Abstract 14189: Paradoxical Hemoconcentration on Admission of Acute Hypertensive Heart Failure Syndrome
Introduction As volume overload is a major profile of acute heart failure syndrome (AHFS), diuretics are a mainstay of therapeutic strategy for those patients. Though decongestion/diuretic therapy are started immediately after admission in most of patients, changes of hemoglobin levels in this period remain to be investigated.
Method and Results In 143 consecutive AHFS patients admitted to our hospital, changes in hemoglobin between on admission and 24±12 hours postadmission were evaluated. Patients with cardiogenic shock, hemodialysis, blood transfusion, and urgent coronary angiography were excluded. In spite of decongestion/diuretic therapy started immediately after admission (urine output; 1600±990mL/ 24h), hemoglobin level on admission was paradoxically higher than the level of 24 h postadmission in 104 patients (73%). Patients in the top tertile of baseline-to-24h decrease of hemoglobin (ΔHb) were defined to have an admission hemoconcentration. The ΔHb in patients with hemoconcentration was 2.0±0.7 g/dL (13.1±2.4 on admission and 11.1±2.3 at 24h, p<0.001) whereas 0.0±0.7 g/dL in those without hemoconcentration. Admission hemoconcentration was more prevalent in hypertensive AHFS (systolic blood pressure (SBP); >140 mmHg) than normo-/hypotensive AHFS (43% vs. 15%, p<0.001). ΔHb was positively correlated with initial SBP (r=0.50, p<0.001) and heart rate (r=0.30, p<0.001), suggesting sympathetic pathophysiology of admission hemoconcentration. Patients with hemoconcentration had lower ejection fraction (30±11 vs. 39±15% p=0.002), higher presence of severe congestion on chest radiography (85% vs 60%, p<0.01), NYHA class 4 (89% vs. 55%, p<0.001), night time admission (60% vs. 27%, p<0.001), and dependence on mechanical ventilation (35% vs. 7%, p<0.001) than those without hemoconcentration. Urine output in 24h (1670±910 vs 1570±1030 ml, p=0.58), age, sex, renal function, and presence of ischemic heart disease were comparable between two groups.
Conclusion Hypertensive AHFS shows paradoxical hemoconcentrateion on admission, which may associate with sympathetically mediated fluid shifts from circulating volume to extracellular spaces and reflect severe congestion.
- © 2012 by American Heart Association, Inc.