Body composition analysis in patients with acute heart failure: the Scale Heart Failure trial

Abstract

Aims In this study, we aimed to investigate whether body composition analysis (BCA) derived from bioelectrical impedance vector analysis (BIVA) could be used to monitor the hydration status of patients with acute heart failure (AHF) during intensified diuretic therapy. Methods and results This observational, single‐centre study involved a novel, validated eight‐electrode segmental body composition analyser to perform BCA derived from BIVA with an alternating current of 100 μA at frequencies of 5, 7.5, 50, and 75 kHz. The BCA‐derived and BIVA‐derived parameters were estimated and compared with daily body weight measurements in hospitalized patients with AHF. A total of 867 BCA and BIVA assessments were conducted in 142 patients (56.3% men; age 76.8 ± 10.7 years). Daily changes in total body water (TBW) and extracellular water (ECW) were significantly associated with changes in body weight in 62.2% and 89.1% of all measurements, respectively (range, ±1 kg). Repeated measures correlation coefficients between weight loss and TBW loss resulted with rho 0.43, P < 0.01, confidence interval (CI) [0.36, 0.50] and rho 0.71, P > 0.01, CI [0.67, 0.75] for ECW loss. Between the first and last assessments, the mean weight loss was −2.5 kg, compared with the −2.6 L mean TBW loss and −1.7 L mean ECW loss. BIVA revealed an increase in mean Resistance R and mean Reactance Xc across all frequencies, with the subsequent reduction in body fluid (including corresponding body weight) between the first and last assessments. Conclusions Body composition analysis derived from BIVA with a focus on ECW is a promising approach to detect changes in hydration status in patients undergoing intensified diuretic therapy. Defining personalized BIVA reference values using bioelectrical impedance devices is a promising approach to monitor hydration status.

The role of bioelectrical phase angle in patients with heart failure

“…Such dynamic change might reflect that related to the congestion status of HF patients during their clinical in-hospital and out-of-hospital course. Similar results were from De Ieso et al [ 43 ] in patients with ADHF: improvement in PhA was observed during the hospital stay after intensified diuretic therapy.…”

“…PhA remained stable at 3-month f.u. 0.7° De Ieso et al 2021 [ 43 ] 142 ADHF Observational Multi-frequency medical whole-body composition analyser (Seca® mBCA 515, Hamburg, Germany) N/A Mean phase angle increased from 3.61 ± 0.82° to 3.83 ± 0.74° from admission to discharge 0.22° Gastelurrutia et al 2011[ 44 ] 54 Stable and unstable HF Observational Imp DF50 (ImpediMed, Queensland, Australia). 50 kHz frequency and 800 microA current N/A Male: PhA: Stable HF 4.5 ± 0.8° vs. unstable HF 3.8 ± 0.7°, p = 0.02 Female: PhA: Stable HF 3.9 ± 0.8° vs. unstable HF 3.9 ± 0.9°, p = 0.96 Male 0.7° Female 0° Massari et al 2016 [ 6 ] 900 487 ADHF and 413 CHF Retrospective CardioEFG, Akern RJL Systems, Florence, Italy Tetrapolar impedance plethysmograph, 50 kHz alternating sinusoidal current N/A Phase Angle ADHF 4.7 ± 1.2° vs. CHF 5.5 ± 1.3° ADHF Phase Angle With peripheral edema: 4.2 ± 1.0° vs. without peripheral edema: 5.1 ± 1.2, p < 0.01 CHF Phase Angle With peripheral edema: 4.5 ± 1.0° vs. without peripheral edema: 5.6 ± 1.2, p < 0.01 ADHF vs. CHF 0.8° ADHF 0.9° CHF 1.1° Castillo Martínez et al 2007 [ 45 ] 243 140 (101 in NYHA I–II and 39 in III–IV) with HFrEF 103 (67 in NYHA I–II and 36 in II–IV) with HFpEF.…”

“…PhA could effectively detect the changes in fluid overload of patients with acute decompensated HF (ADHF, i.e. those with overt symptoms -breathlessness, ankle swelling, and fatigue -or signs -elevated jugular venous pressure, pulmonary crackles, and peripheral oedema of acute decompensation from De Ieso et al [43] in patients with ADHF: improvement in PhA was observed during the hospital stay after intensified diuretic therapy.…”

Pathophysiology, Functional Assessment and Prognostic Implications of Nutritional Disorders in Systemic Amyloidosis

“…It is a non-invasive method that allows the analysis of the body composition in a few seconds thanks to the detection of the impedance, or the “resistance” opposed by the body to the passage of an alternating electric current of very low intensity (400 µÅ) and high frequency (50 kHz). It is a safe, fast and reproducible method that can be easily integrated into clinical practice to detect patients with congestion (even subclinical) and monitor disease progression and decongestion with diuretic therapy [ 41 ].…”

Diagnosis of Fluid Overload: From Conventional to Contemporary Concepts

“…In patients with acute HF, BIA reliably reflects changes in hydration status, correlates with echocardiographic parameters, natriuretic peptide levels, and predicts hospital length of stay. However, BIA-guided decongestive therapy has not shown to be superior compared to standard care with respect to outcome [69][70][71][72]. In critically ill patients, the accuracy of BIA as a measure of hydration status remains unclear at this time [73].…”