Complex assessment of patients with decompensated heart failure: The clinical value of impedance cardiography and N-terminal pro-brain natriuretic peptide

Agata Galas; Paweł Krzesiński; Grzegorz Gielerak; Wiesław Piechota; Beata Uziębło-Życzkowska; Adam Stańczyk; Katarzyna Piotrowicz; Małgorzata Banak

doi:10.1016/j.hrtlng.2018.10.004

Complex assessment of patients with decompensated heart failure: The clinical value of impedance cardiography and N-terminal pro-brain natriuretic peptide

Heart Lung. 2019 Jul-Aug;48(4):294-301. doi: 10.1016/j.hrtlng.2018.10.004. Epub 2018 Oct 31.

Authors

Agata Galas¹, Paweł Krzesiński², Grzegorz Gielerak², Wiesław Piechota², Beata Uziębło-Życzkowska², Adam Stańczyk², Katarzyna Piotrowicz², Małgorzata Banak²

Affiliations

¹ Department of Cardiology and Internal Diseases, Military Institute of Medicine, ul. Szaserów 128, 04-141 Warszawa, Poland. Electronic address: agalas@wim.mil.pl.
² Department of Cardiology and Internal Diseases, Military Institute of Medicine, ul. Szaserów 128, 04-141 Warszawa, Poland.

PMID: 30391076
DOI: 10.1016/j.hrtlng.2018.10.004

Abstract

Background: Acute decompensated heart failure (ADHF) is a serious clinical problem and a condition requiring immediate diagnostics, supporting the therapeutic decision adequate to the specific ADHF mechanism. N-terminal pro-brain natriuretic peptide (NT-proBNP) is an established biochemical marker of heart failure, strongly related to hemodynamic status. Impedance cardiography (ICG) provides non-invasive hemodynamic assessment that can be performed immediately at the bedside and revealed to be useful diagnostic tool in some clinical settings in cardiology.

Objectives: The aim of this study was to evaluate the usefulness of ICG in the admission diagnostics and monitoring the effects of treatment in patients hospitalized due to ADHF, with special emphasis on its relation to NT-proBNP.

Methods: This study enrolled 102 patients, aged over 18 years, hospitalized due to ADHF. The subjects underwent detailed clinical assessment, including ICG and NT-proBNP at admission and at discharge day.

Results: Among all analyzed ICG parameters thoracic fluid content (TFC), a marker of chest overload, was the most significantly correlated with NT-proBNP level (R = 0.46; p = 0.000001). In comparison with patients with low thoracic fluid content (TFC ≤ 35/kΩ), those with higher TFC values (>35/kΩ) exhibited a greater severity of symptoms (NYHA functional class); higher NT-proBNP levels; lower left ventricular ejection fraction (LVEF), stroke index (SI), and cardiac index (CI); as well as significantly higher systemic vascular resistance index (SVRI). These TFC-based subgroups showed no significant differences in terms of heart rate (HR), systolic blood pressure (SBP), or diastolic blood pressure (DBP).

Conclusions: The evaluation of hemodynamic parameters, especially TFC, seems to be a worthwhile addition to standard diagnostics, both at the stage of hospital admission and while monitoring the effects of treatment. Impedance cardiography is a useful method in evaluating individual hemodynamic profiles in patients with ADHF.

Keywords: Acute heart failure; Congestion; Hypervolemia; Impedance cardiography; Thoracic fluid content.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Acute Disease
Aged
Biomarkers / blood
Blood Pressure / physiology
Cardiography, Impedance / methods*
Female
Follow-Up Studies
Heart Failure / blood
Heart Failure / diagnosis*
Heart Failure / physiopathology
Heart Rate / physiology
Humans
Male
Natriuretic Peptide, Brain / blood*
Peptide Fragments / blood*
Prospective Studies
Ventricular Function, Left / physiology*

Substances

Biomarkers
Peptide Fragments
pro-brain natriuretic peptide (1-76)
Natriuretic Peptide, Brain