Estimated plasma volume status in heart failure: clinical implications and future directions

Congestion is one of the main predictors of poor outcome in patients with heart failure (HF). Assessing and monitoring congestion is essential for optimizing HF therapy. Among the various available methods, serial measurements of estimated plasma volume (ePVS) using routine blood count and/or body weight (e.g., the Strauss, Duarte, Hakim formulas) may be useful in HF management. Further prospective study is warranted to determine whether ePVS can help optimize decongestion therapy (loop diuretics, mineralocorticoid receptor antagonists, SGLT2i) in various HF settings. This narrative review summarizes the recent evidence supporting the association of ePVS with clinical congestion and outcome(s) and discusses future directions for monitoring ePVS in HF. Graphic abstract

Automated summary

Congestion is a major predictor of poor outcomes in heart failure patients. Serial measurements of estimated plasma volume (ePVS) using routine blood count and/or body weight may be useful in optimizing therapy, but further study is needed to determine its impact. Monitoring ePVS in heart failure could help improve decongestion therapy in different settings.