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PROGNOSTIC IMPACT OF RESIDUAL CONGESTION ESTIMATED BY BIOIMPEDANCE IN HEART FAILURE
Session:
Comunicações Orais - Sessão 08 - Insuficiência cardíaca: da clínica aos dispositivos
Speaker:
Bruno Bragança
Congress:
CPC 2024
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Bruno Bragança; Inês G. Campos; Rafaela G. Lopes; Mauro Moreira; Ricardo Barbosa; Patrícia Silva; Sónia Apolinário; Licínia Aguiar; Magda Silva; Aurora Andrade
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Background:</span></strong><span style="font-family:"Arial",sans-serif"> Optimal decongestion is of utmost importance to the hospitalization recovering process from a heart failure (HF) decompensation event. Persistence of residual congestion despite continued therapy builds up relentlessly during the worsening of HF. Clinical examination and biomarkers often miss identifying residual congestion in HF<sup>1</sup>. Thus, we explore the prognosis of residual congestion assessed by bioimpedance spectroscopy (BIS) in HF patients. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Methods: </span></strong><span style="font-family:"Arial",sans-serif">A single-center prospective observational study recruited adult outpatients with ongoing or previous HF with reduced ejection fraction (HFrEF) for characterization of body’s composition by multi-frequency BIS (InBody BWA 2.0). Residual congestion was defined as the ratio between extracellular fluid (ECF) and total body water (ECF/TBW) above 38.6% with no evidence of congestion signs by physical examination assessed by cardiologists blinded for BIS data<sup>2</sup>. The primary outcome was a composite of all-cause death, hospitalization or unplanned visit and, up-titration of diuretics due to HF decompensation. </span><span style="font-family:"Arial",sans-serif">Logistic and Cox regression models were used in time-to-event analysis. Data presented as mean ± standard deviation; 95% confidence interval (CI) for hazard ratios (HR) adjusted to potential confounders; <em>p</em><0.05 was significant.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Results: </span></strong><span style="font-family:"Arial",sans-serif">A total of 56 patients were included in this study with a mean age of 65±12 years; 68% males; 52% non-ischemic HFrEF; 38% diabetes; 57% hypertension; 84% dyslipidemia; 74% chronic kidney disease. The mean ECF/TWB was 39.1±1.7%; 42% patients had residual congestion, while 28% were euvolemic at baseline. During the mean follow-up time of 6±1 months the primary outcome occurred in 34% patients (2 deaths, 10 HF hospitalizations/unplanned visits, and up-titration of diuretics in 13 outpatients). In time-to-event analysis, residual congestion was independently associated with the primary outcome after adjusting for sex, age, and cardiovascular risk factors (HR 6.92; 1.01-47.28; <em>p</em>=0.048). </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Conclusions:</span></strong><span style="font-family:"Arial",sans-serif"> BIS is a simple and reliable non-invasive technology that improves detection of residual congestion. Residual congestion estimated by BIS is independently associated with a worse prognosis in HF patients. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:8.0pt"><span style="font-family:"Arial",sans-serif">1 - SJ Green, et al., JACC Heart Failure, 2021 | 2 - A. Ambrosy, et al. European Heart Journal, 2013</span></span></span></span></p>
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