title: Usefulness of combining admission brain natriuretic peptide (BNP) plus hospital discharge bioelectrical impedance vector analysis (BIVA) in predicting 90 days cardiovascular mortality in patients with acute heart failure.
abstract: Heart failure is a disease characterized by high prevalence and mortality, and frequent rehospitalizations. The aim of this study is to investigate the prognostic power of combining brain natriuretic peptide (BNP) and congestion status detected by bioelectrical impedance vector analysis (BIVA) in acute heart failure patients. This is an observational, prospective, and a multicentre study. BNP assessment was measured upon hospital arrival, while BIVA analysis was obtained at the time of discharge. Cardiovascular deaths were evaluated at 90 days by a follow up phone call. 292 patients were enrolled. Compared to survivors, BNP was higher in the non-survivors group (mean value 838 vs 515 pg/ml, p < 0.001). At discharge, BIVA shows a statistically significant difference in hydration status between survivors and non-survivors [respectively, hydration index (HI) 85 vs 74, p < 0.001; reactance (Xc) 26.7 vs 37, p < 0.001; resistance (R) 445 vs 503, p < 0.01)]. Discharge BIVA shows a prognostic value in predicting cardiovascular death [HI: area under the curve (AUC) 0.715, 95% confidence interval (95% CI) 0.65-0.76; p < 0.004; Xc: AUC 0.712, 95% CI 0.655-0.76, p < 0.007; R: AUC 0.65, 95% CI 0.29-0.706, p < 0.0247]. The combination of BIVA with BNP gives a greater prognostic power for cardiovascular mortality [combined receiving operating characteristic (ROC): AUC 0.74; 95% CI 0.68-0.79; p < 0.001]. In acute heart failure patients, higher BNP levels upon hospital admission, and congestion detected by BIVA at discharge have a significant predictive value for 90 days cardiovascular mortality. The combined use of admission BNP and BIVA discharge seems to be a useful tool for increasing prognostic power in these patients.
authors.affiliation: Department of Medical-Surgery Sciences and Translational Medicine, Emergency Medicine, Postgraduate School of Emergency Medicine, University La Sapienza, Via di Grottarossa 1035/1039, 00189, Rome, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Santarelli
authors.affiliation: Department of Medical-Surgery Sciences and Translational Medicine, Emergency Medicine, Postgraduate School of Emergency Medicine, University La Sapienza, Via di Grottarossa 1035/1039, 00189, Rome, Italy.
authors.forename: Veronica
authors.initials: V
authors.lastname: Russo
authors.affiliation: Department of Medical-Surgery Sciences and Translational Medicine, Emergency Medicine, Postgraduate School of Emergency Medicine, University La Sapienza, Via di Grottarossa 1035/1039, 00189, Rome, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Lalle
authors.affiliation: Department of Medical-Surgery Sciences and Translational Medicine, Emergency Medicine, Postgraduate School of Emergency Medicine, University La Sapienza, Via di Grottarossa 1035/1039, 00189, Rome, Italy.
authors.forename: Benedetta
authors.initials: B
authors.lastname: De Berardinis
authors.affiliation: Department of Medical-Surgery Sciences and Translational Medicine, Emergency Medicine, Postgraduate School of Emergency Medicine, University La Sapienza, Via di Grottarossa 1035/1039, 00189, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Navarin
authors.affiliation: Department of Medical-Surgery Sciences and Translational Medicine, Emergency Medicine, Postgraduate School of Emergency Medicine, University La Sapienza, Via di Grottarossa 1035/1039, 00189, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Magrini
authors.affiliation: Department of Medicine, University of Padova, Padua, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Piccoli
authors.affiliation: Department of Medicine, University of Padova, Padua, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Codognotto
authors.affiliation: Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.
authors.forename: Luigi Maria
authors.initials: LM
authors.lastname: Castello
authors.affiliation: Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.
authors.forename: Gian Carlo
authors.initials: GC
authors.lastname: Avanzi
authors.affiliation: Department of Cardiology, Fluminense Federal University, Niteroi, RJ, Brazil.|Hospital Unimed Rio, Rio de Janeiro, RJ, Brazil.
authors.forename: Humberto
authors.initials: H
authors.lastname: Villacorta
authors.affiliation: Department of Cardiology, Fluminense Federal University, Niteroi, RJ, Brazil.
authors.forename: Bernardo Luiz Campanário
authors.initials: BLC
authors.lastname: Precht
authors.affiliation: Department of Cardiology, Fluminense Federal University, Niteroi, RJ, Brazil.
authors.forename: Pilar Barreto
authors.initials: PB
authors.lastname: de Araújo Porto
authors.affiliation: Department of Cardiology, Fluminense Federal University, Niteroi, RJ, Brazil.
authors.forename: Aline Sterque
authors.initials: AS
authors.lastname: Villacorta
authors.affiliation: Department of Medical-Surgery Sciences and Translational Medicine, Emergency Medicine, Postgraduate School of Emergency Medicine, University La Sapienza, Via di Grottarossa 1035/1039, 00189, Rome, Italy. salvatore.disomma@uniroma1.it.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Somma
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D004417:Dyspnea / Q000209:etiology; D017097:Electric Impedance / Q000627:therapeutic use*; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000032:analysis* / Q000097:blood; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011379:Prognosis; D011446:Prospective Studies; D012384:Rome; D016019:Survival Analysis
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: Acute heart failure; Bioelectrical impedance vector analysis; Brain natriuretic peptide; Prognosis