Differences in red blood cell mass profiles impact intravascular volume and outcome risk in chronic heart failure

Wayne L. Miller, Diane E. Grill, Brian P. Mullan

Research output: Contribution to journalArticlepeer-review


Aims: To identify different red blood cell mass (RBCM) profiles, separate from haemoglobin concentrations, and their impact on blood volume expansion and clinical outcomes in chronic heart failure. Methods and results: RBCM was measured at hospital discharge using standardized nuclear medicine indicator-dilution methodology in patients following diuretic treatment for clinical congestion. Individual RBCM phenotypes were prospectively identified and analysed for heart failure-related mortality or first rehospitalization over 1 year. Of 132 patients, 42 (32%) demonstrated normal RBCM, 36 (27%) RBCM deficit (true anaemia), and 54 (41%) RBCM excess (erythrocythemia). Dilutional ‘anaemia’ defined by haemoglobin <12 g/dL with normal or an excess in RBCM with plasma volume expansion was identified in 37 (28%) patients. There were 61 composite outcome events, which included 38 deaths (29% of cohort) occurring over the 1 year follow-up period [14/36 (39%) in RBCM deficit, 12/42 (29%) in normal RBCM, and 12/54 (22%) in RBCM excess subgroups]. By Kaplan–Meier and multivariate analyses, RBCM excess was independently associated with the best event-free survival while RBCM deficit (true anaemia) the poorest outcomes; both compared with normal RBCM (P < 0.001). Dilutional ‘anaemia’ demonstrated a lower risk compared with true anaemia (P = 0.03). Conclusions: Markedly different RBCM profiles are identifiable among comparably compensated heart failure patients, and this variability carries significant implications for post-hospital outcomes. Novel to this analysis and in contrast to RBCM deficit is the independent association of RBCM excess with better event-free survival compared with normal RBCM. The distinction of RBCM profiles to guide risk stratification and individualized patient management strategies warrants further study.

Original languageEnglish (US)
Pages (from-to)1270-1279
Number of pages10
JournalESC Heart Failure
Issue number2
StatePublished - Apr 2023


  • Heart failure
  • Intravascular volume
  • Outcomes
  • Red blood cell mass

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Differences in red blood cell mass profiles impact intravascular volume and outcome risk in chronic heart failure'. Together they form a unique fingerprint.

Cite this