The role of bioelectrical phase angle in patients with heart failure

Abstract

The most challenging feature of heart failure (HF) still remains the evaluation of congestion. Residual congestion at discharge and the difficulties in perfectly dosing therapies in order to balance the hydration status of the patient are the most worrisome issues when dealing with HF. The use of bioimpedance vector analysis (BIVA) might promote a different approach in the general management of patients with HF. BIVA is a reliable, fast, bedside tool able to assess the congestion status. It proved to be helpful to physicians for diagnosing congestive status, managing therapies, and providing prognostic information in the setting of HF. Bioelectrical Phase Angle (PhA) – as derived from equations related to the parameters of BIVA – recently surged as a possible biomarker for patients with HF. Studies provided data about the application of PhA in the clinical management and in the overall risk stratification of HF patients. Basically, the use of PhA might be considered as a holistic evaluation of patients with HF which includes the need for a multiparametric approach able to effectively depict the clinical status of patients. There is no definite biomarker able to comprehensively describe and identify all the features of HF patient, but scores based on molecules/techniques able to explore the different pathogenetic mechanisms of HF are desirable. The aim of this review was to provide a comprehensive evaluation of literature related to PhA role in HF and the impact of this biomarker on clinical management and risk stratification of HF patients.

Anaemia and Congestion in Heart Failure: Correlations and Prognostic Role

“…Hydration index [HI] might effectively be considered as an early instrument for the detection of peripheral congestion in HF as compared to the commonest signs and symptoms of peripheral congestion [ 12 , 14 , 29 , 42 ]. Peripheral congestion is characterised by fluid accumulation in peripheral districts.…”

Assessment of Volume Status in Hospitalized Patients With Chronic Heart Failure

“…Bioelectrical impedance analysis (BIA) has been studied as a rapid, noninvasive and inexpensive method for the evaluation of volume status [40][41][42][43][44][45]. Bioimpedance analysis utilizes electrical currents from superficially-placed electrodes to assess fluid composition across a given area, operating on the theory that fluid will more efficiently conduct electricity than solid tissue [40].…”

“…While not yet incorporated into routine clinical practice to the degree of serum biomarkers such as NT-ProBNP, BIA has potential to augment clinician judgment with regards to volume assessment [43,45]. Prospective, controlled such as the SCALE-HF trials using BIA to guide clinical decision making in HF patients are currently underway [46,47].…”

“…Since this time, several retrospective and prospective analyses have demonstrated utility of BIA as an independent prognostic marker for patients with HF and specific parameters have been suggested to have clinical utility to indicate successful decongestion [ 42 , 44 , 45 ]. While not yet incorporated into routine clinical practice to the degree of serum biomarkers such as NT-ProBNP, BIA has potential to augment clinician judgment with regards to volume assessment [ 43 , 45 ]. Prospective, controlled such as the SCALE-HF trials using BIA to guide clinical decision making in HF patients are currently underway [ 46 , 47 ].…”

Phase angle in applications of bioimpedance in health and disease

“…Acute and serial BI measurements afford a practical opportunity to identify and track disease-related fluid imbalance, malnutrition and prognosis. Scicchitano and Massari [18] evaluate the role of PhA in the assessment of diagnosis of congestion (central and peripheral fluid accumulation), managing therapeutic interventions and prognosis of patients with heart failure. They conclude that PhA is a holistic indicator of broad risk stratification and contributes to the multiparametric assessment, including molecular biomarkers, of patients with heart failure.…”