Prognostic value of decreased peripheral congestion detected by Bioelectrical Impedance Vector Analysis (BIVA) in patients hospitalized for acute heart failure: BIVA prognostic value in acute heart failure

Abstract

In AHF patients, an accurate physical examination evaluating the presence of rales and lower limbs oedema remains the cornerstone in the management of patients with AHF. A congestion reduction, obtained as a consequence of therapies and detected through BIVA analysis, with an increase of dR/H >11 Ω/m during hospitalization seems to be associated with increased 90 day survival in patients admitted for AHF.

Multiparametric approach to congestion for predicting long-term survival in heart failure

“…interstitial fluid status), which confirmed its prognostic role in our study. The literature has indicated that HI is a good 90-day (C-Index: 0.71) [10] and 1-year (C-Index: 0.72) [9] predictor of mortality in patients with AHF. Our findings confirmed the good diagnostic performance of this marker in predicting long-term mortality (C-Index 0.72) and identified a cut-off value of 73.8% (close to 74.3%, as reported by Núñez et al [11]).…”

“…However, the BNPs alone do not reflect pathophysiological pathways of congestion, and other markers of congestion might be useful in evaluating congestion and the risk stratification of HF patients. Among emerging techniques, BIVA has been demonstrated to be a simple and fast method for the assessment of body peripheral hydration status [6], providing prognostic information in HF patients [9][10][11]. Nevertheless, evidence also suggested that higher values of the BUN/Cr ratio are associated with "venous" congestion [7,12], and, in parallel, these values demonstrated prognostic impacts in HF patients independent of creatinine levels and glomerular filtration rate [7,[12][13][14][15][16].…”

Mortality in adult patients with fluid overload evaluated by BIVA upon admission to the emergency department

“…The usefulness of BIVA in the prognosis of mortality of cardiac patients was demonstrated by Santarelli et al ,32 where they found that a resistance/height variation greater than 11 Ω/m from hospital admission to discharge was associated with greater acute heart failure survival, since BIVA plus clinical evaluation proved a predictive value (area under the curve (AUC) 0.97, p<0.0001) for adverse outcomes (rehospitalisation and death) at 90 days. Regarding the management of patients with acute heart failure at the ED, Di Somma et al 18 verified that BIVA correlates with brain natriuretic peptide (BNP), ultrasound IVC index and width, and that the combination of BIVA with BNP can support ED clinicians’ decision making about diuretic therapy.…”

Implicación de la congestión venosa sistémica en la insuficiencia cardíaca

“…En este sentido, se han propuesto diferentes definiciones para cuantificar de manera fiable la respuesta diurética, como la pérdida de peso en Kg por cada 40 mg i.v. de furosemida 66 , el uso de la ecografía pulmonar 9,10 o la impedanciometría 66,67 .…”