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

Abstract

| 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.

Machine Learning Model Based on Transthoracic Bioimpedance and Heart Rate Variability for Lung Fluid Accumulation Detection: Prospective Clinical Study

“…Lindholm et al [ 22 ] also performed a longitudinal study including over 500,000 participants and determined that leg bioimpedance was inversely correlated with new-onset heart failure and that by combining the leg bioimpedance with clinical parameters such as age, sex, and history of myocardial infarction, accurate prediction of heart failure could be achieved. In another study [ 23 ] on participants with congenital heart disease, bioelectrical impedance correlated with heart failure severity. In contrast to these prior studies, we sought to evaluate the performance of intrathoracic bioimpedance measured using a novel dry electrode for detecting acute decompensated heart failure.…”

“…Lindholm et al [ 22 ] determined that leg bioimpedance was inversely correlated with heart failure incidence, and by combining leg bioimpedance with demographic information, they obtained accurate heart failure predictions. Sato et al [ 23 ] evaluated parameters from bioelectrical impedance analysis in participants with congenital heart disease and determined that the edema index obtained from bioelectrical impedance analysis could also be a marker for heart failure severity.…”

Bioelectrical impedance analysis for perioperative water management in adult cardiovascular valve disease surgery

“…BIA has been applied for the water management of hemodialysis patients and also recently for the water management of heart failure and cardiac surgery patients [16][17][18][19][20][21][22].…”

“…Previous studies found that the EI was a useful marker for heart failure [16][17][18] and the phase angle was a predictive marker for cardiac surgery [12][13][14][15]. The EI shows the ratio between intra-and extracellular water.…”

“…According to several reports on BIA in clinical studies, the phase angle (PA), one type of BIA readout, shared a correlation with a nutrition marker and was a potential postoperative risk marker for cardiac surgery [12][13][14][15]. Studies on the differences in water behavior with some kinds of diuretics found that one readout of BIA, the edema index (EI), being the ratio of extracellular water to total body water, can predict the amount of fluid reduction needed for patients with acute heart failure and chronic renal disease [16][17][18][19][20][21][22]. We hypothesized that perioperative water management could be improved by a better understanding of perioperative water behavior through BIA.…”