques used to measure blood volume require validation against more recently developed nuclear medicine techniques using statistical methods other than regression analysis. Until validated, they should be used with caution for estimating blood volume in adult patients currently undergoing cardiac surgical procedures. If a formula using height, weight and sex is used to estimate blood volume in the context of cardiac surgery, then it must be derived using a much more comprehensive sample of the population to which it is applied than has occurred to date. In particular, it should include broader distributions of height, weight and the presence or absence and type of significant valvular disease.
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Affiliation(s)
- Philip Cumpston
- Visiting Senior Specialist Anaesthetist, 3621Greenslopes Private Hospital, Greenslopes, QLD, Australia.,1974The University of Queensland, Saint Lucia, QLD, Australia
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Strategy for Calculating Magnesium Sulfate Dose in Obese Patients: A Randomized Blinded Trial. Anesthesiol Res Pract 2022; 2022:8424670. [DOI: 10.1155/2022/8424670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/14/2022] [Accepted: 10/22/2022] [Indexed: 11/09/2022] Open
Abstract
Background. Magnesium sulfate has analgesic properties during the postoperative period. However, there is a knowledge gap in pharmacology related to the use of the real, ideal, or corrected ideal body weight to calculate its dose in obese patients. This trial compared postoperative analgesia using actual and corrected ideal body weight. Methods. Seventy-five obese patients scheduled to undergo laparoscopic gastroplasty or cholecystectomy under general anesthesia were randomly assigned to three groups. The patients in the control group did not receive magnesium sulfate; the other two groups received magnesium sulfate at 40 mg·kg−1 of actual body weight or corrected ideal body weight. Results. In patients with body mass index >30 mg·kg−2 (mean body mass index ranging from 32.964 kg·m−2 to 33.985 kg·m−2, according to the groups) scheduled for video laparoscopic cholecystectomy, there were no differences in the blood magnesium concentrations in the groups receiving magnesium sulfate throughout the study, regardless of whether the strategy to calculate its dose was based on total or corrected ideal body weight. Patients in the groups receiving magnesium sulfate showed a significant reduction in morphine consumption (
) and pain scores (
) in the postoperative period compared to those in the control group. There were no significant differences in morphine consumption (
) or pain scores (
) between the two groups receiving magnesium sulfate. There were no differences in the total duration of neuromuscular block induced by cisatracurium among the three groups (
). Conclusions. Magnesium sulfate decreased postoperative pain and morphine consumption without affecting the recovery time of cisatracurium in obese patients undergoing laparoscopic cholecystectomy. Strategies to calculate the dose based on the actual or corrected ideal body weight had similar outcomes related to analgesia and the resulting blood magnesium concentration. However, as the sample in this trial presented body mass indices ranging from 30.11 kg·m−2 to 47.11 kg/m−2, further studies are needed to confirm these findings in more obese patients, easily found in centers specialized.
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Utilizing Total Blood Volume and Red Cell Volume to Clarify Adverse Outcomes in Patients With High Hematocrit During Cardiac Surgery. Anesth Analg 2022; 135:e5-e6. [PMID: 35709459 DOI: 10.1213/ane.0000000000006023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Blood loss estimation during posterior spinal fusion for adolescent idiopathic scoliosis. Spine Deform 2022; 10:581-588. [PMID: 34784000 DOI: 10.1007/s43390-021-00440-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Blood loss (BL) during posterior spinal fusion for adolescent idiopathic scoliosis (AIS) may be estimated using a variety of unproven techniques. Patient care and research on BL are likely impacted by a lack of standardization. A novel FDA-approved blood volume (BV) analysis system (BVA-100 Blood Volume Analyzer) allows rapid processing with > 97% accuracy. The purpose of this study was to investigate common methods for BL estimation. METHODS BV assessment was performed with the BVA-100. After obtaining a baseline sample of 5 mL of blood, 1 mL of I-131-labeled albumin was injected intravenously over 1 min. Five milliliter blood samples were then collected at 12, 18, 24, 30, and 36 min post-injection. Intravenous fluid was minimized to maintain euvolemia. Salvaged blood was not administered during surgery. BL was estimated using several common techniques and compared to the BV measurements provided by the BVA-100 (BVABL). RESULTS Thirty AIS patients were prospectively enrolled with major curves of 54° and underwent fusions of 10 levels. BL based on the BVA-100 (BVABL) was 519.2 [IQR 322.9, 886.2] mL. Previously published formulas all failed to approximate BVABL. Multiplying the cell saver volume return by 3 (CS3) approximates BVABL well with a Spearman correlation coefficient and ICC of 0.80 and 0.72, respectively. An extrapolated cell salvage-based estimator also showed high intraclass correlation coefficient (ICC) and Spearman coefficients with less bias than CS3. CONCLUSION Published formulaic approaches do not approximate true blood loss. Multiplying the cell saver volume by 3 or using the cell salvage-based estimator had the highest correlation coefficient and ICC. LEVEL OF EVIDENCE Prospective cohort Level 2.
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Hasimbegovic E, Russo M, Andreas M, Werner P, Coti I, Wiedemann D, Kocher A, Laufer G, Hofer BS, Mach M. Deviations From the Ideal Plasma Volume and Isolated Tricuspid Valve Surgery—Paving the Way for New Risk Stratification Parameters. Front Cardiovasc Med 2022; 9:849972. [PMID: 35402525 PMCID: PMC8990912 DOI: 10.3389/fcvm.2022.849972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCongestion and plasma volume expansion are important features of heart failure, whose prognostic significance has been investigated in a range of surgical and non-surgical settings. The aim of this study was to evaluate the value of the estimated plasma volume status (ePVS) in patients undergoing isolated tricuspid valve surgery.MethodsThis study included patients who underwent isolated tricuspid valve surgery at the Vienna General Hospital (Austria) between July 2008 and November 2018. The PVS cut-off was calculated using ROC analysis and Youden's Index.ResultsEighty eight patients (median age: 58 [IQR: 35-70] years; 44.3% male; 75.6% NYHA III/IV; median EuroSCORE II 2.65 [IQR: 1.70-5.10]; 33.0% endocarditis-related regurgitation; 60.2% isolated repair; 39.8% isolated replacement) were included in this study. Patients who died within 1 year following surgery had significantly higher baseline ePVS values than survivors (median ePVS 5.29 [IQR: −1.55-13.55] vs. −3.68 [IQR: −10.92-4.22]; p = 0.005). During a median actuarial follow-up of 3.02 (IQR: 0.36-6.80) years, patients with a preoperative ePVS ≥ −4.17 had a significantly increased mortality (log-rank p = 0.006).ConclusionsePVS is an easily obtainable risk parameter for patients undergoing isolated tricuspid valve surgery capable of predicting mid- and long-term outcomes after isolated tricuspid valve surgery.
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Affiliation(s)
- Ena Hasimbegovic
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Marco Russo
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Andreas
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Paul Werner
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Iuliana Coti
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Dominik Wiedemann
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Alfred Kocher
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Günther Laufer
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Benedikt S. Hofer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Markus Mach
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
- *Correspondence: Markus Mach
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Hasegawa T, Iba Y, Naraoka S, Nakajima T, Hashimoto S, Murohashi T, Umeta R, Hosaka I, Ohkawa A, Yasuda N, Shibata T, Kawaharada N. Improvement of predicted hematocrit values after the initiation of cardiopulmonary bypass in cardiovascular surgery. J Artif Organs 2021; 25:117-124. [PMID: 34689296 DOI: 10.1007/s10047-021-01295-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 09/22/2021] [Indexed: 11/24/2022]
Abstract
Hematocrit (Hct) values after the initiation of cardiopulmonary bypass (CPB) must be maintained appropriately to avoid perioperative complications. Therefore, an accurate prediction is required. However, the standard prediction equation often results in actual values that are lower than the predicted values. This study aimed to clarify the limits of agreement (LOA) and bias of the prediction equations and investigate better the prediction equations. A retrospective study was performed on adult patients between April 2015 and December 2020. Study 1 included 158 patients, and Study 2 included 55 patients. The primary outcomes were the LOA and bias between the predicted and measured Hct values after the initiation of CPB, and two studies were conducted. In Study 1, total blood volume (TBV) was estimated, and the new blood volume index (BVI) was calculated. BVI was also evaluated for the overall value and gender differences. Therefore, the patient's background was compared by gender differences. In, Study 2 the conventional predicted equation (Eq. 1), the predicted equation using the new BVI (Eq. 2), and the predicted equation using the new BVI including physiological factors in the TBV equation (Eq. 3) were compared. In Study 1, BVI was 53 (44-67) mL/kg. In Study 2, bias ± LOA was - 2.5 ± 6.8% for Eq. 1, 0.1 ± 6.6% for Eq. 2, and 0.4 ± 6.2% for Eq. 3. The new equation is expected to predict the Hct value after the initiation of CPB with better LOA and bias than the conventional equation.
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Affiliation(s)
- Takeo Hasegawa
- Department of Clinical Engineering, Sapporo Medical University Hospital, West-16, South-1, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Yutaka Iba
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, West-16, South-1, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
| | - Shuichi Naraoka
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, West-16, South-1, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Tomohiro Nakajima
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, West-16, South-1, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Syuichi Hashimoto
- Department of Clinical Engineering, Sapporo Medical University Hospital, West-16, South-1, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Takao Murohashi
- Department of Clinical Engineering, Sapporo Medical University Hospital, West-16, South-1, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Riko Umeta
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, West-16, South-1, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Itaru Hosaka
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, West-16, South-1, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Akihito Ohkawa
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, West-16, South-1, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Naomi Yasuda
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, West-16, South-1, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Tsuyoshi Shibata
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, West-16, South-1, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, West-16, South-1, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
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16
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Parvinian B, Bighamian R, Scully CG, Hahn JO, Pathmanathan P. Credibility Assessment of a Subject-Specific Mathematical Model of Blood Volume Kinetics for Prediction of Physiological Response to Hemorrhagic Shock and Fluid Resuscitation. Front Physiol 2021; 12:705222. [PMID: 34603074 PMCID: PMC8481867 DOI: 10.3389/fphys.2021.705222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022] Open
Abstract
Subject-specific mathematical models for prediction of physiological parameters such as blood volume, cardiac output, and blood pressure in response to hemorrhage have been developed. In silico studies using these models may provide an effective tool to generate pre-clinical safety evidence for medical devices and help reduce the size and scope of animal studies that are performed prior to initiation of human trials. To achieve such a goal, the credibility of the mathematical model must be established for the purpose of pre-clinical in silico testing. In this work, the credibility of a subject-specific mathematical model of blood volume kinetics intended to predict blood volume response to hemorrhage and fluid resuscitation during fluid therapy was evaluated. A workflow was used in which: (i) the foundational properties of the mathematical model such as structural identifiability were evaluated; (ii) practical identifiability was evaluated both pre- and post-calibration, with the pre-calibration results used to determine an optimal splitting of experimental data into calibration and validation datasets; (iii) uncertainty in model parameters and the experimental uncertainty were quantified for each subject; and (iv) the uncertainty was propagated through the blood volume kinetics model and its predictive capability was evaluated via validation tests. The mathematical model was found to be structurally identifiable. Pre-calibration identifiability analysis led to splitting the 180 min of time series data per subject into 50 and 130 min calibration and validation windows, respectively. The average root mean squared error of the mathematical model was 12.6% using the calibration window of (0 min, 50 min). Practical identifiability was established post-calibration after fixing one of the parameters to a nominal value. In the validation tests, 82 and 75% of the subject-specific mathematical models were able to correctly predict blood volume response when predictive capability was evaluated at 180 min and at the time when amount of infused fluid equals fluid loss.
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Affiliation(s)
- Bahram Parvinian
- Department of Mechanical Engineering, University of Maryland College Park, College Park, MD, United States
| | - Ramin Bighamian
- Office of Science and Engineering Laboratories, Food and Drug Administration, Silver Spring, MD, United States
| | - Christopher George Scully
- Office of Science and Engineering Laboratories, Food and Drug Administration, Silver Spring, MD, United States
| | - Jin-Oh Hahn
- Department of Mechanical Engineering, University of Maryland College Park, College Park, MD, United States
| | - Pras Pathmanathan
- Office of Science and Engineering Laboratories, Food and Drug Administration, Silver Spring, MD, United States
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17
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Bakker J, Horowitz JM, Hagedorn J, Kozloff S, Kaufman D, Castro R. Blood volume and albumin transudation in critically ill COVID-19 patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:269. [PMID: 34332641 PMCID: PMC8325200 DOI: 10.1186/s13054-021-03699-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/21/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Jan Bakker
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA. .,Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA. .,Department of Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, Netherlands. .,Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - James M Horowitz
- Division of Cardiology, New York University School of Medicine, New York, NY, USA
| | - Jackie Hagedorn
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - Sam Kozloff
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - David Kaufman
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - Ricardo Castro
- Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile
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18
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Chang HP, Kim SJ, Shah DK. Whole-Body Pharmacokinetics of Antibody in Mice Determined using Enzyme-Linked Immunosorbent Assay and Derivation of Tissue Interstitial Concentrations. J Pharm Sci 2020; 110:446-457. [PMID: 32502472 DOI: 10.1016/j.xphs.2020.05.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/06/2020] [Accepted: 05/20/2020] [Indexed: 12/20/2022]
Abstract
Here we have reported whole-body disposition of wild-type IgG and FcRn non-binding IgG in mice, determined using Enzyme-Linked Immunosorbent Assay (ELISA). The disposition data generated using ELISA are compared with previously published biodistribution data generated using radiolabelled IgG. In addition, we introduce a novel concept of ABCIS values, which are defined as percentage ratios of tissue interstitial and plasma AUC values. These values can help in predicting tissue interstitial concentrations of monoclonal antibodies (mAbs) based on the plasma concentrations. Tissue interstitial concentrations derived from our study are also compared with previously reported values measured using microdialysis or centrifugation method. Lastly, the new set of biodistribution data generated using ELISA are used to refine the PBPK model for mAbs.
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Affiliation(s)
- Hsuan-Ping Chang
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, The State University of New York at Buffalo, Buffalo, NY, USA
| | - Se Jin Kim
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, The State University of New York at Buffalo, Buffalo, NY, USA
| | - Dhaval K Shah
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, The State University of New York at Buffalo, Buffalo, NY, USA.
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19
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Abstract
Abnormal fluid handling leads to physiologic abnormalities in multiple organ systems. Deranged hemodynamics, neurohormonal activation, excessive tubular sodium reabsorption, inflammation, oxidative stress, and nephrotoxic medications are important drivers of harmful cardiorenal interactions in patients with heart failure. Accurate quantitative measurement of fluid volume is vital to individualizing therapy for such patients. Blood volume analysis and pulmonary artery pressure monitoring seem the most reliable methods for assessing fluid volume and guiding decongestive therapies. Still the cornerstone of decongestive therapy, diuretics' effectiveness decreases with progression of heart failure. Extracorporeal ultrafiltration, an alternative to diuretics, has been shown to reduce heart-failure events.
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Affiliation(s)
- Maria Rosa Costanzo
- Heart Failure Research, Advocate Heart Institute, Edward Hospital Center for Advanced Heart Failure, 801 South Washington Street, Naperville, IL, USA.
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20
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Mozzor M, Sadowsky D, Suarez-Mazon A, Lugo C, Rashid T, Wu J, Gerard P. Rapid nuclear medicine blood volume analysis for emergency assessment. J Emerg Trauma Shock 2020; 13:301-305. [PMID: 33897148 PMCID: PMC8047966 DOI: 10.4103/jets.jets_167_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 01/13/2020] [Accepted: 03/20/2020] [Indexed: 12/04/2022] Open
Abstract
Assessment of fluid status can play a critical role in the diagnosis and management of emergent conditions such as trauma, shock, decompensated heart failure, syncope, and hypertension. Unfortunately, common methods are all qualitative and/or indirect, and often inaccurate. With the recent introduction of a modernized method of nuclear medicine blood volume analysis (NM-BVA), offering results in 90 min or less as well as improved precision and ease of performance, this decade-old technique is for the first time a viable tool in the emergent setting. In this review, we discuss the history of NM-BVA, the modern method, and our institution’s experience implementing this method.
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21
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Aguree S, Gernand AD. An efficient method for measuring plasma volume using indocyanine green dye. MethodsX 2019; 6:1072-1083. [PMID: 31193322 PMCID: PMC6526294 DOI: 10.1016/j.mex.2019.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 05/04/2019] [Indexed: 01/09/2023] Open
Abstract
Plasma volume (PV) can be an important marker of health status and may affect the interpretation of plasma biomarkers, but is rarely measured due to the complexity and time required. Indocyanine green (ICG) is a water-soluble tricarbocyanine dye with a circulatory half-life of 2–3 min, allowing for quick clearance and repeated use. It is used extensively in medical diagnostic tests including ophthalmologic imaging, liver function, and cardiac output, particularly in critical care. ICG has been validated for measuring PV in humans, however previous work has provided minimal published details or has focused on a single aspect of the method. We aimed to develop a detailed, optimal protocol for the use of ICG to measure PV in women of reproductive age. We combined best practices from other studies and optimized the protocol for efficiency.
This method reduces the time from blood collection to PV determination to ˜2 h and the amount of plasma required to estimate PV to 2.5 mL (1.5 mL before ICG injection and 1.0 mL post-injection). Participant inconvenience is reduced by inserting an intravenous (IV) catheter in only one arm, not both arms. Five post-injection plasma samples (2–5 min after ICG bolus) are enough to accurately develop the decay curve for plasma ICG concentration and estimate PV by extrapolation.
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Affiliation(s)
- Sixtus Aguree
- Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Laboratory, University Park, PA, 16802, United States
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Laboratory, University Park, PA, 16802, United States
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22
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Johnson DM, Roberts J, Gordon D. The acute effects of whole blood donation on cardiorespiratory and haematological factors in exercise: A systematic review. PLoS One 2019; 14:e0215346. [PMID: 30990829 PMCID: PMC6467450 DOI: 10.1371/journal.pone.0215346] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 04/01/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND This systematic review aimed to collect the relevant historical and current literature to produce an informed analysis of the acute effects on cardiorespiratory and haematological factors following whole blood donation (~ 470 ml) during exercise. Testing the hypothesises that blood donation produces either no changes (Null) or produces significant changes (alternate) in haematology, [Formula: see text], heart rate, exercising power and time. METHODS Four databases of medical and science orientations were searched with terms sensitive to connections regarding exercise, blood donation (400-500 ml)/haematology, [Formula: see text], heart rate, exercising power and time. The study retrieval process utilised the PRISMA approach and selection was via an adapted scoring method according to the Consensus based Standards for the selection of health Measurements Instruments (COSMIN). Systematic review focused on 24-48 hrs post donation. Details of the PRSIMA checklist can be found in the accompanying online document. RESULTS Following scrutiny of 48 research papers by two independent assessors 8 experimental studies were included. Four studies showed a mean reduction for difference in [Formula: see text] (- 2.4 ± 1.4 ml∙kg-1∙min-1) and a medium effect size (-0.26). No statistical significance was present at the mean meta-analysis level, also the case for heart rate, time to exhaustion and power. A mean reduction was seen in haemoglobin (- 1.05 g.dL-1), haematocrit (- 3.71%) and red blood cells (- 0.44 Mio μL-1), very large effect size was observed (Cohen's d, -0.75, -1.16 and -4.23 respectively) and statistical significance (95% CI, -2.04, -0.54; -4.59, 2.28 and -4.37, -4.10 respectively). CONCLUSION Although individual studies show that [Formula: see text] Is reduced from blood donation pooled results show that [Formula: see text] is indeed not significantly reduced from blood donation 24-48 hrs post donation. Additionally sub-maximally there isn't enough data to produce substantial comparatives. Furthermore, this systematic review demonstrates that there are not enough high-quality studies regarding cardiorespiratory outcomes following blood donation.
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Affiliation(s)
- Diane Maria Johnson
- Cambridge Centre for Sport & Exercise Sciences, School of Psychology & Sports Science, Anglia Ruskin University, Cambridge, United Kingdom
| | - Justin Roberts
- Cambridge Centre for Sport & Exercise Sciences, School of Psychology & Sports Science, Anglia Ruskin University, Cambridge, United Kingdom
| | - Dan Gordon
- Cambridge Centre for Sport & Exercise Sciences, School of Psychology & Sports Science, Anglia Ruskin University, Cambridge, United Kingdom
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23
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Molitoris BA, George AG, Murray PT, Meier D, Reilly ES, Barreto E, Sandoval RM, Rizk DV, Shaw AD, Peacock WF. A Novel Fluorescent Clinical Method to Rapidly Quantify Plasma Volume. Cardiorenal Med 2019; 9:168-179. [PMID: 30844821 PMCID: PMC7175413 DOI: 10.1159/000496480] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/28/2018] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES To determine the performance of a rapid fluorescent indicator technique for measuring plasma volume (PV). METHODS This was an open-label, observational evaluation of a two-component intravenous visible fluorescent dye technique to rapidly measure PV in 16 healthy subjects and 16 subjects with chronic kidney disease (8 stage 3 and 8 stage 4 CKD), at 2 clinical research sites. The method consisted of a single intravenous injection of 12 mg of a large 150-kDa carboxy-methyl dextran conjugated to a fluorescent rhodamine-derived dye as the PV marker (PVM), and 35 mg of a small 5-kDa carboxy-methyl dextran conjugated to fluorescein, the renal clearance marker. Dye concentrations were quantified 15 min after the injections for initial PV measurements using the indicator-dilution principle. Additional samples were taken over 8 h to evaluate the stability of the PVM as a determinant of PV. Blood volumes (BV) were calculated based on PV and the subject's hematocrit. Pharmacokinetic parameters were calculated from the plasma concentration data taken over several days using noncompartmental methods (Phoenix WinNonlin®). Linear correlation and Bland-Altman plots were used to compare visible fluorescent injectate-measured PV compared to Nadler's formula for estimating PV. Finally, 8 healthy subjects received 350 mL infusion of a 5% albumin solution in normal saline over 30 min and a repeat PV determination was then carried out. RESULTS PV and BV varied according to weight and body surface area, with PV ranging from 2,115 to 6,234 mL and 28.6 to 41.9 mL/kg when weight adjusted. Both parameters were stable for > 6 h with repeated plasma measurements of the PVM. There was no difference between healthy subjects and CKD subjects. Overall, there was general agreement with Nadler's estimation formula for the mean PV in subjects. A 24-h repeat dose measurement in 8 healthy subjects showed PV variability of 98 ± 121 mL (mean = 3.8%). Additionally, following an intravenous bolus of 350 mL of a 5% albumin solution in normal saline in 8 healthy subjects, the mean (SD) measured increase in PV was 356 (±50.0) mL post-infusion. There were no serious adverse events reported during the study. CONCLUSIONS This minimally invasive fluorescent dye approach safely allowed for rapid, accurate, and reproducible determination of PV, BV, and dynamic monitoring of changes following fluid administration.
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Affiliation(s)
- Bruce A Molitoris
- Indiana University, Indianapolis, Indiana, USA,
- FAST BioMedical, Carmel, Indiana, USA,
| | - Anthony G George
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | | | - Ruben M Sandoval
- Indiana University, Indianapolis, Indiana, USA
- FAST BioMedical, Carmel, Indiana, USA
| | - Dana V Rizk
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andrew D Shaw
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada
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24
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Malha L, Fattah H, Modersitzki F, Goldfarb DS. Blood volume analysis as a guide for dry weight determination in chronic hemodialysis patients: a crossover study. BMC Nephrol 2019; 20:47. [PMID: 30744587 PMCID: PMC6371522 DOI: 10.1186/s12882-019-1211-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Volume overload and depletion both lead to high morbidity and mortality. Achieving euvolemia is a challenge in patients with end stage kidney disease on hemodialysis (HD). Blood volume analysis (BVA) uses radiolabeled albumin to determine intravascular blood volume (BV). The measured BV is compared to an ideal BV (validated in healthy controls). We hypothesized that BVA could be used in HD to evaluate the adequacy of the current clinically prescribed "estimated dry weight" (EDW) and to titrate EDW in order to improve overall volume status. We were also interested in the reproducibility of BVA results in end stage kidney disease. METHODS Twelve adults on chronic HD were recruited; 10 completed the study. BVA (Daxor, New York, NY, USA) was used to measure BV at baseline. EDW was kept the same if the patient was deemed to be euvolemic by BVA otherwise, the prescribed EDW was changed with the aim that measured BV would match ideal BV. A second BVA measurement was done 1-3 months later in order to measure BV again. RESULTS Based on BVA, 6/10 patients were euvolemic at baseline and 5/10 were euvolemic at the second measurement. When comparing patients who had their prescribed EDW changed after the initial BVA to those who did not, both groups had similar differences between measured and ideal BV (P = 0.75). BV values were unchanged at the second measurement (P = 0.34) and there was no linear correlation between BV change and weight change (r2 = 0.08). CONCLUSIONS This pilot study is the first longitudinal measurement of BVA in HD patients. It revealed that changing weight did not proportionally change intravascular BV. BV remained stable for 1-3 months. BVA may not be helpful in clinically stable HD patients but studies on patients with hemodynamic instability and uncertain volume status are needed. TRIAL REGISTRATION ClinicalTrials.gov (NCT02717533), first registered February 4, 2015.
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Affiliation(s)
- Line Malha
- Nephrology and Hypertension Division, Weill-Cornell Medicine, 424 East 70th street, New York, NY, 10021, USA
| | - Hasan Fattah
- Nephrology Division, University of Kentucky, UK Transplant Center, 740 S. Limestone, 3rd fl, suite K348, Lexington, KY, 40536, USA
| | - Frank Modersitzki
- Nephrology Section, New York Harbor VA Healthcare System, Nephrology Section/111G, 423 East. 23 St., New York, NY, 10010, USA
| | - David S Goldfarb
- Nephrology Division, NYU School of Medicine and NYU Langone Medical Center, New York University School of Medicine, 423 E. 23 St., New York, NY, USA.
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25
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Liu CY, Lai S, Lima JAC. MRI gadolinium dosing on basis of blood volume. Magn Reson Med 2019; 81:1157-1164. [PMID: 30387903 PMCID: PMC6289805 DOI: 10.1002/mrm.27454] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/19/2018] [Accepted: 06/24/2018] [Indexed: 11/09/2022]
Abstract
PURPOSE Gadolinium-based contrast agents (GBCAs) for MRI are generally administrated in direct relationship to body weight. Instead, we propose a model for GBCA dosing on the basis of blood volume. The new method was tested by exploring the associations between MRI T1 mapping indices and weight in the MESA (Multi-Ethnic Study of Atherosclerosis. METHODS Empirically derived methods based on sex and body habitus were used to calculate blood volumes. GBCA dose (in mL) in blood (in L) was calculated as the injected volume divided by the blood volume (i.e., DBV). Of the 1219 participants with cardiac MRI T1 mapping, 845 studies had standard dose of 0.15 mmol/kg (cohort 1) and 166 studies had 30 mL of GBCA regardless of weight (cohort 2). We also created a specific cohort with similar DBV (N = 357; cohort 3). RESULTS Postcontrast blood relaxation rate R1blood and DBV were significantly correlated (R = 0.641; P < 0.001). R1blood was significantly associated with weight in cohort 1 and 2, but the correlation coefficient was positive for cohort 1 and negative for cohort 2, indicating GBCA overdosing in cohort 1 and underdosing in cohort 2 in heavy relative to lean subjects. R1blood was not associated with weight in cohort 3. Simulated results demonstrated that less contrast should be administrated for heavy subjects compared to the conventional weight-based dose. CONCLUSION GBCA dosing on the basis of blood volume could improve the efficacy and safety of contrast-enhanced MRI studies. This method could be implemented to standardize dose and augment precision in study comparisons.
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Affiliation(s)
- Chia-Ying Liu
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD
- Department of Radiology, Johns Hopkins Hospital, Baltimore, MD
| | - Shenghan Lai
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
| | - João A. C. Lima
- Department of Radiology, Johns Hopkins Hospital, Baltimore, MD
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Affiliation(s)
- Mark Nelson
- Virginia Commonwealth University, Richmond, VA
| | | | - Nirvik Pal
- Virginia Commonwealth University, Richmond, VA
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Mandikian D, Figueroa I, Oldendorp A, Rafidi H, Ulufatu S, Schweiger MG, Couch JA, Dybdal N, Joseph SB, Prabhu S, Ferl GZ, Boswell CA. Tissue Physiology of Cynomolgus Monkeys: Cross-Species Comparison and Implications for Translational Pharmacology. AAPS JOURNAL 2018; 20:107. [PMID: 30298434 DOI: 10.1208/s12248-018-0264-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/10/2018] [Indexed: 01/08/2023]
Abstract
We previously performed a comparative assessment of tissue-level vascular physiological parameters in mice and rats, two of the most commonly utilized species in translational drug development. The present work extends this effort to non-human primates by measuring tissue- and organ-level vascular volumes (Vv), interstitial volumes (Vi), and blood flow rates (Q) in cynomolgus monkeys. These measurements were accomplished by red blood cell labeling, extracellular marker infusion, and rubidium chloride bolus distribution, respectively, the same methods used in previous rodent measurements. In addition, whole-body blood volumes (BV) were determined across species. The results demonstrate that Vv, Vi, and Q, measured using our methods scale approximately by body weight across mouse, rat, and monkey in the tissues considered here, where allometric analysis allowed extrapolation to human parameters. Significant differences were observed between the values determined in this study and those reported in the literature, including Vv in muscle, brain, and skin and Q in muscle, adipose, heart, thymus, and spleen. The impact of these differences for selected tissues was evaluated via sensitivity analysis using a physiologically based pharmacokinetic model. The blood-brain barrier in monkeys was shown to be more impervious to an infused radioactive tracer, indium-111-pentetate, than in mice or rats. The body weight-normalized total BV measured in monkey agreed well with previously measured value in rats but was lower than that in mice. These findings have important implications for the common practice of scaling physiological parameters from rodents to primates in translational pharmacology.
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Affiliation(s)
- Danielle Mandikian
- Preclinical and Translational Pharmacokinetics, Genentech Research and Early Development, South San Francisco, California, 94080, USA
| | - Isabel Figueroa
- Preclinical and Translational Pharmacokinetics, Genentech Research and Early Development, South San Francisco, California, 94080, USA
| | - Amy Oldendorp
- Safety Assessment, Genentech Research and Early Development, South San Francisco, California, 94080, USA
| | - Hanine Rafidi
- Preclinical and Translational Pharmacokinetics, Genentech Research and Early Development, South San Francisco, California, 94080, USA
| | - Sheila Ulufatu
- Safety Assessment, Genentech Research and Early Development, South San Francisco, California, 94080, USA
| | - Michelle G Schweiger
- Safety Assessment, Genentech Research and Early Development, South San Francisco, California, 94080, USA
| | - Jessica A Couch
- Safety Assessment, Genentech Research and Early Development, South San Francisco, California, 94080, USA
| | - Noel Dybdal
- Safety Assessment, Genentech Research and Early Development, South San Francisco, California, 94080, USA
| | - Sean B Joseph
- Preclinical and Translational Pharmacokinetics, Genentech Research and Early Development, South San Francisco, California, 94080, USA
| | - Saileta Prabhu
- Preclinical and Translational Pharmacokinetics, Genentech Research and Early Development, South San Francisco, California, 94080, USA
| | - Gregory Z Ferl
- Preclinical and Translational Pharmacokinetics, Genentech Research and Early Development, South San Francisco, California, 94080, USA. .,Genentech Inc., 1 DNA Way MS 463a, South San Francisco, California, 94080, USA.
| | - C Andrew Boswell
- Preclinical and Translational Pharmacokinetics, Genentech Research and Early Development, South San Francisco, California, 94080, USA. .,Genentech Inc., 1 DNA Way MS 463a, South San Francisco, California, 94080, USA.
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Ramasawmy R, Rogers T, Alcantar MA, McGuirt DR, Khan JM, Kellman P, Xue H, Faranesh AZ, Campbell-Washburn AE, Lederman RJ, Herzka DA. Blood volume measurement using cardiovascular magnetic resonance and ferumoxytol: preclinical validation. J Cardiovasc Magn Reson 2018; 20:62. [PMID: 30201013 PMCID: PMC6131893 DOI: 10.1186/s12968-018-0486-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 08/20/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The hallmark of heart failure is increased blood volume. Quantitative blood volume measures are not conveniently available and are not tested in heart failure management. We assess ferumoxytol, a marketed parenteral iron supplement having a long intravascular half-life, to measure the blood volume with cardiovascular magnetic resonance (CMR). METHODS Swine were administered 0.7 mg/kg ferumoxytol and blood pool T1 was measured repeatedly for an hour to characterize contrast agent extraction and subsequent effect on Vblood estimates. We compared CMR blood volume with a standard carbon monoxide rebreathing method. We then evaluated three abbreviated acquisition protocols for bias and precision. RESULTS Mean plasma volume estimated by ferumoxytol was 61.9 ± 4.3 ml/kg. After adjustment for hematocrit the resultant mean blood volume was 88.1 ± 9.4 ml/kg, which agreed with carbon monoxide measures (91.1 ± 18.9 ml/kg). Repeated measurements yielded a coefficient of variation of 6.9%, and Bland-Altman repeatability coefficient of 14%. The blood volume estimates with abbreviated protocols yielded small biases (mean differences between 0.01-0.06 L) and strong correlations (r2 between 0.97-0.99) to the reference values indicating clinical feasibility. CONCLUSIONS In this swine model, ferumoxytol CMR accurately measures plasma volume, and with correction for hematocrit, blood volume. Abbreviated protocols can be added to diagnostic CMR examination for heart failure within 8 min.
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Affiliation(s)
- Rajiv Ramasawmy
- Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2C713, 10 Center Drive, Bethesda, MD 20892 USA
| | - Toby Rogers
- Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2C713, 10 Center Drive, Bethesda, MD 20892 USA
| | - Miguel A. Alcantar
- Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2C713, 10 Center Drive, Bethesda, MD 20892 USA
| | - Delaney R. McGuirt
- Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2C713, 10 Center Drive, Bethesda, MD 20892 USA
| | - Jaffar M. Khan
- Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2C713, 10 Center Drive, Bethesda, MD 20892 USA
| | - Peter Kellman
- Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2C713, 10 Center Drive, Bethesda, MD 20892 USA
| | - Hui Xue
- Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2C713, 10 Center Drive, Bethesda, MD 20892 USA
| | - Anthony Z. Faranesh
- Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2C713, 10 Center Drive, Bethesda, MD 20892 USA
| | - Adrienne E. Campbell-Washburn
- Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2C713, 10 Center Drive, Bethesda, MD 20892 USA
| | - Robert J. Lederman
- Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2C713, 10 Center Drive, Bethesda, MD 20892 USA
| | - Daniel A. Herzka
- Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2C713, 10 Center Drive, Bethesda, MD 20892 USA
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Nelson M, Green J, Spiess B, Kasirajan V, Nicolato P, Liu H, Meshkin RS. Measurement of Blood Loss in Cardiac Surgery: Still Too Much. Ann Thorac Surg 2018; 105:1176-1181. [PMID: 29506777 DOI: 10.1016/j.athoracsur.2017.11.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/06/2017] [Accepted: 11/06/2017] [Indexed: 10/17/2022]
Abstract
BACKGROUND Cardiac surgery is associated with a significant decrease in hematocrit. It is unclear whether that occurs from hemodilution, loss of red cells, or both. Hematocrit is a major determinant of transfusion decisions although transfusion is associated with increased morbidity and mortality. Physicians must determine whether this anemia is the result of hemodilution or red blood cell loss as the former would be treated with packed red blood cell transfusions and the latter by diuresis. We hypothesize that the decrease in hematocrit observed in cardiac surgery is due to hemodilution. METHODS Blood volume (BV), plasma volume (PV), and red blood cell volume (RBCV) were measured in 54 patients undergoing coronary artery bypass graft surgery, valve surgery, or coronary artery bypass graft/valve surgery. Measurements were made preoperatively, immediately postoperatively, and 2 hours after surgery utilizing a dilution tracer method and hematocrit measurements. RESULTS Preoperative average BV was 6,094 mL (SD 1,904 mL), RBCV was 2,024 mL (SD 720 mL), and PV was 4,070 mL (SD 1,339 mL). Postoperative average BV was 4,834 mL (SD 1,432 mL), RBCV 1,226 mL (SD 527 mL), and PV 3,607 mL (SD 993 mL). Blood volume decreased 18% (p < 0.0001), RBCV decreased 38% (p < 0.001), and PV decreased 8% (p < 0.012). There were no significant changes between postoperative values and those 2 hours later in the cardiac surgery intensive care unit. CONCLUSIONS Decreases in hematocrit observed in cardiac surgery patients are due to significant red blood cell losses and not to hemodilution. Red blood cell losses averaged 38%. Plasma volume also decreased.
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Affiliation(s)
- Mark Nelson
- Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, Virginia Commonwealth University, Richmond, Virginia.
| | - Jeffrey Green
- Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, Virginia Commonwealth University, Richmond, Virginia
| | - Bruce Spiess
- Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, Virginia Commonwealth University, Richmond, Virginia
| | - Vigneshwar Kasirajan
- Department of Surgery, Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Patricia Nicolato
- Department of Surgery, Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Hangcheng Liu
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Ryan S Meshkin
- Department of Biology, Virginia Commonwealth University, Richmond, Virginia
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Roumelioti ME, Glew RH, Khitan ZJ, Rondon-Berrios H, Argyropoulos CP, Malhotra D, Raj DS, Agaba EI, Rohrscheib M, Murata GH, Shapiro JI, Tzamaloukas AH. Fluid balance concepts in medicine: Principles and practice. World J Nephrol 2018; 7:1-28. [PMID: 29359117 PMCID: PMC5760509 DOI: 10.5527/wjn.v7.i1.1] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/16/2017] [Accepted: 11/27/2017] [Indexed: 02/06/2023] Open
Abstract
The regulation of body fluid balance is a key concern in health and disease and comprises three concepts. The first concept pertains to the relationship between total body water (TBW) and total effective solute and is expressed in terms of the tonicity of the body fluids. Disturbances in tonicity are the main factor responsible for changes in cell volume, which can critically affect brain cell function and survival. Solutes distributed almost exclusively in the extracellular compartment (mainly sodium salts) and in the intracellular compartment (mainly potassium salts) contribute to tonicity, while solutes distributed in TBW have no effect on tonicity. The second body fluid balance concept relates to the regulation and measurement of abnormalities of sodium salt balance and extracellular volume. Estimation of extracellular volume is more complex and error prone than measurement of TBW. A key function of extracellular volume, which is defined as the effective arterial blood volume (EABV), is to ensure adequate perfusion of cells and organs. Other factors, including cardiac output, total and regional capacity of both arteries and veins, Starling forces in the capillaries, and gravity also affect the EABV. Collectively, these factors interact closely with extracellular volume and some of them undergo substantial changes in certain acute and chronic severe illnesses. Their changes result not only in extracellular volume expansion, but in the need for a larger extracellular volume compared with that of healthy individuals. Assessing extracellular volume in severe illness is challenging because the estimates of this volume by commonly used methods are prone to large errors in many illnesses. In addition, the optimal extracellular volume may vary from illness to illness, is only partially based on volume measurements by traditional methods, and has not been determined for each illness. Further research is needed to determine optimal extracellular volume levels in several illnesses. For these reasons, extracellular volume in severe illness merits a separate third concept of body fluid balance.
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Affiliation(s)
- Maria-Eleni Roumelioti
- Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Robert H Glew
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Zeid J Khitan
- Division of Nephrology, Department of Medicine, Joan Edwards School of Medicine, Marshall University, Huntington, WV 25701, United States
| | - Helbert Rondon-Berrios
- Division of Renal and Electrolyte, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, United States
| | - Christos P Argyropoulos
- Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Deepak Malhotra
- Division of Nephrology, Department of Medicine, University of Toledo School of Medicine, Toledo, OH 43614-5809, United States
| | - Dominic S Raj
- Division of Renal Disease and Hypertension, Department of Medicine, George Washington University, Washington, DC 20037, United States
| | - Emmanuel I Agaba
- Division of Nephology, Department of Medicine, Jos University Medical Center, Jos, Plateau State 930001, Nigeria
| | - Mark Rohrscheib
- Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Glen H Murata
- Research Service, Raymond G Murphy VA Medical Center and University of New Mexico School of Medicine, Albuquerque, NM 87108, United States
| | | | - Antonios H Tzamaloukas
- Research Service, Raymond G Murphy VA Medical Center and University of New Mexico School of Medicine, Albuquerque, NM 87108, United States
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Kotanko P, Levin NW. Estimation of peripheral blood volume and interstitial volume in hemodialysis patients using bioimpedance techniques. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:1389-1392. [PMID: 29060136 DOI: 10.1109/embc.2017.8037092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This paper describes a method to estimate interstitial fluid volume and peripheral blood volume (BVP) in hemodialysis (HD) patients using whole body (wBIS) and calf (cBIS) bioimpedance spectroscopy techniques. The aim of this study was to evaluate the usefulness of the technique. Thirty five HD patients were studied pre and post HD. Extracellular volume (ECV) and total body water (TBW) were measured using wBIS and cBIS. The calf resistances at 5 kHz (R5) and at 1000 kHz (R1000) respectively reflect ECV and TBW in the calf. A blood pressure cuff was placed over the area of cBIS. Regional and whole body plasma or BVP and interstitial (VIT) or total fluid volume are measured at R5 or R1000 when the cuff was inflated to just above the systolic blood pressure. According to calf normalized resistivity (CNR) post HD, patients were divided into two groups: overhydration (OH, CNR<;18.5, 10-2*Ωm3/kg) and normal hydration (NH, CNR≥18.5, 10-2*Ωm3/kg). BVP was higher in OH than in NH group which can be explained by the low ratio of change in VIT to ultrafiltration volume in the OH group (0.57±0.23 vs 0.83±0.45 L, p<;0.05). In conclusion, the method could be useful to better understand fluid dynamics during HD.
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Chang DC, Piaggi P, Krakoff J. A Novel Approach to Predict 24-Hour Energy Expenditure Based on Hematologic Volumes: Development and Validation of Models Comparable to Mifflin-St Jeor and Body Composition Models. J Acad Nutr Diet 2017; 117:1177-1187. [PMID: 28571655 DOI: 10.1016/j.jand.2017.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Accurate prediction of 24-hour energy expenditure (24EE) relies on knowing body composition, in particular fat-free mass (FFM), the largest determinant of 24EE. FFM is closely correlated with hematologic volumes: blood volume (BV), red cell mass (RCM), and plasma volume (PV). However, it is unknown whether predicted hematologic volumes, based on easily collected variables, can improve 24EE prediction. OBJECTIVE The aim was to develop and validate equations to predict 24EE based on predicted BV, RCM, and PV and to compare the accuracy and agreement with models developed from FFM and with the Mifflin-St Jeor equation, which is recommended for clinical use by the Academy of Nutrition and Dietetics. DESIGN Participants had body composition measured by underwater weighing and 24EE by respiratory chamber. BV, RCM, and PV were calculated from five published equations. PARTICIPANTS/SETTING Native American and white men and women were studied (n=351). Participants were healthy adults aged 18 to 49 years from the Phoenix, AZ, metropolitan area. MAIN OUTCOME MEASURE Accuracy to within ±10% of measured 24EE and agreement by Bland-Altman analysis. STATISTICAL ANALYSIS Regression models to predict 24EE from hematologic and body composition variables were developed in half the dataset and validated in the other half. RESULTS Hematologic volumes were all strongly correlated with FFM in both men and women (r≥0.94). Whereas the accuracy of FFM alone was 69%, four hematologic volumes were individually more accurate (75% to 78%) in predicting 24EE. Equations based on hematologic volumes plus demographics had mean prediction errors comparable to those based on body composition plus demographics; although the Mifflin-St Jeor had modestly better mean prediction error, body composition, hematologic, and Mifflin-St Jeor models all had similar accuracy (approximately 80%). CONCLUSIONS Prediction equations based on hematologic volumes were developed, validated, and found to be comparable to Mifflin-St Jeor and body composition models in this population of healthy adults.
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Furuta S, Inouye DS, Hayashi MS, Takanishi DM, Yu M. Blood volume measured by ultrasound and radioisotope dilution in critically ill subjects. J Surg Res 2017; 207:77-84. [DOI: 10.1016/j.jss.2016.08.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/26/2016] [Accepted: 08/24/2016] [Indexed: 02/08/2023]
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Assessment of circulating blood volume with fluid administration targeting euvolemia or hypervolemia. Neurocrit Care 2016; 22:82-8. [PMID: 25142828 DOI: 10.1007/s12028-014-9993-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The occurrence of hypovolemia in the setting of cerebral vasospasm reportedly increases the risk for delayed ischemic neurologic deficits. Few studies have objectively assessed blood volume (BV) in response to fluid administration targeting normovolemia (NV) or hypervolemia (HV) and none have done so with crystalloids alone. The primary purpose was to evaluate the BV of patients with SAH receiving crystalloid fluid administration targeting NV or HV. METHODS The University of Washington IRB approved the study. Prospectively collected data was obtained from patients enrolled in a clinical trial and a concurrent group of patients who received IV fluids during the ICU stay. We defined a normovolemia (NV) and hypervolemia (HV) group based on the cumulative amount of IV fluid administered in mL/kg from ICU admission to day 5; ≥30-60 mL/kg/day (NV) and ≥60 mL/kg/day (HV), respectively. In a subgroup of patients, BV was measured on day 5 post ictus using iodinated (131)I-labeled albumin injection and the BVA-100 (Daxor Corp, New York, NY). Differences between the NV and HV groups were compared using Student's t-test with assumption for unequal variance. RESULTS Twenty patients in the NV and 19 in the HV groups were included. The HV group received more fluid and had a higher fluid balance than the NV group. The subgroup of patients in whom BV was measured on day 5 (n = 19) was not different from the remainder of the cohort with respect to the total amount of administered fluid and net cumulative fluid balance by day 5. BV was not different between the two groups and varied widely. CONCLUSIONS Routinely targeting prophylactic HV using crystalloids does not result in a higher circulating BV compared to targeting NV, but the possibility of clinically unrecognized hypovolemia remains.
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Gai ND, Sandfort V, Liu S, Lima JAC, Bluemke DA. Dose correction for post-contrast T1 mapping of the heart: the MESA study. Int J Cardiovasc Imaging 2015; 32:271-279. [PMID: 26362875 DOI: 10.1007/s10554-015-0754-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/22/2015] [Indexed: 11/29/2022]
Abstract
Post-contrast myocardial T1 (T1(myo,c)) values have been shown to be sensitive to myocardial fibrosis. Recent studies have shown differences in results obtained from T1(myo,c) and extracellular volume fraction (ECV) with respect to percentage fibrosis. By exploring the relationship between blood plasma volume and T1(myo,c), the underlying basis for the divergence can be explained. Furthermore, dose administration based on body mass index (BMI), age and gender can mitigate the divergence in results. Inter-subject comparison of T1(myo,c) required adjustment for dose (in mmol/kg), time and glomerular filtration rate. Further adjustment for effective dose based on lean muscle mass reflected by blood/plasma volume was performed. A test case of 605 subjects from the MESA study who had undergone pre- and post-contrast T1 mapping was studied. T1(myo,c) values were compared between subjects with and without metabolic syndrome (MetS), between smoking and non-smoking subjects, and subjects with and without impaired glucose tolerance, before and after dose adjustment based on plasma volume. Comparison with ECV (which is dose independent), pre-contrast myocardial T1 and blood normalized myocardial T1 values was also performed to validate the correction. There were significant differences in T1(myo,c) (post plasma volume correction) and ECV between current and former smokers (p value 0.017 and 0.01, respectively) but not T1(myo,c) prior to correction (p = 0.12). Prior to dose adjustment for plasma volume, p value was <0.001 for T1(myo,c) between MetS and non-MetS groups and was 0.13 between subjects with and without glucose intolerance; after adjustment for PV, p value was 0.63 and 0.99. Corresponding ECV p values were 0.44 and 0.99, respectively. Overall, ECV results showed the best agreement with PV corrected T1(myo,c) (mean absolute difference in p values = 0.073) and pre-contrast myocardial T1 in comparison with other measures (T1(myo,c( prior to correction, blood/plasma T1 value normalized myocardium). Weight-based contrast dosing administered in mmol/kg results in a bias in T1 values which can lead to erroneous conclusions. After adjustment for lean muscle mass based on plasma volume, results from T1(myo,c) were in line with ECV derived results. Furthermore, the use of a modified equivalent dose adjusted for BMI, age, sex and hematocrit can be adopted for quantitative imaging.
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Affiliation(s)
- Neville D Gai
- Radiology and Imaging Sciences (RAD&IS), National Institutes of Health/Clinical Center, 9000 Rockville Pike, Bldg 10, Bethesda, MD, 20892, USA.
| | - Veit Sandfort
- Radiology and Imaging Sciences (RAD&IS), National Institutes of Health/Clinical Center, 9000 Rockville Pike, Bldg 10, Bethesda, MD, 20892, USA
| | - Songtao Liu
- Radiology and Imaging Sciences (RAD&IS), National Institutes of Health/Clinical Center, 9000 Rockville Pike, Bldg 10, Bethesda, MD, 20892, USA
| | | | - David A Bluemke
- Radiology and Imaging Sciences (RAD&IS), National Institutes of Health/Clinical Center, 9000 Rockville Pike, Bldg 10, Bethesda, MD, 20892, USA.,NIBIB, Bethesda, MD, USA
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Johnson EC, Muñoz CX, Le Bellego L, Klein A, Casa DJ, Maresh CM, Armstrong LE. Markers of the hydration process during fluid volume modification in women with habitual high or low daily fluid intakes. Eur J Appl Physiol 2015; 115:1067-74. [PMID: 25564016 DOI: 10.1007/s00421-014-3088-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/17/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE Human daily total water intake (TWI) has a large inter-individual range. Recently, water supplementation has been suggested as a potential preventative and therapeutic modality. Thus, we aimed to measure hydration biomarkers in women with high (HIGH) versus low (LOW) daily TWI to determine baseline differences, and the efficacy of these markers during a systematic alteration in TWI. METHODS This cohort study identified 14 HIGH [3.34 (0.56) L day(-1)] and 14 LOW [1.62 (0.48) L day(-1)] from 120 women. Next, fluid intake was decreased in HIGH [2.00 (0.21) L day(-1)] while LOW increased [3.50 (0.13) L day(-1)] across 4 days. Body mass, fluid intake, serum osmolality (S osmo), total plasma protein (TPP), 24 h urine osmolality, and 24 h urine volume, were measured on each day of modified TWI. Estimated plasma volume (E pv) was calculated using measured body mass and hematocrit values. RESULTS At baseline, urinary markers and TPP differentiated HIGH from LOW [7.0 (0.3) versus 7.3 (0.3) mg dL(-1), respectively]. Upon TWI intervention, (1) body mass decreased in HIGH [-0.7 (1.1) kg, p = 0.010)] but did not increase in LOW [+0.0 (0.6) kg, p = 0.110], (2) E pv decreased 2.1 (2.4) %, p = 0.004, (3) urine osmolality increased in HIGH [397 (144)-605 (230) mOsm kg(-1), p < 0.001] and decreased in LOW [726 (248)-265 (97) mOsm kg(-1) p < 0.001], and (4) no changes of serum osmolality occurred in either HIGH or LOW (all p > 0.05). CONCLUSIONS Urinary markers and TPP are sensitive measures to habitual high and low TWI and to changes in TWI. Both groups through urinary and some hematological responses following TWI manipulation achieved regulation of hemoconcentration.
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Affiliation(s)
- Evan C Johnson
- Department of Health, Human Performance, and Recreation, University of Arkansas, 155 Stadium Dr, Fayetteville, AR, 72701, USA,
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Gómez Perales JL. Blood volume analysis by radioisotopic dilution techniques: state of the art. Appl Radiat Isot 2014; 96:71-82. [PMID: 25479437 DOI: 10.1016/j.apradiso.2014.11.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 09/19/2014] [Accepted: 11/14/2014] [Indexed: 12/17/2022]
Abstract
In the last years, there has been a growing recognition of the importance of blood volume abnormalities in the pathophysiology of several conditions and, consequently, a growing interest of accurate and rapid volume status assessment. Accordingly, there has been a surge of interest in blood volume analysis by radioisotopic dilution technique. However, there are still some controversies about this technique, such as the use of the f-cell ratio, the errors associated with the method and the reference values. This review aims to revise and discuss the theoretical and methodological aspects of this technique and also to discuss their controversies. Furthermore, it is questioned whether red cell volume or plasma volume can be accurately estimated once the other quantity has been measured or should red cell volume and plasma volume be directly measured. As a conclusion, blood volume analysis by radioisotopic dilution technique is still valid and very useful.
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Affiliation(s)
- Jesús Luis Gómez Perales
- Nuclear Medicine Service, Puerta del Mar University Hospital, Avenida Ana de Viya 21, 11009 Cádiz, Spain.
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D'Angelo M, Hodgen RK, Wofford K, Vacchiano C. A Theoretical Mathematical Model to Estimate Blood Volume in Clinical Practice. Biol Res Nurs 2014; 17:478-86. [PMID: 25332464 DOI: 10.1177/1099800414555410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Perioperative intravenous (IV) fluid management is controversial. Fluid therapy is guided by inaccurate algorithms and changes in the patient's vital signs that are nonspecific for changes to the patient's blood volume (BV). Anesthetic agents, patient comorbidities, and surgical techniques interact and further confound clinical assessment of volume status. Through adaptation of existing acute normovolemic hemodilution algorithms, it may be possible to predict patient's BV by measuring hematocrit (HcT) before and after hemodilution. Our proposed mathematical model requires the following four data points to estimate a patient's total BV: ideal BV, baseline HcT, a known fluid bolus (FB), and a second HcT following the FB. To test our method, we obtained 10 ideal and 10 actual subject BV data measures from 9 unique subjects derived from a commercially used Food and Drug Administration-approved, semi-automated, BV analyzer. With these data, we calculated the theoretical BV change following a FB. Using the four required data points, we predicted BVs (BVp) and compared our predictions with the actual BV (BVa) measures provided by the data set. The BVp calculated using our model highly correlated with the BVa provided by the BV analyzer data set (df = 8, r = .99). Our calculations suggest that, with accurate HcT measurement, this method shows promise for the identification of abnormal BV states such as hyper- and hypovolemia and may prove to be a reliable method for titrating IV fluid.
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Affiliation(s)
- Matthew D'Angelo
- Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, Bethesda, MD, USA
| | - R Kyle Hodgen
- Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, Bethesda, MD, USA
| | - Kenneth Wofford
- Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, Bethesda, MD, USA
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Hilberath JN, Smith T, Jara C, Thomas M, FitzGerald DJ, Muehlschlegel JD. Blood volumes in cardiac surgery with cardiopulmonary bypass. Perfusion 2014; 30:395-9. [PMID: 25249518 DOI: 10.1177/0267659114550230] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Total blood volume (TBV) estimation potentially impacts various aspects of cardiac surgical care, including pharmacological and transfusion interventions, hemodynamic and volume management and perfusion equipment selection. TBV is commonly computed during cardiopulmonary bypass (CPB), using standardized formulae. We hypothesized that these equations fail to accurately predict individual blood volume variability. The aim of this study was to determine TBV with a dilution technique and compare the results to commonly utilized TBV calculations. METHODS After institutional review board approval, data was prospectively collected and analyzed for 101 patients undergoing open-heart surgery. Hematocrits (Hct) just prior to and immediately after the initiation of CPB were used to calculate the TBV. Results were compared to (1) the Allen formula and (2) weight-based standards (70 ml/kg for males (SM); 65 ml/kg for females (SF)). RESULTS The average dilution TBV (male: 4684 ± 1641 ml; female: 3027 ± 1067 ml; total: 4175 ± 1617 ml) was significantly smaller (p<0.05) than TBV estimated by Allen's formula (male: 6328 ± 973 ml; female: 4167 ± 643 ml; total: 5665 ± 1134 ml) and weight-based standards (male: 6278 ± 1256 ml; female: 4924 ± 1064 ml; total: 5862 ± 1350 ml). Allen's formula and the weight-based standards correlated strongly (R(2) = 0.821, p<0.001), suggesting similar estimates of TBV when using these methods. In contrast, hemodilution correlated poorly with the estimates by Allen (R(2) = 0.221, p<0.001) and weight-based formulae (R(2) = 0.122, p<0.001), suggesting different TBV computation. CONCLUSIONS The dilution method during CPB for TBV estimation is applicable and reproducible in the cardiac surgical arena and can be utilized to calculate TBV. Our results suggest that traditional TBV assessment in cardiac surgical patients by Allen's and weight-based formulae lacks the desired accuracy in estimating true TBV.
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Affiliation(s)
- J N Hilberath
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - T Smith
- Department of Cardiac Perfusion, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - C Jara
- Department of Cardiac Perfusion, Duke University Medical Center, Durham, NC, USA
| | - M Thomas
- Department of Anesthesiology, Warren Alpert School of Medicine, Rhode Island Hospital, Providence, RI, USA
| | - D J FitzGerald
- Department of Cardiac Perfusion, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - J D Muehlschlegel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Hilberath JN, Thomas ME, Smith T, Jara C, Fitzgerald DJ, Wilusz K, Liu X, Muehlschlegel JD. Blood volume measurement by hemodilution: association with valve disease and re-evaluation of the Allen Formula. Perfusion 2014; 30:305-11. [PMID: 25125291 DOI: 10.1177/0267659114547250] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Total blood volume (TBV) assessment is central to the management of cardiac surgical patients with cardiopulmonary bypass (CPB). The widely accepted Allen Formula lacks accuracy in estimating TBV in these patients. Moreover, the impact of commonly encountered cardiac disease states on TBV has not been systematically investigated. The aim of this study was to determine TBV by hemodilution (TBVHD) for patients with valve disease, compare TBVHD to algorithms frequently used during cardiac surgery and to modify the Allen Formula to better fit today's patient population. METHODS TBVHD was prospectively measured upon initiation of CPB. Ninety-six patients were grouped into 4 cohorts by preoperative diagnosis and compared to Allen and weight-based formulae in a univariate analysis: mitral regurgitation (MR), coronary artery disease requiring bypass surgery (CABG) and aortic stenosis (AS) ± CABG. The independent effects of height and weight on TBV were correlated to the original Allen Formula by multiple linear regression. RESULTS Patients with MR had significantly larger TBVHD compared to patients with AS, CABG or both. The smallest TBVHD was found in the patients with AS and CABG. The modified Allen Formula had an excellent model fit (R(2) = 0.88 and R(2) = 0.95 for males and females, respectively; p<0.001) while the classic formula overestimated TBV by 30% in males and females. For males, height impacted TBV calculations the most whereas weight was the predominant determinant in females. CONCLUSION Blood volume assessment via the Allen Formula or bodyweight overestimated TBV in cardiac surgical patients, with potential implications on their management. The assumption that MR frequently presents with increased intravascular volume was confirmed whereas AS patients with coronary disease had a relatively smaller TBV. Lastly, a modified Allen Formula to better reflect today's patient population was derived to reproducibly improve accuracy in mathematical estimates of TBV.
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Affiliation(s)
- J N Hilberath
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - M E Thomas
- Department of Anesthesiology, Warren Alpert School of Medicine, Rhode Island Hospital, Providence, USA
| | - T Smith
- Department of Cardiac Perfusion, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - C Jara
- Department of Cardiovascular Perfusion, Duke University Medical Center, Durham, USA
| | - D J Fitzgerald
- Department of Cardiac Perfusion, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - K Wilusz
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - X Liu
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - J D Muehlschlegel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
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Brain-type natriuretic peptide and right ventricular end-diastolic volume index measurements are imprecise estimates of circulating blood volume in critically ill subjects. J Trauma Acute Care Surg 2014; 75:813-8. [PMID: 24158199 DOI: 10.1097/ta.0b013e3182a85f3a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Surrogate indicators have often been used to estimate intravascular volume to guide fluid management. Brain-type natriuretic peptide (BNP) has been used as a noninvasive adjunct in the diagnosis of fluid overload and as a marker of response to therapy, especially in individuals with congestive heart failure. Similarly, right ventricular end-diastolic volume index (RVEDVI) measurements represent another parameter used to guide fluid resuscitation. The aim of this study was to evaluate whether BNP and RVEDVI are clinically valuable parameters that can distinguish among hypovolemia, euvolemia, and hypervolemia, as measured by blood volume (BV) analysis in critically ill surgical subjects. METHODS This observational study was part of a prospective, randomized controlled trial. Subjects with pulmonary artery catheters for the treatment of traumatic injuries, severe sepsis/septic shock, cardiovascular collapse, adult respiratory distress syndrome, and postsurgical care were studied. Circulating BV was measured by a radioisotope dilution technique using the BVA-100 Analyzer (Daxor Corporation, New York, NY) within the first 24 hours of acute resuscitation. BV results were reported as percent deviation from the patient's ideal BV based on height and percent deviation from optimum weight. Hypovolemia was defined as less than 0%, euvolemia was defined as 0% to +16%, and hypervolemia was defined as greater than +16% deviation from ideal BV. RVEDVI was measured by continuous cardiac output pulmonary artery catheters (Edwards Lifesciences, Irvine, CA). BNP and RVEDVI measurements obtained with BV analysis were evaluated with Fisher's exact test and regression analysis. RESULTS In 81 subjects, there was no difference in BV status between those with BNP of 500 pg/mL or greater and BNP of less than 500 pg/mL (p = 0.82) or in those with RVEDVI of 140 mL/m or greater and RVEDVI of less than 140 mL/m (p = 0.43). No linear relationship existed between BV and these parameters. CONCLUSION In critically ill surgical patients, BNP and RVEDVI were not associated with intravascular volume status, although they may be useful as indices that reflect increased cardiac preload. LEVEL OF EVIDENCE Diagnostic study, level III.
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Abstract
The method for determining blood volume has evolved substantially since first attempts were made in the latter part of the nineteenth century with the exsanguination of animals. The now accepted methods are based on indicator dilution methodologies. First attempts utilized inert dyes such as Evans Blue and Cardiogreen. These were found to be impractical due, primarily, to their rapid clearance from the blood. For many years, the most accepted method for blood volume determination was the dual isotope technique. This procedure utilizes chromium 51 or 99mTc to label autologous red cells and radioiodine 125 or 131 to label human serum albumin (HSA). Plasma and red cell volumes are measured separately and the results "combined". The procedure requires on-site labeling of autologous red cells and HSA, and meticulous preparation of standards and doses. The complexity of this method leads to performance times of 6 to 8 hours. An FDA-approved single isotope method is now employed in over 60 major institutions. HSA is labeled with radioiodine 131 at an FDA radiopharmaceutical facility, and test doses and standards are provided to laboratories in kit form. The red cell volume is derived by a calculation utilizing the measured plasma volume and the value for the average whole-body hematocrit. All calculations are carried out by a dedicated microprocessor, and a final report is generated and printed. The results are compared with predicted normal values for male and female patients based on percentage deviation from normal weight. Preliminary results are available in 30 minutes and complete calculations in 90 minutes.
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Affiliation(s)
- Donald Margouleff
- Division of Nuclear Medicine, Department of Medicine, North Shore University Hospital, Manhasset, NY, USA.
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Matsuda Y, Kawate H, Shimada S, Matsuzaki C, Nagata H, Adachi M, Ohnaka K, Nomura M, Takayanagi R. Perioperative sequential monitoring of hemodynamic parameters in patients with pheochromocytoma using the Non-Invasive Cardiac System (NICaS). Endocr J 2014; 61:571-5. [PMID: 24621777 DOI: 10.1507/endocrj.ej13-0471] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Surgical treatment of pheochromocytoma is associated with a high risk of hemodynamic instability. To reduce the risk of perioperative complications, adequate medical treatment to normalize blood pressure and restore blood volume is required. Accurate evaluation of the circulating blood volume (CBV) in perioperative patients with pheochromocytoma is clinically important. In the present study, we adopted whole-body bioimpedance monitoring technique using the Non-Invasive Cardiac System (NICaS), which can non-invasively measure cardiac output (CO) values. NICaS-derived CO values were evaluated in eight preoperative patients with pheochromocytoma and were compared with simultaneous CBV values measured by a conventional indicator dilution method using (131)I-labeled human serum albumin. In these patients with pheochromocytoma, the NICaS-derived CO values were significantly correlated with the CBV values measured by (131)I-labeled human serum albumin (4.86 ± 1.05 L/min vs 4.79 ± 1.02 L; r = 0.906; P = 0.002). Sequential NICaS-derived CO values confirmed that CBV increased after preoperative treatment with an α-blocker, with or without volume loading. The results of this study indicate that NICaS can be used to accurately and non-invasively evaluate the hemodynamic status. By sequential monitoring of NICaS-derived CO values, we are able to confirm whether adequate CBV in a patient with pheochromocytoma is obtained by preoperative medical treatment with α-blockers or volume loading, to avoid perioperative complications.
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Affiliation(s)
- Yayoi Matsuda
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
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Rembach A, Ryan TM, Roberts BR, Doecke JD, Wilson WJ, Watt AD, Barnham KJ, Masters CL. Progress towards a consensus on biomarkers for Alzheimer’s disease: a review of peripheral analytes. Biomark Med 2013; 7:641-62. [DOI: 10.2217/bmm.13.59] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Alzheimer’s disease (AD) is the most common cause of dementia in the elderly population and attempts to develop therapies have been unsuccessful because there is no means to target an effective therapeutic window. CNS biomarkers are insightful but impractical for high-throughput population-based screening. Therefore, a peripheral, blood-based biomarker for AD would significantly improve early diagnosis, potentially enable presymptomatic detection and facilitate effective targeting of disease-modifying treatments. The various constituents of blood, including plasma, platelets and cellular fractions, are now being systematically explored as a pool of putative peripheral biomarkers for AD. In this review we cover some less known peripheral biomarkers and highlight the latest developments for their clinical application.
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Affiliation(s)
- Alan Rembach
- The Mental Health Research Institute, The University of Melbourne, Kenneth Myer Building, 30 Royal Parade, Parkville, Victoria, 3010, Australia.
| | - Tim M Ryan
- The Mental Health Research Institute, The University of Melbourne, Kenneth Myer Building, 30 Royal Parade, Parkville, Victoria, 3010, Australia
| | - Blaine R Roberts
- The Mental Health Research Institute, The University of Melbourne, Kenneth Myer Building, 30 Royal Parade, Parkville, Victoria, 3010, Australia
| | - James D Doecke
- The Australian e-Health Research Centre, Herston, Queensland, 4029, Australia
- CSIRO Preventative Health National Research Flagship, North Ryde, New South Wales, 2113, Australia
| | - William J Wilson
- CSIRO Preventative Health National Research Flagship, North Ryde, New South Wales, 2113, Australia
| | - Andrew D Watt
- The Mental Health Research Institute, The University of Melbourne, Kenneth Myer Building, 30 Royal Parade, Parkville, Victoria, 3010, Australia
| | - Kevin J Barnham
- The Mental Health Research Institute, The University of Melbourne, Kenneth Myer Building, 30 Royal Parade, Parkville, Victoria, 3010, Australia
| | - Colin L Masters
- The Mental Health Research Institute, The University of Melbourne, Kenneth Myer Building, 30 Royal Parade, Parkville, Victoria, 3010, Australia
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Lee JJ, Dassau E, Zisser H, Harvey RA, Jovanovič L, Doyle FJ. In silico evaluation of an artificial pancreas combining exogenous ultrafast-acting technosphere insulin with zone model predictive control. J Diabetes Sci Technol 2013; 7:215-26. [PMID: 23439180 PMCID: PMC3692236 DOI: 10.1177/193229681300700127] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Because of the slow pharmacokinetics of subcutaneous (SC) insulin, avoiding postprandial hyperglycemia has been a major challenge for an artificial pancreas (AP) using SC insulin without a meal announcement. METHODS A semiautomated AP with Technosphere® Insulin (TI; MannKind Corporation, Valencia, CA) was designed to combine pulmonary and SC insulin. Manual inhalation of 10 U ultrafast-absorbing TI at mealtime delivers the first, or cephalic, phase of insulin, and an SC insulin pump controlled by zone model predictive controller delivers second-phase and basal insulin. This AP design was evaluated on 100 in silico subjects from the University of Virginia/Padova metabolic simulator using a protocol of two 50 g carbohydrate (CHO) meals and two 15 g CHO snacks. RESULTS Simulation analysis shows that the semiautomated AP with TI provides 32% and 16% more time in the controller target zone (80-140 mg/dl) during the 4 h postprandial period, with 39 and 20 mg/dl lower postprandial blood glucose peak on average than the pure feedback AP and the AP with manual feed-forward SC bolus, respectively. No severe hypoglycemia (<50 mg/dl) was observed in any cases. CONCLUSIONS The semiautomated AP with TI provides maximum time in the clinically accepted region when compared with pure feedback AP and AP with manual feed-forward SC bolus. Furthermore, the semiautomated AP with TI provides a flexible operation (optional TI inhalation) with minimal user interaction, where the controller design can be tailored to specific user needs and abilities to interact with the device.
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Affiliation(s)
- Justin J Lee
- Department of Chemical Engineering, University of California, Santa Barbara, Santa Barbara, California 93106-5080, USA
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Roberson RS, Bennett-Guerrero E. Impact of red blood cell transfusion on global and regional measures of oxygenation. ACTA ACUST UNITED AC 2012; 79:66-74. [PMID: 22238040 DOI: 10.1002/msj.21284] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Anemia is common in critically ill patients. Although the goal of transfusion of red blood cells is to increase oxygen-carrying capacity, there are contradictory results about whether red blood cell transfusion to treat moderate anemia (e.g., hemoglobin 7-10 g/dL) improves tissue oxygenation or changes outcomes. Whereas increasing levels of anemia eventually lead to a level of critical oxygen delivery, increased cardiac output and oxygen extraction are homeostatic mechanisms the body uses to prevent a state of dysoxia in the setting of diminished oxygen delivery due to anemia. In order for cardiac output to increase in the face of anemia, normovolemia must be maintained. Transfusion of red blood cells increases blood viscosity, which may actually decrease cardiac output (barring a state of hypovolemia prior to transfusion). Studies have generally shown that transfusion of red blood cells fails to increase oxygen uptake unless oxygen uptake/oxygen delivery dependency exists (e.g., severe anemia or strenuous exercise). Recently, near-infrared spectroscopy, which approximates the hemoglobin saturation of venous blood, has been used to investigate whether transfusion of red blood cells increases tissue oxygenation in regional tissue beds (e.g., brain, peripheral skeletal muscle). These studies have generally shown increases in near-infrared spectroscopy derived measurements of tissue oxygenation following transfusion. Studies evaluating the effect of transfusion on the microcirculation have shown that transfusion increases the functional capillary density. This article will review fundamental aspects of oxygen delivery and extraction, and the effects of red blood cell transfusion on tissue oxygenation as well as the microcirculation.
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Affiliation(s)
- Russell S Roberson
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
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Pannek K, Fidler F, Kartäusch R, Jakob PM, Hiller KH. Contrast agent derived determination of the total circulating blood volume using magnetic resonance. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2011; 25:215-22. [PMID: 21928062 DOI: 10.1007/s10334-011-0282-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 08/31/2011] [Accepted: 08/31/2011] [Indexed: 10/17/2022]
Abstract
OBJECT Knowledge of the total circulating blood volume (TCBV) is essential for the treatment of a variety of medical conditions and blood disorders. To date, blood volume analysis is rarely carried out due to the disadvantages of available methods. Our aim was to develop a widely available, simple, fast, yet accurate method for the determination of the total circulating blood volume. MATERIALS AND METHODS Magnetic resonance (MR) is a well-established, non-invasive technique. In this article, we present a method that uses MR contrast agents for the determination of the blood volume. The dependence of MR relaxation times on the concentration of MR contrast agents allows the calculation of the volume the contrast agent has been diluted in. RESULTS In phantom and in vivo experiments we could demonstrate that TCBV can be determined with high accuracy and precision. CONCLUSION This work introduces a novel method for the determination of the total circulating blood volume using magnetic resonance contrast agents as tracers.
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Affiliation(s)
- Kerstin Pannek
- Research Center Magnetic-Resonance-Bavaria, Wuerzburg, Germany
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Ohwaki K, Endo F, Muraishi O, Yano E. Relationship between changes in haemoglobin A1C and prostate-specific antigen in healthy men. Eur J Cancer 2010; 47:262-6. [PMID: 20951574 DOI: 10.1016/j.ejca.2010.09.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 07/26/2010] [Accepted: 09/14/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although many studies have shown an inverse relationship between diabetes and prostate cancer, it still remains unclear why diabetes may reduce the risk of prostate cancer. An inverse association between haemoglobin A(1C) (HbA(1C)) and prostate-specific antigen (PSA) also has been reported in previous studies that assessed the association cross-sectionally. To fully understand the relationship between diabetes and prostate cancer, it is essential to examine the association in a longitudinal design. The effect of plasma volume should also be considered in examining the PSA level. The aim of this study was to determine whether changes in HbA(1C) were associated with PSA levels, independent of plasma volume changes, as indicated by haematocrit and weight. METHODS We investigated 5917 Japanese men aged 50 and over who visited St. Luke's International Hospital, Tokyo for routine health check-ups in 2006 and 2007. We performed a multiple linear regression analysis to examine any association between changes in HbA(1C) and PSA over 1 year. RESULTS Adjusting for age, body mass index at baseline and changes in weight and haematocrit, the increases in HbA(1C) and PSA were concordant (5.7% increase per 1-unit HbA(1C) change; 95% confidence interval, 2.8-8.5%; p<0.001). CONCLUSIONS In contrast to previous cross-sectional observations showing an inverse association between HbA(1C) and PSA, longitudinal observations suggest a positive association between the two. Further studies are needed to investigate the association between diabetes and prostate cancer.
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Affiliation(s)
- Kazuhiro Ohwaki
- Department of Hygiene and Public Health, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan.
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