Use of BNP and Bioimpedance to Drive Therapy in Heart Failure Patients

Abstract

The aim of the study was to verify whether the bioimpedance vector analysis (BIVA) could be a valid methodology to assess the fluid overload, whether there was a correlation between brain natriuretic peptide (BNP) and the fluid overload detected by BIVA, and whether this technique could be a valid guide in the management of the therapy in patients with acute decompensated heart failure (ADHF). A total of 51 patients arriving to the emergency department of the University Hospital Sant'Andrea (Rome, Italy) from December 2008 to April 2009 were enrolled. Hydration state, BNP, and caval index were evaluated at admission in the emergency department, at 24 and 72 hours, and at discharge. Vascular pedicle width was evaluated at admission and at discharge. BIVA values were correlated with BNP levels. A follow-up by phone at 3 months was performed. ADHF patients showed higher values of hydration state compared with controls. In ADHF patients, the difference between t 0 and t 72 BIVA mean values (P<.001) and between t 0 and discharge BIVA mean value (P<.0001) was statistically significant. Vascular pedicle width in ADHF patients showed a statistically significant difference (P<.0004) in compared with vascular pedicle width in controls.

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

“…The subject is laid recumbent on a non-conductive surface. Free fl uid in thorax and abdomen (lung congestion, pleural effusion, ascites, urine, food) does not affect the impedance values measured by this technique (6) .…”

“…Although radiography is performed on many patients presenting to the ED with decompensated HF, it is still unclear whether the test would provide correct and appropriate diagnostic information. An important chest radiography parameter is, however, the vascular pedicle width, since its evaluation shows a statistically signifi cant difference (p < 0.0004) in AHF patients as compared with healthy controls (6) .…”

“…In this important scenario, several studies have investigated and have further confi rmed the emerging role of biomarkers, such as natriuretic peptides (NPs) (5) , assisted by bio-impedance vector analysis (BIVA) in the management of congestion due to increased TBW content in the setting of chronic heart failure (CHF) or acute heart failure (AHF) patients (6,7) .…”

The feasibility of using compression bioimpedance measurements to quantify peripheral edema

“…Based on these results, it appears there is a large change in bioimpedance with modest stress compared with the bioimpedance changes normally seen clinically [1,2,39,40]. Further, this approach may allow investigators to gather more meaningful information in that the data collected is based on a process that replicates the clinical exam, eliciting information on fluid content based on tissue viscoelastic response to stress.…”

“…Recently, interest has grown in attempts at quantitative assessment of tissue hydration using BIS in many disease states [1,2,3]. In addition, the tissue response to stress in the setting of edema has recently been the subject of study as a quantitative tool for edema assessment [4,5,6].…”