Body fluid status assessment by bio-impedance analysis in patients presenting to the emergency department with dyspnea.
- Author:
Chan Soon PARK
1
;
Sang Eun LEE
;
Hyun Jai CHO
;
Yong Jin KIM
;
Hyun Jae KANG
;
Byung Hee OH
;
Hae Young LEE
Author Information
- Publication Type:Original Article
- Keywords: Heart failure; Electric impedance; Dyspnea; Natriuretic peptide, brain
- MeSH: Body Composition; Body Fluids*; Body Water; Dyspnea*; Echocardiography; Electric Impedance; Emergencies*; Emergency Service, Hospital*; Heart Failure; Humans; Lower Extremity; Multivariate Analysis; Natriuretic Peptide, Brain; Sensitivity and Specificity; Upper Extremity; Water
- From:The Korean Journal of Internal Medicine 2018;33(5):911-921
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND/AIMS: Fluid retention occurs in patients with heart failure, accounting for dyspnea. We investigated the diagnostic implication of body fluid status, assessed by bio-impedance analysis (BIA), in acute heart failure (AHF) among patients who presented with dyspnea. METHODS: A total of 100 patients who presented with dyspnea and suspected with AHF were analyzed in this study. We enrolled 50 AHF and 50 non-AHF patients discriminated through echocardiographic analysis and Framingham criteria and were matched by age and sex. Body composition was analyzed using a multifrequency BIA. RESULTS: AHF patients demonstrated higher extracellular water (ECW)/total body water (TBW) compared with non-AHF patients (0.412 ± 0.017 vs. 0.388 ± 0.023, p < 0.001). A significant difference of ECW/TBW between AHF patients and nonAHF patients was noted when the upper extremities, trunk, and lower extremities were analyzed (all p < 0.001, respectively). ECW/TBW was not different between patients with reduced ejection fraction (EF) and preserved EF along body compartments. The best cut-off value to predict AHF was > 0.412 at lower extremities with sensitivity and specificity of 0.780 and 0.960. The ECW/TBW of the lower extremities (ECW/TBWL) was correlated with log B-type natriuretic peptide (BNP) levels (r = 0.603, p < 0.001) and also improved the net reclassification improvement and integrated discriminated improvement when added to log BNP level. Multivariate analysis revealed that ECW/TBWL > 0.412 had an independent association with AHF patients (p = 0.011). CONCLUSIONS: The ECW/TBWL was higher in patients with dyspnea caused by AHF than their counterparts and demonstrated an independent diagnostic implication. It may be a promising marker to diagnose AHF at bedside.
