Additive diagnostic and prognostic value of Bioelectrical Impedance Vector Analysis (BIVA) to brain natriuretic peptide ‘grey-zone’ in patients with acute heart failure in the emergency department

Somma, Salvatore Di; Lalle, Irene; Magrini, L.; Russo, Veronica; Navarin, Silvia; Castello, Luigi Mario; Avanzi, Gian Carlo; Stasio, Enrico Di; Maisel, Alan

doi:10.1177/2048872614521756

Cited by 44 publications

(43 citation statements)

References 31 publications

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“…We also found that BIVA had significant prognostic value for death for each considered follow-up time. This is not surprising and confirms previous study of our group, we also demonstrated additive value for AHF risk stratification of BIVA + BNP [8, 9]. The most important of our opinion results of our study is that the combination of BIVA + GAL3 increases the prognostic value for death and also for rehospitalization.…”

Section: Discussionsupporting

confidence: 92%

“…Moreover, within subjects referring to the Emergency Department (ED) for AHF, BIVA has been demonstrated to be able to identify people at high risk for short-term mortality [8, 9]. In consideration of the two different aspects of GAL3 and of BIVA (the first is a fibrosis marker, and the second is a dynamic marker of congestion), we decided to evaluate in this study the degree of congestion correlated to that of fibrosis in AHF patients alone or together for the prediction of events.…”

Section: Introductionmentioning

confidence: 99%

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Usefulness of Combining Galectin-3 and BIVA Assessments in Predicting Short- and Long-Term Events in Patients Admitted for Acute Heart Failure

Berardinis

Magrini

Zampini

et al. 2014

BioMed Research International

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Introduction. Acute heart failure (AHF) is associated with a higher risk for the occurrence of rehospitalization and death. Galectin-3 (GAL3) is elevated in AHF patients and is an indicator in predicting short-term mortality. The total body water using bioimpedance vector analysis (BIVA) is able to identify mortality within AHF patients. The aim of this study was to evaluate the short- and long-term predictive value of GAL3, BIVA, and the combination of both in AHF patients in Emergency Department (ED). Methods. 205 ED patients with AHF were evaluated by testing for B type natriuretic peptide (BNP) and GAL3. The primary endpoint was death and rehospitalization at 30, 60, 90, and 180 days and 12 and 18 months. AHF patients were evaluated at the moment of ED arrival with clinical judgment and GAL3 and BIVA measurement. Results. GAL3 level was significantly higher in patients >71 years old, and with eGFR < 30 cc/min. The area under the curve (AUC) of GAL3 + BIVA, GAL3 and BIVA for death and rehospitalization both when considered in total and when considered serially for the follow-up period showed that the combination has a better prognostic value. Kaplan-Meier survival curve for GAL3 values >17.8 ng/mL shows significant survival difference. At multivariate Cox regression analysis GAL3 is an independent variable to predict death + rehospitalization with a value of 32.24 ng/mL at 30 days (P < 0.005). Conclusion. In patients admitted for AHF an early assessment of GAL3 and BIVA seems to be useful in identifying patients at high risk for death and rehospitalization at short and long term. Combining the biomarker and the device could be of great utility since they monitor the severity of two pathophysiological different mechanisms: heart fibrosis and fluid overload.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Usefulness of Combining Galectin-3 and BIVA Assessments in Predicting Short- and Long-Term Events in Patients Admitted for Acute Heart Failure

Berardinis

Magrini

Zampini

et al. 2014

BioMed Research International

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“…Furthermore, in patients with CHF, BNP levels can be elevated; and it is harder to determine whether dyspnea symptoms are related to HF exacerbation or another extracardiac factor. In such cases, BIVA measurement could offer a complementary means for AHF diagnosis in the ED where cardiac ultrasound scan is not readily available as Di Somma et al [31] tried to show. In their study, BIVA did not increase diagnostic accuracy provided by BNP.…”

Section: Discussionmentioning

confidence: 97%

Bioelectrical impedance analysis for heart failure diagnosis in the ED

Genot

Mewton

Bresson

et al. 2015

The American Journal of Emergency Medicine

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“…In a phase II trial, treatment guided by lung impedance (assessed using external electrodes) reduced heart failure hospitalizations 13. In addition, bioimpedance measures have been suggested as an adjunctive test for patients presenting with dyspnea at the emergency department, to identify heart failure patients when other tests are equivocal 14, 15. Whether the information obtained from impedance measures in patients with established heart failure translates into improved outcomes is, however, uncertain 13, 16, 17…”

Section: Discussionmentioning

confidence: 99%

Bioimpedance and New‐Onset Heart Failure: A Longitudinal Study of >500 000 Individuals From the General Population

Lindholm

Fukaya

Leeper

et al. 2018

JAHA

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BackgroundHeart failure constitutes a high burden on patients and society, but although lifetime risk is high, it is difficult to predict without costly or invasive testing. We aimed to establish new risk factors of heart failure, which potentially could enable early diagnosis and preemptive treatment.Methods and ResultsWe applied machine learning in the UK Biobank in an agnostic search of risk factors for heart failure in 500 451 individuals, excluding individuals with prior heart failure. Novel factors were then subjected to several in‐depth analyses, including multivariable Cox models of incident heart failure, and assessment of discrimination and calibration. Machine learning confirmed many known and putative risk factors for heart failure and identified several novel candidates. Mean reticulocyte volume appeared as one novel factor and leg bioimpedance another, the latter appearing as the most important new marker. Leg bioimpedance was lower in those who developed heart failure during an up to 9.8‐year follow‐up. When adjusting for known heart failure risk factors, leg bioimpedance was inversely related to heart failure (hazard ratio [95% confidence interval], 0.60 [0.48–0.73] and 0.75 [0.59–0.94], in age‐ and sex‐adjusted and fully adjusted models, respectively, comparing the upper versus lower quartile). A model including leg bioimpedance, age, sex, and self‐reported history of myocardial infarction showed good discrimination for future heart failure hospitalization (Concordance index [C‐index]=0.82) and good calibration.ConclusionsLeg bioimpedance is inversely associated with heart failure incidence in the general population. A simple model of exclusively noninvasive measures, combining leg bioimpedance with history of myocardial infarction, age, and sex provides accurate predictive capacity.

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Additive diagnostic and prognostic value of Bioelectrical Impedance Vector Analysis (BIVA) to brain natriuretic peptide ‘grey-zone’ in patients with acute heart failure in the emergency department

Cited by 44 publications

References 31 publications

Usefulness of Combining Galectin-3 and BIVA Assessments in Predicting Short- and Long-Term Events in Patients Admitted for Acute Heart Failure

Usefulness of Combining Galectin-3 and BIVA Assessments in Predicting Short- and Long-Term Events in Patients Admitted for Acute Heart Failure

Bioelectrical impedance analysis for heart failure diagnosis in the ED

Bioimpedance and New‐Onset Heart Failure: A Longitudinal Study of >500 000 Individuals From the General Population

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