Accuracy of bioimpedance vector analysis and brain natriuretic peptide in detection of peripheral edema in acute and chronic heart failure

Massari, Francesco; Iacoviello, Massimo; Scicchitano, Pietro; Mastropasqua, Filippo; Guida, Pietro; Riccioni, Graziano; Saglio, Giuseppe; Caldarola, Pasquale; Ciccone, Marco Matteo; Somma, Salvatore Di

doi:10.1016/j.hrtlng.2016.03.008

Cited by 48 publications

(44 citation statements)

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“…BNP is a reliable marker for central edema, but it is not correlated with peripheral edema. In contrast, EI can detect peripheral edema and may be superior for detecting the early stages of HF that are not accompanied by central edema 28,29. In the present study, EI had a higher OR of HF-related admission than BNP level.…”

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confidence: 56%

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: 56%

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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“…In addition to brain natriuretic peptide (BNP), well-known biomarkers of "hemodynamic" congestion [4], the estimated plasma volume status (ePVS), hydration status assessed by bioimpedance vector analysis (BIVA), and the blood urea nitrogen to creatinine ratio (BUN/Cr) are emerging biomarkers for congestion in HF, as they can be considered an expression of "intravascular," "peripheral," and "venous" congestion, respectively [5][6][7]. Currently, circulating plasma concentrations of BNP are recognized as gold-standard predictive biomarkers both in acute HF (AHF) and in chronic HF (CHF) [8].…”

Section: Introductionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Massari¹,

Scicchitano

Iacoviello

et al. 2020

Journal of Cardiology

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Background: Congestion is a marker of adverse prognosis in patients with heart failure (HF). In addition to brain natriuretic peptide (BNP), estimated plasma volume status (ePVS), bioimpedance vector analysis (BIVA), and blood urea nitrogen/creatinine ratio (BUN/Cr) are emerging as new markers for congestion. The aim of this study was to evaluate the prognostic value of BNP, ePVS, BIVA, and BUN/Cr in HF. Methods: We analyzed the data from 436 patients with acute or chronic heart failure (AHF, n = 184, and CHF, n = 252, respectively). BNP, ePVS, hydration index (HI%), and BUN/Cr were collected from all patients at admission. The endpoint was all-cause mortality. Results: Ninety-two patients died after a median follow-up of 463 days (IQR: 287-669). The cumulative mortality of all of the patients was 21% (31% and 13% in AHF and CHF, respectively, p < 0.0001). The optimal cutoffs for death occurrence were BNP: >441 pg/mL, ePVS: >5.3 dL/gr, HI: >73.8%, BUN/Cr: >25. Multivariate Cox regression analysis maintained an independent predictive value for mortality (HR 2. 1, HR 2.2, HR 2.1, and HR 1.7; C-index 0.756). AHF status was no longer associated with death. Together, these variables explained 40% of the risk of death (R 2 adjusted = 0.40). Patients with all four parameters below or above their optimal cutoff had mortality rates of 4% and 59%, respectively. Conclusions: BNP, ePVS, BIVA, and BUN/Cr at admission provide independent and complementary prognostic information in patients with HF and, when combined, explain the 40% risk of death in these patients independent from the acute or chronic HF condition.

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“…Dedicated software (Bodygram 1.4, Akern RJL Systems, Florence, Italy) estimated body hydration and percentage of fat free mass (Lukaski, et al., ; Massari et al., ). BIVA documented a dehydration condition (biavector at the upper pole of the seventy‐fifth percentile) (Figure ).…”

Section: Case Reportmentioning

confidence: 99%

“…During pregnancy, the autonomic nervous system shows sequential changes: the increase in blood volume in the first trimester lowers sympathetic and intensifies vagal activities (Kuo, Chen, Yang, Lo, & Tsai, ; Yoshimura et al., ). Bioimpedance vector analysis (BIVA) and hemoglobin/hematocrit variations can indirectly and noninvasively outline plasma volume variations and their influence on heart performance (Di Somma et al., ; Dill & Costill, ; Lukaski, Siders, Nielsen, & Hall, ; Massari et al., ). All of these changes can enhance the occurrence of SVT during pregnancy (Kay & Priano, ; Robins & Lyons, ; Shotan et al., ; Tawam et al., ).…”

Section: Introductionmentioning

confidence: 99%

Supraventricular tachycardia, pregnancy, and water: A new insight in lifesaving treatment of rhythm disorders

Massari¹,

Scicchitano²,

Potenza³

et al. 2017

Noninvasive Electrocardiol

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Pregnancy may predispose to paroxysmal supraventricular tachycardia (SVT), in subjects with or without identifiable heart disease. Many physiological conditions such as autonomic nervous system changes, altered systemic hemodynamics, etc. can contribute to the onset of arrhythmias during pregnancy. Some cases reported the occurrence of arrhythmias in relation to systemic fluid variations. We report the case of a pregnant woman who experienced SVT due to fluid depletion, detected by bioimpedance vector analysis (BIVA), which was successfully treated by water repletion under tight BIVA monitoring. Emergency physicians can overcome dangerous drug administration by considering historical examination and using fast and reproducible techniques such as BIVA.

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Accuracy of bioimpedance vector analysis and brain natriuretic peptide in detection of peripheral edema in acute and chronic heart failure

Cited by 48 publications

References 43 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

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

Supraventricular tachycardia, pregnancy, and water: A new insight in lifesaving treatment of rhythm disorders

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