title: Prognostic value of decreased peripheral congestion detected by Bioelectrical Impedance Vector Analysis (BIVA) in patients hospitalized for acute heart failure: BIVA prognostic value in acute heart failure.
abstract: OBJECTIVE
  The objective of this study was to investigate the prognostic role of quantitative reduction of congestion during hospitalization assessed by Bioelectrical Impedance Vector Analysis (BIVA) serial evaluations in patients admitted for acute heart failure (AHF).
  
  
  BACKGROUND
  AHF is a frequent reason for patients to be admitted. Exacerbation of chronic heart failure is linked with a progressive worsening of the disease with increased incidence of death. Fluid overload is the main mechanism underlying acute decompensation in these patients. BIVA is a validated technique able to quantify fluid overload.
  
  
  METHODS
  a prospective, multicentre, observational study in AHF and no AHF patients in three Emergency Departments centres in Italy. Clinical data and BIVA evaluations were performed at admission (t0) and discharge (tdis). A follow-up phone call was carried out at 90 days.
  
  
  RESULTS
  Three hundred and thirty-six patients were enrolled (221 AHF and 115 no AHF patients). We found that clinical signs showed the most powerful prognostic relevance. In particular the presence of rales and lower limb oedema at tdis were linked with events relapse at 90 days. At t0, congestion detected by BIVA was observed only in the AHF group, and significantly decreased at tdis. An increase of resistance variation (dR/H) >11 Ω/m during hospitalization was associated with survival. BIVA showed significant results in predicting total events, both at t0 (area under the curve (AUC) 0.56, p<0.04) and at tdis (AUC 0.57, p<0.03). When combined with clinical signs, BIVA showed a very good predictive value for cardiovascular events at 90 days (AUC 0.97, p<0.0001).
  
  
  CONCLUSIONS
  In AHF patients, an accurate physical examination evaluating the presence of rales and lower limbs oedema remains the cornerstone in the management of patients with AHF. A congestion reduction, obtained as a consequence of therapies and detected through BIVA analysis, with an increase of dR/H >11 Ω/m during hospitalization seems to be associated with increased 90 day survival in patients admitted for AHF.
authors.affiliation: 1 Department of Medical-Surgery Sciences and Translational Medicine, Emergency Department Sant'Andrea Hospital, Postgraduate School of Emergency Medicine, University La Sapienza, Rome, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Santarelli
authors.affiliation: 1 Department of Medical-Surgery Sciences and Translational Medicine, Emergency Department Sant'Andrea Hospital, Postgraduate School of Emergency Medicine, University La Sapienza, Rome, Italy.
authors.forename: Veronica
authors.initials: V
authors.lastname: Russo
authors.affiliation: 1 Department of Medical-Surgery Sciences and Translational Medicine, Emergency Department Sant'Andrea Hospital, Postgraduate School of Emergency Medicine, University La Sapienza, Rome, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Lalle
authors.affiliation: 1 Department of Medical-Surgery Sciences and Translational Medicine, Emergency Department Sant'Andrea Hospital, Postgraduate School of Emergency Medicine, University La Sapienza, Rome, Italy.
authors.forename: Benedetta
authors.initials: B
authors.lastname: De Berardinis
authors.affiliation: 1 Department of Medical-Surgery Sciences and Translational Medicine, Emergency Department Sant'Andrea Hospital, Postgraduate School of Emergency Medicine, University La Sapienza, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Vetrone
authors.affiliation: 1 Department of Medical-Surgery Sciences and Translational Medicine, Emergency Department Sant'Andrea Hospital, Postgraduate School of Emergency Medicine, University La Sapienza, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Magrini
authors.affiliation: 2 Institute of Biochemistry and Clinical Biochemistry, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Di Stasio
authors.affiliation: 3 Department of Medicine, University of Padova, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Piccoli
authors.affiliation: 3 Department of Medicine, University of Padova, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Codognotto
authors.affiliation: 3 Department of Medicine, University of Padova, Italy.
authors.forename: Monica M
authors.initials: MM
authors.lastname: Mion
authors.affiliation: 4 Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.
authors.forename: Luigi M
authors.initials: LM
authors.lastname: Castello
authors.affiliation: 4 Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.
authors.forename: Gian Carlo
authors.initials: GC
authors.lastname: Avanzi
authors.affiliation: 1 Department of Medical-Surgery Sciences and Translational Medicine, Emergency Department Sant'Andrea Hospital, Postgraduate School of Emergency Medicine, University La Sapienza, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Somma
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D004417:Dyspnea / Q000175:diagnosis; D004489:Edema, Cardiac / Q000150:complications / Q000175:diagnosis; D017097:Electric Impedance; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D035002:Lower Extremity / Q000473:pathology; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012135:Respiratory Sounds / Q000175:diagnosis
keywords: Acute heart failure; bioelectrical impedance analysis; congestion; death; prognosis; rehospitalization