Multi-frequency bioimpedance analysis in acute decompensated heart failure: changes following hemodynamic stabilisation
M Winiarczyk, E Dziewiecka, K Graczyk, N Przytula, A Stepien-Wroniecka, J Wozniak, N Kapczynski, P RubisAbstract
Background/Introduction
Acute decompensated heart failure (ADHF) is characterized by fluid retention and redistribution between body compartments. Clinical assessment of fluid status remains challenging. Bioimpedance analysis (BIA) offers non-invasive, real-time quantification of body fluid distribution. Its utility in detecting fluid shifts during ADHF management has not been thoroughly evaluated.
Purpose
To assess changes in bioimpedance analysis parameters during acute heart failure decompensation and compensation.
Methods
Multi-frequency BIA was performed using BodyStat Quadscan 4000 device in 60 ADHF patients (age 69 [58; 79] years, NYHA class 3 [2; 4], left ventricular ejection fraction 40 [23; 50]%, and NTproBNP 3159 [1215; 6566] pg/ml) at hospital admission (decompensated state) and at discharge (after haemodynamic stabilization). Total body water (TBW), extracellular water (ECW), intracellular water (ICW), and illness marker (impedance ratio 200 kHz/5 kHz) were recorded. Additionally, lung ultrasound B-lines sum (8-zone protocol), right ventricular systolic pressure (RVSP), and inferior vena cava dimension (IVC) were assessed. Paired statistical analysis was used to compare measurements between admission and discharge.
Results
Significant changes in all bioimpedance analysis parameters were observed between admission and discharge. Total body water decreased from 56.5 [50.0; 65.3] to 53.8 [48.3; 59.4] L (p<0.001). Extracellular water significantly reduced from 19.75 [17.9; 21.7] to 17.35 [15.7; 19.6] L (p<0.001), while intracellular water decreased from 23.25 [20.4; 27.1] to 21.9 [19.2; 25.6] L (p<0.001). Illness marker improved from 0.845 [0.819; 0.863] to 0.45 [-0.4; 1.25] (p<0.001). Concurrent improvements were noted in clinical surrogate markers: lung ultrasound B-lines sum (20 [12; 34] to 3 [0; 9], p<0.001), right ventricular systolic pressure (30 [22; 42] to 22.5 [20; 30] mmHg, p=0.007), and inferior vena cava (25 [22; 29] to 20 [17; 23.5] mm, p<0.001). Bioimpedance parameters showed significant correlation (Table 2) with both B-lines sum (r=0.35–0.41 for total, intracellular and extracellular water) and body weight (r=0.61–0.83 for all fluid compartments), with stronger weight correlations at discharge, confirming that measured fluid shifts corresponded to clinical improvement and objective weight reduction.
Conclusion
Bioimpedance analysis demonstrates significant utility in quantifying fluid redistribution during acute heart failure management. The consistent correlation between BIA parameters and pulmonary congestion markers validates BIA as an objective measure of fluid status changes. These findings support further investigation of BIA's role in guiding diuretic therapy optimization and predicting treatment response in ADHF.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.