Quantitative Assessment of Fluid Accumulation Using Bioelectrical Impedance Analysis in Patients With Acute Decompensated Heart Failure

Sakaguchi, Taiki; Yasumura, Kaori; Nishida, Hiroki; Inoue, Hiroyuki; Furukawa, Tatsuo; Shinouchi, Kazuya; Miura, Hiroyuki; Miyazaki, Koichi; Hamano, Gou; Koide, Masaaki; Abe, Haruhiko; Date, Motoo; Hirooka, Keiji; Koretsune, Yukihiro; Kusuoka, Hideo; Yasumura, Yoshio

doi:10.1253/circj.cj-15-0723

Cited by 36 publications

(41 citation statements)

References 31 publications

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“…In other words, excess body water in patients with HF consists mainly of ECW, which agrees with the findings of Sakaguchi et al regarding the quantitative assessment of fluid accumulation using ECW 12. In other words, excess body water in patients with HF consists mainly of ECW, which agrees with the findings of Sakaguchi et al regarding the quantitative assessment of fluid accumulation using ECW 12.…”

supporting

confidence: 89%

“…28,34 Sakaguchi et al reported that the ratio of measured ECW to predicted ECW at discharge was a prognostic marker for cardiac events in 130 patients with acute decompensated HF. 12 However, their subjects were restricted to those with a normal heart structure. The present study clarified the prognostic importance of EI in a complex circulation with CHD.…”

Section: Predictors Of Hf-related Admission After Dischargementioning

confidence: 99%

“…Previous reports demonstrated the value of BIA in treating HF [10][11][12][13][14][15][16][17][18] ; however, data regarding its role in treating patients with congenital heart disease (CHD) are limited. The present study aimed to clarify the correlation between BIA and HF severity as well as the prognostic value of BIA in adult patients with CHD.…”

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confidence: 99%

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Bioelectrical impedance analysis in the management of heart failure in adult patients with congenital heart disease

Satō

Inai

Shimizu

et al. 2018

Congenital Heart Disease

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| INTRODUC TI ONFluid retention with dyspnea is the most often encountered cause of rehospitalization after acute heart failure (HF). Decompensated HF generally leads to fluid overload caused by elevated ventricular filling pressure or neurohormonal activation. Thus, the ability to recognize and quantify fluid retention is critical for the treatment of HF; however, optimal markers for the presence of fluid retention have yet to be identified. Brain natriuretic peptide (BNP) testing, chest radiography, cardiac ultrasonography, and blood sampling are insufficient for assessing fluid retention.Bioelectrical impedance analysis (BIA) was recently introduced in many clinical fields, such as cardiology, nephrology, hepatology, nutrition, and rehabilitation. 1-9 BIA is a safe, rapid, and noninvasive assessment method that involves the application of alternating currents to the body to achieve 8-polar tactile-electrode impedance. These impedances are obtained using differences in cell membrane permeability based on variable frequencies. AbstractObjective: The recognition of fluid retention is critical in treating heart failure (HF).Bioelectrical impedance analysis (BIA) is a well-known noninvasive method; however, data on its role in managing patients with congenital heart disease (CHD) are limited.Here, we aimed to clarify the correlation between BIA and HF severity as well as the prognostic value of BIA in adult patients with CHD.Design: This prospective single-center study included 170 patients with CHD admitted between 2013 and 2015. We evaluated BIA parameters (intra-and extracellular water, protein, and mineral levels, edema index [EI, extracellular water-to-total body water ratio]), laboratory values, and HF-related admission prevalence. Results: Patients with New York Heart Association (NYHA) functional classes III-IVhad a higher EI than those with NYHA classes I-II (mean ± SD, 0.398 ± 0.011 vs 0.384 ± 0.017, P < .001). EI was significantly correlated with brain natriuretic peptide level (r = 0.51, P < .001). During the mean follow-up period of 7.1 months, Kaplan-Meier analysis showed that a discharge EI > 0.386, the median value in the present study, was significantly associated with a future increased risk of HF-related admission (HR = 4.15, 95% CI = 1.70-11.58, P < .001). A body weight reduction during hospitalization was also related to EI reduction.Conclusions: EI determined using BIA could be a useful marker for HF severity that could predict future HF-related admissions in adult patients with CHD.

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confidence: 89%

Section: Predictors Of Hf-related Admission After Dischargementioning

confidence: 99%

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Bioelectrical impedance analysis in the management of heart failure in adult patients with congenital heart disease

Satō

Inai

Shimizu

et al. 2018

Congenital Heart Disease

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“…It has been suggested as a good surrogate marker for body fluid volume and a useful guide for the management of patients with ADHF. 8,9) BIA can be used to determine fluid balance parameters like the edema index, which is calculated as the ratio of ECW to TBW. 26) BIA and calculating the ECW/ICW ratio are also useful to assess changes in body fluid distribution, as occurs in critically ill patients (especially those with sepsis) when fluid from the intravascular space migrates to the extravascular space.…”

Section: Relevance Of Intravascular Volume and Wrf Evaluated By Biamentioning

confidence: 99%

“…7) Recently, bioelectrical impedance analysis (BIA) has been suggested as a useful guide for the management of ADHF patients. 8,9) BIA takes into consideration whole body (or regional or segmental) impedance, phase angle, resistance, reactance, and capacitance by means of an electric current transmitted at different fre-quencies. 10,11) New techniques can be used to measure total body water (TBW), which is separated into extracellular and intracellular water (ICW).…”

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Mechanisms of Diuresis for Acute Decompensated Heart Failure by Tolvaptan

et al. 2017

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SummaryTolvaptan, a vasopressin type 2 receptor antagonist, does not affect kidney circulation or cause worsening of renal function (WRF) in patients with acute decompensated heart failure (ADHF). Bioelectrical impedance analysis (BIA) can be used to evaluate intravascular volume by calculating the ratio of extracellular water (ECW) to intracellular water (ICW). There have been no reports examining the mechanisms of tolvaptan-induced diuresis using BIA. We investigated whether tolvaptan decreases excess volume while maintaining intravascular volume in ADHF patients.Study patients included 29 ADHF patients (age 48-95, men 69%) diagnosed between April 2013 and May 2016 and who underwent BIA before and after treatment. Fifteen patients were treated with tolvaptan in addition to conventional diuresis therapy (tolvaptan group), and 14 patients were treated with conventional diuresis therapy only (control group). In the control group, the numerical value of serum creatinine (Cre) significantly increased from 0.89 ± 0.22 mg/ dL to 1.07 ± 0.29 mg/dL (P = 0.004), and the ECW/ICW significantly decreased from 0.696 ± 0.036 to 0.673 ± 0.032 (P = 0.004). These values were not significantly different from those obtained for the tolvaptan group. Furthermore, regression analysis showed a negative correlation between ΔCre and ΔECW/ICW, which are the differences between values before and after treatment (ΔCre = -0.002-5.668 × ΔECW/ICW, r 2 = 0.306, P = 0.002). Our findings suggest that WRF is caused by a reduction in intravascular volume and that tolvaptan treatment can decrease the excess volume while maintaining intravascular volume. (Int Heart J 2017; 58: 593-600)

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Differences in extracellular fluid volume between acute heart failure patients with and without high systolic blood pressure

et al. 2022

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Aims Some reports have suggested that hypertensive acute heart failure (AHF) is caused by intravascular congestion, not interstitial congestion. We evaluated the differences in extracellular fluid volume assessed by bioelectrical impedance analysis (BIA) between AHF patients with and without high systolic blood pressure (sBP). Methods This prospective single‐centre study (UMIN000030266) included 178 patients hospitalized due to AHF between September 2017 and August 2018. We calculated extracellular water (ECW), intracellular water (ICW), total body water (TBW), and ECW‐to‐TBW ratio (oedema index: EI) by BIA and evaluated conventional parameters as follows: weight, N‐terminal pro brain natriuretic peptide values, and echocardiography parameters on admission and before discharge. One‐year outcomes included all‐cause death and re‐admission due to heart failure. We compared patients with sBP > 140 mmHg on admission [clinical scenario 1 (CS1) group] and with sBP of ≤140 mmHg on admission (non‐CS1 group). Results The mean age of the patients was 79.5 ± 11.1 years, and 48.9% of the patients were female. EI on admission of 83 patients in the CS1 group was lower than that of 95 patients in the non‐CS1 group. The change in EI from admission to before discharge was no significant in the CS1 group but was significant in the non‐CS1 group. Comparing the changes from admission to before discharge between the CS1 and the non‐CS1 group, delta ECW, delta ICW, delta TBW, and delta EI of the CS1 group were significantly smaller than those of the non‐CS1 group. During the 1‐year follow‐up period after discharge of the 178 patients, the numbers of deaths and re‐admissions due to acute HF were 26 (15%) and 49 (28%), respectively. Patients with high EI before discharge [>0.408 (median)] had significantly more cardiac events than patients with low EI [hazard ratio (HR): 2.15, 95% confidence interval (CI): 1.30–3.55]. Cox regression analysis revealed that higher EI as a continuous variable was significantly associated with worse outcome in non‐CS1 group (HR: 1.46, 95% CI: 1.13–1.87), but not significantly associated with worse outcome in CS1 group (HR: 1.29, 95% CI: 0.98–1.69). Conclusions EI on admission in patients with high sBP was not elevated, and changes in ECW, ICW, TBW, and EI in patients with high sBP were smaller than those in patients without high sBP. EI measured by BIA could distinguish AHF with interstitial or intravascular congestion.

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Quantitative Assessment of Fluid Accumulation Using Bioelectrical Impedance Analysis in Patients With Acute Decompensated Heart Failure

Cited by 36 publications

References 31 publications

Bioelectrical impedance analysis in the management of heart failure in adult patients with congenital heart disease

Bioelectrical impedance analysis in the management of heart failure in adult patients with congenital heart disease

Mechanisms of Diuresis for Acute Decompensated Heart Failure by Tolvaptan

Differences in extracellular fluid volume between acute heart failure patients with and without high systolic blood pressure

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