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Edema index established by a segmental multifrequency bioelectrical impedance analysis provides prognostic value in acute heart failure

Liu, Min-Hui; Wang, Chao-Hung; Huang, Yu-Yen; Tung, Tao-Hsin; Lee, Chii-Ming; Yang, Ning-I; Liu, Ping-Chang; Cherng, Wen-Jin

Journal of Cardiovascular Medicine: May 2012 - Volume 13 - Issue 5 - p 299–306
doi: 10.2459/JCM.0b013e328351677f
Original articles: Heart failure

Objectives A segmental multifrequency bioelectrical impedance analysis (SMBIA) is a noninvasive and reproducible modality for estimating the fluid state. The aim of this study was to test whether the SMBIA-derived edema index provides prognostic value in patients hospitalized due to acute heart failure (AHF).

Methods To estimate the 6-month prognostic value of the predischarge edema index in patients hospitalized due to AHF, 112 patients were consecutively enrolled. Both predischarge edema index and B-type natriuretic peptide (BNP) were measured. Outcome follow-up focused on heart failure-related and all-cause re-hospitalizations and all events.

Results On the basis of a cutoff value of edema index of 0.390, patients were separated into two groups: edema index more than 0.390 (n = 44) and edema index of 0.390 or less (n = 68). Compared with patients with edema index 0.390 or less, those with edema index of more than 0.390 were older, had lower blood albumin and hemoglobin levels, and had higher predischarge BNP levels, functional class, incidence of diabetes mellitus, valvular cause, and diuretic use. Although edema indexes were correlated with BNP levels (r = 0.47, P < 0.0001), a mismatch was noted in 33 (29%) patients. Univariate and multivariate analysis showed that an edema index of more than 0.390 predicted a higher incidence of heart failure-related re-hospitalization [odds ratio (OR) = 4.14, confidence interval (CI) = 1.05–15.28, P = 0.04] and all events (OR = 3.97, CI = 1.4–11.25, P = 0.01). The edema index provided a prognostic value superior to that of BNP. Reducing the edema index in high-risk patients resulted in fewer heart failure-related re-hospitalizations (OR = 0.81, CI = 0.77–0.84, P < 0.001) and all events (OR = 0.8, CI = 0.76–0.85, P < 0.001).

Conclusion Edema index provides 6-month prognostic values in patients hospitalized due to AHF. Reducing the edema index in high-risk patients results in better outcomes.

aDivision of Cardiology, Department of Internal Medicine, Heart Failure Center, Chang Gung Memorial Hospital at Keelung, Keelung

bChang Gung University College of Medicine, Taoyuan

cTaiwan Cooperative Oncology Group, National Health Research Institutes, Miaoli

dDepartment of Medical Research and Education, Cheng Hsin General Hospital

eDivision of Cardiology, Department of Internal Medicine, National Taiwan University, Taipei, Taiwan

Correspondence to Chao-Hung Wang, MD, Division of Cardiology, Department of Internal Medicine, Heart Failure Center, Chang Gung Memorial Hospital, 222 Mai Chin Road, Keelung, Taiwan Tel: +886 2 24313131; fax: +886 2 24335342; e-mail: bearty@adm.cgmh.org.tw

Received 12 September, 2011

Revised 17 November, 2011

Accepted 13 January, 2012

© 2012 Italian Federation of Cardiology. All rights reserved.