Optimizing fluid management in patients with acute decompensated heart failure (ADHF): the emerging role of combined measurement of body hydration status and brain natriuretic peptide (BNP) levels

Valle, Roberto; Aspromonte, Nadia; Milani, L.; Peacock, W. Frank; Maisel, Alan S.; Santini, Massimo; Ronco, Claudio

doi:10.1007/s10741-011-9244-4

Cited by 85 publications

(72 citation statements)

References 42 publications

(63 reference statements)

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“…Moreover, vectors above or below the minor axis (meaning upper-left or lower right half of ellipses) are associated with more or less cell mass in soft tissue, respectively, with extremes along the minor axis. As previously discussed, the normal BIVAderived hydration values for the hydrograph are comprised between 72.7 % and 74.3 % , values above or below such relative thresholds indicate a state of hyperhydration (wet) and dehydration (dry) (91) . These two classes can be further subdivided into mild, moderate or severe volume abnormalities (92) .…”

Section: Bio-electrical Impedance Vector Analysis (Biva)mentioning

confidence: 90%

“…Valle et al (91) found that the combination of BNP and BIVA measurements could prevent unnecessary aggressive diuretic therapy, thereby reducing the level of renal complications. BIVA-BNP guided management during hospitalization for HF was associated with lower events after discharge, independent of other prognostic variables (91) .…”

Section: Future Directions In Managing Ahf Patients Using Biomarkers mentioning

confidence: 99%

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The emerging role of biomarkers and bio-impedance in evaluating hydration status in patients with acute heart failure

Somma¹,

Navarin²,

Giordano³

et al. 2012

Clinical Chemistry and Laboratory Medicine (CCLM)

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The quantitative and qualitative estimation of total body fl uid content has proven to be crucial for both diagnosis and prognosis assessment in patients with heart failure. The aim of this review is to summarize the current techniques for assessing body hydration status as well as the principal biomarkers associated with acute heart failure (AHF). Although clinical history, physical examination and classical imaging techniques (e.g., standard radiography and echocardiography) still represent the cornerstones, novel and promising tools, such as biomarkers and bio-electrical impedance are achieving an emerging role in clinical practice for the assessment of total body fl uid content. In the acute setting, the leading advantages of these innovative methods over device are represented by the much lower invasiveness and the reasonable costs, coupled with an easier and faster application. This article is mainly focused on AHF patients, not only because the overall prevalence of this disease is dramatically increasing worldwide, but also because it is well-known that their fl uid overload has a remarkable diagnostic and prognostic significance. It is thereby conceivable that the bio-electrical vector analysis (BIVA) coupled with laboratory biomarkers might achieve much success in AHF patient management in the future, especially for assisting diagnosis, risk stratifi cation, and therapeutic decision-making.

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Section: Bio-electrical Impedance Vector Analysis (Biva)mentioning

confidence: 90%

Section: Future Directions In Managing Ahf Patients Using Biomarkers mentioning

confidence: 99%

The emerging role of biomarkers and bio-impedance in evaluating hydration status in patients with acute heart failure

Somma¹,

Navarin²,

Giordano³

et al. 2012

Clinical Chemistry and Laboratory Medicine (CCLM)

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“…Bioimpedance is a noninvasive method for body composition assessment that has been extensively validated for evaluation of body composition2, 3, 4, 5, 6 and hydration status7, 8, 9, 10, 11, 12, 13 in patients undergoing cardiac surgery. Phase angle (PA) is a measurement obtained via bioimpedance analysis that reflects the resistance and reactance of the human body in response to the application of an external current 14. PA is strongly associated with sarcopenia15, 16, 17, 18 and frailty18, 19, 20 in geriatric patients, and represents a promising candidate as a noninvasive tool for frailty assessment in the cardiac population.…”

Section: Introductionmentioning

confidence: 99%

Phase Angle as a Biomarker for Frailty and Postoperative Mortality: The BICS Study

Mullie

O’Brand

Bendayan

et al. 2018

JAHA

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BackgroundPhase angle (PA) is a bioimpedance measurement that is determined lean body mass and hydration status. Patients with low PA values are more likely to be frail, sarcopenic, or malnourished. Previous work has shown that low PA predicts adverse outcomes after cardiac surgery, but the effect of PA on survival has not previously been assessed in this setting.Methods and ResultsThe BICS (Bioimpedance in Cardiac Surgery) study recruited 277 patients undergoing major cardiac surgery at 2 university‐affiliated hospitals in Montreal, QC, Canada. Bioimpedance measurements as well as frailty and nutritional assessments were performed preoperatively. The primary outcome was all‐cause mortality. Secondary outcomes were 30‐day mortality, postoperative morbidity, and hospital length of stay. There were 10 deaths at 1 month of follow‐up and 16 deaths at 12 months of follow‐up. PA was associated with age, sex, body mass index, comorbidities, and frailty, as measured by the Short Physical Performance Battery and Fried scales. After adjusting for Society of Thoracic Surgeons–predicted mortality, lower PA was associated with higher mortality at 1 month (adjusted odds ratio, 3.57 per 1° decrease in PA; 95% confidence interval, 1.35–9.47) and at 12 months (adjusted odds ratio, 3.03 per 1° decrease in PA; 95% confidence interval, 1.30–7.09), a higher risk of overall morbidity (adjusted hazard ratio, 2.51 per 1° decrease in PA; 95% confidence interval, 1.32–4.75), and a longer hospital length of stay (adjusted β, 4.8 days per 1° decrease in PA; 95% confidence interval, 1.3–8.2 days).ConclusionsLow PA is associated with frailty and is predictive of mortality, morbidity, and length of stay after major cardiac surgery. Further work is needed to determine the responsiveness of PA to interventions aimed at reversing frailty.

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“…It is conceivable that real time monitoring of body water content using bioelectrical impedance vectorial analysis combined with measurement of blood natriuretic peptides could lead to not only better assessments of congestion but also indicators of the need for additional therapy. 6 In addition, ultrasound lung comets are a simple echographic tool recognizing extravascular lung water, associated with left ventricular diastolic or systolic dysfunction as well as pulmonary congestion. The complement of new molecular targets to identify AKI, such as neutrophil gelatinase associated lipocalin, kidney injury molecule-1, L-type fatty acid binding protein, and cystatin-C will help further understand the patient with combined cardiorenal failure.…”

Section: To the Editormentioning

confidence: 99%

Letter by Palazzuoli et al Regarding Article, “Is Worsening Renal Function an Ominous Prognostic Sign in Patients With Acute Heart Failure? The Role of Congestion and Its Interaction With Renal Function”

Palazzuoli

Ronco

McCullough

2012

Circ: Heart Failure

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We congratulate Dr Metra and colleagues in helping us further understand the problem of worsening renal function, better termed acute kidney injury (AKI), in heart failure (HF) patients. 1 This study adds to the literature in that residual congestion at the time of discharge is an additional risk to AKI as an in-hospital complication. Approximately 20% to 40% of patients admitted with HF have an associated development of AKI, defined on the basis of conventional criteria. In a meta-analysis evaluating the impact of AKI in HF at 6 months follow-up, there was a strong association to an unfavorable prognosis (odds ratio 1.62). In less advanced HF stages, chronic kidney disease is associated with left ventricular systolic volume and higher functional class.2 It is likely that many of the patients in the study by Metra and colleagues had resolving AKI because it appears the baseline and peak serum creatinine at any time was used to generate change in serum creatinine and, thus, the definition of AKI.Irrespective of any measure of congestion, changes in renal function are consistently related to higher short and longer term HF mortality. In a retrospective analysis of 949 patients from OPTIME-CHF Trial, Klein et al 3 investigated the relation between the admission values and changes in blood urea nitrogen (BUN) and estimated glomerular filtration rate, and the rate of death within 60 days after discharge. Independent of values at admission, an increase of >10 mg/dL in BUN during hospitalization at any time was associated with a worse 60 day survival; BUN (per 5 mg/dL increase) had a hazard ratio of 1.08 (95% CI, 1.01-1.16).3 In the POSH study, among 248 patients with acute decompensated heart failure and systolic dysfunction, one third developed AKI during hospitalization. Of note, only in those with complicated courses during hospitalization (development of shock or cardiac ischemia) did AKI have a significant association with mortality. 4 Rusinaru et al 5 demonstrated in patients admitted for HF and preserved left ventricular systolic function that reduced baseline eGFR and AKI predicted long term mortality. Finally, the same authors of the present paper previously reported that an increase of 0.3 mg/dL in creatinine was an independent predictor of death or HF rehospitalization (hazards ratio 1.47).The findings of Metra et al suggest persistent hemodynamic compromise in addition to AKI identify high risk patients over the next several weeks to months. Furthermore, it may be renal venous congestion in these circumstances that is the common pathophysiologic link leading to cardiorenal death. It appears to take only 1 clinical feature to identify a persistently congested patient. It is conceivable that real time monitoring of body water content using bioelectrical impedance vectorial analysis combined with measurement of blood natriuretic peptides could lead to not only better assessments of congestion but also indicators of the need for additional therapy. In addition, ultrasound lung comets are a simple echographic t...

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Optimizing fluid management in patients with acute decompensated heart failure (ADHF): the emerging role of combined measurement of body hydration status and brain natriuretic peptide (BNP) levels

Cited by 85 publications

References 42 publications

The emerging role of biomarkers and bio-impedance in evaluating hydration status in patients with acute heart failure

The emerging role of biomarkers and bio-impedance in evaluating hydration status in patients with acute heart failure

Phase Angle as a Biomarker for Frailty and Postoperative Mortality: The BICS Study

Letter by Palazzuoli et al Regarding Article, “Is Worsening Renal Function an Ominous Prognostic Sign in Patients With Acute Heart Failure? The Role of Congestion and Its Interaction With Renal Function”

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