Clinical Utility of Fluid Volume Assessment in Heart Failure Patients Using Bioimpedance Spectroscopy

Abstract

Background: Bioimpedance spectroscopy (BIS) is a non-invasive method used to measure fluid volumes. In this report, we compare BIS measurements from patients with heart failure (HF) to those from healthy adults, and describe how these point-of-care fluid volume assessments may be applied to HF management.Methods and results: Fluid volumes were measured in 64 patients with NYHA class II or III HF and 69 healthy control subjects. BIS parameters including extracellular fluid (ECF), intracellular fluid (ICF), total body water (TBW), and ECF as a percentage of TBW (ECF%TBW) were analyzed. ECF%TBW values for the HF and control populations differed significantly (49.2 ± 3.2% vs. 45.2 ± 2.1%, respectively; p < 0.001); both distributions satisfied criteria for normality. Interquartile ranges did not overlap (46.7–51.0% vs. 43.8–46.4%, respectively; p < 0.001). Subgroup analyses of HF patients who underwent transthoracic echocardiography showed that impedance measurements correlated with inferior vena cava size (Pearson correlation −0.73, p < 0.0001). A case study is presented for illustrative purposes.Conclusions: BIS-measured ECF%TBW values were significantly higher in HF patients as compared to adults without HF. We describe three strata of ECF%TBW (normal, elevated, fluid overload) that may aid in clinical risk stratification and fluid volume monitoring of HF patients.Clinical Trial Registration: COMPARE – www.ClinicalTrials.gov; IMPEL – www.ClinicalTrials.gov; Heart Failure at Home – www.ClinicalTrials.gov, identifier: NCT02939053; NCT02857231; NCT04013373.

Total body water and sicca symptoms in primary Sjögren's syndrome

“…First, TBW was not obtained by deuterium dilution, which is the reference method for measurement. Nevertheless, the agreement between bioimpedance and isotope dilution techniques has been reported (6)(7)(8)(9). Second, we did not evaluate tear osmolarity and other ophthalmological tests besides Schirmer-I test.…”

“…The extracellular water/TBW ratio is a useful indicator for assessing nutritional status and fluid status (9). For example, under-hydration has been associated with chronic kidney disease, diabetes, urinary tract infection, and reduced cognitive performance (7,8,16). Conversely, an increase in TBW was linked with adverse outcomes in patients on haemodialysis and heart failure (7,8).…”

“…For example, under-hydration has been associated with chronic kidney disease, diabetes, urinary tract infection, and reduced cognitive performance (7,8,16). Conversely, an increase in TBW was linked with adverse outcomes in patients on haemodialysis and heart failure (7,8). pSS is a disease with impaired production of tears and saliva, both of them constituted by a high percentage of wa-ter.…”

“…Furthermore, saliva is an extracellular fluid containing 99.5% water as well as electrolytes, mucus, enzymes and antimicrobial agents (6). Determining the body liquid volume has been useful in some diseases such as renal disorders and heart failure (7,8). Moreover, the ratio between extracellular and intracellular fluid has been proposed as an index of health status (9).…”

A Wearable Multimodal Sensing System for Tracking Changes in Pulmonary Fluid Status, Lung Sounds, and Respiratory Markers

“…Prior work has illustrated the efficacy of these individual modalities for capturing salient cardiopulmonary health markers. BIS has previously been employed in the detection of pulmonary fluid accumulation in patients with HF [ 8 , 9 ]. Similarly, digital lung auscultation enables the quantification of acoustic properties that have long been used to distinguish cardiopulmonary disorders [ 10 , 11 ], and promising results have recently been reported from single- [ 12 ] and multi-channel lung sounds recordings [ 13 , 14 ].…”