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

Abstract

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.

Mechanisms of Diuresis for Acute Decompensated Heart Failure by Tolvaptan

“…It has been suggested as a good surrogate marker for body fluid volume and a useful guide for the management of patients with ADHF. 8,9) BIA can be used to determine fluid balance parameters like the edema index, which is calculated as the ratio of ECW to TBW. 26) BIA and calculating the ECW/ICW ratio are also useful to assess changes in body fluid distribution, as occurs in critically ill patients (especially those with sepsis) when fluid from the intravascular space migrates to the extravascular space.…”

“…7) Recently, bioelectrical impedance analysis (BIA) has been suggested as a useful guide for the management of ADHF patients. 8,9) BIA takes into consideration whole body (or regional or segmental) impedance, phase angle, resistance, reactance, and capacitance by means of an electric current transmitted at different fre-quencies. 10,11) New techniques can be used to measure total body water (TBW), which is separated into extracellular and intracellular water (ICW).…”

Acute heart failure (suspected or confirmed): Initial diagnosis and subsequent evaluation with traditional and novel technologies

“…However, there is a great range of different bioimpedance equipment and in some studies it has been performed poorly [48]. More experience is required to understand its utility and accuracy [49].…”

Ischemic heart disease in the emergency room: state of the art, innovation and research

“…Among them, natriuretic peptides, mid-regional adrenomedullin and copetin, for example, may help identify those patients with an increased risk of heart and renal impairment after an AMI, thus enabling a tailored treatment and a better outcome. 23,24 Multi-leads electrocardiogram evaluation of acute chest pain in the emergency department As previously mentioned, the evaluation of patients with symptoms of suspected ACS who present to the ED is expensive and time consuming, and always starts with the 12-lead ECG. This rapid, non-invasive and relatively inexpensive diagnostic tool should be performed at the earliest, preferably within 10 min from patient presentation.…”