SP219PROGNOSTIC VALUE OF BIOIMPEDANCE VECTOR ANALYSIS VERSUS CLINICAL CHARACTERISTICS IN PATIENTS WITH ACUTE DECOMPENSATION OF HEART FAILURE

Abstract

Objective: Volume overload is the known main driver for morbidity, mortality and hospital readmission in patients with acute decompensation of heart failure (ADHF). Acute kidney injury (AKI) occurs up to 70% in ADHF. Bioimpedance vector analysis (BIVA) is a non-invasive accurate technique for hydration status (HS) evaluation. The aim of the study was to evaluate HS in ADHF patients by BIVA and clinical/ radiographic criteria and to determine the diagnostic and prognostic value of these methods. Methods: in 183 patients admitted with ADHF (125 male, 69+/-9 years (M+/-SD), arterial hypertension 87%, ischemic heart disease 56%, myocardial infarction 53%, atrial fibrillation 51%, diabetes mellitus 36%, known chronic kidney disease 40%, ejection fraction (EF) 44+/-15%) HS was assessed by BIVA and clinical/ radiographic criteria. AKI was defined using 2012 KDIGO Guidelines.Mann-Whitney test was performed. P <0.05 was considered statistically significant. Results: In 78% overhydrated patients clinical evaluation corresponded to BIVA results (G1), 9% patients were overhydrated only by BIVA (G2). Patients G1 compared with patients G2 had more marked clinically presentation of systemic congestion: ascites (37 vs 0%, p<0.01), Rg-hydrothorax (70 vs 0%, p<0.001), echo-hydropericardium (20 vs 0%, p<0.05). Patients G1 compared with patients G2 were older (70+/-9 vs 60+/-10 years, p<0.01), had higher rate of prior HF hospitalizations (81 vs 53%, c2%=7, p<0.01), lower EF (45+/-15 vs 53+/-13%, p<0.01), higher level of NT-proBNP (13171+/-3655 vs 8945+/-2301 fmol/ml, p<0.05). There were no differences between groups in frequency of AKI (41 in G1 vs 53% in G2, p>0.05), but all AKI in G2 was transient (100 vs 41%, p<0.01). Patients G1 compared with patients G2 had higher rate of HF rehospitalization (54 vs 0%, c2%=17, p<0.001) and 30-days mortality (9 vs 0%, c2%=10, p<0.01). Conclusions: In 78% of patients with ADHF and overhydration clinical/ radiographic criteria corresponded to BIVA results, 9% patients were overhydrated by BIVA only. Patients with overhydration by BIVA only had less evident systemic congestion; AKI was transient andwas not associated with poor short-term and long-term outcomes. Hydration status evaluation by BIVA has no independent prognostic value in patients with ADHF.