背景：血容量（BV）扩张与血管顺应性变化在心力衰竭（HF）恶化中的作用仍在争论中。我们旨在评估心力衰竭恶化中BV与静息和压力血流动力学之间的关系，并进一步阐明BV在心脏代偿失调中的重要性。
结果：心力衰竭恶化患者接受放射性标记的指标稀释BV分析和心导管检查。记录血管内容积和静息/应激血流动力学。挑衅性的压力操作包括从躺到站立的收缩压（ΔSBP）变化以及Valsalva和腿抬高的心内压变化。通过线性回归评估BV与侵入性血流动力学之间的相关性。在27例恶化的HF患者中，患者的特征包括平均年龄61±12岁，70%男性,19%黑色,平均射血分数29%±15%。在患者中，以总BV测量的13例（48%）血容量过高，通过位置（R2=0.009）和Valsalva（R2=0.003）与ΔSBP弱相关，并与右心房（R2=0.049）和肺毛细血管楔（R2=0.047）在腿抬高期间的压力变化相关。
结论：在心力衰竭恶化的患者中，静息时BV与心内压轻度相关。旨在测试血管顺应性的挑衅性动作与BV无关，表明合规性可以作为HF中的独立指标。
The role of blood volume (BV) expansion vs a change in vascular compliance in worsening heart failure (HF) remains under debate. We aimed to assess the relationship between BV and resting and stress hemodynamics in worsening HF and to further elucidate the significance of BV in cardiac decompensation.
Patients with worsening HF underwent radiolabeled indicator-dilution BV analysis and cardiac catheterization. Intravascular volumes and resting/stress hemodynamics were recorded. Provocative stress maneuvers included change in systolic blood pressure (ΔSBP) from lying to standing and Valsalva and intracardiac pressure changes with leg raise. Correlation between BV and invasive hemodynamics were assessed by linear regression. Of 27 patients with worsening HF, patients\' characteristics included mean age 61 ± 12 years, 70% male, 19% Black, and mean ejection fraction 29% ± 15%. Of the patients, 13 (48%) had hypervolemia as measured by total BV, which weakly correlated with ΔSBP by position (R2 = 0.009) and Valsalva (R2 = 0.003) and with right atrial (R2 = 0.049) and pulmonary capillary wedge (R2 = 0.047) pressure changes during leg raise.
In patients with worsening HF, BV mildly correlated with intracardiac pressures at rest. Provocative maneuvers intended to test vascular compliance did not correlate with BV, indicating that compliance may serve as a stand-alone metric in HF.
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