SPC365

PHENOTYPING HEART FAILURE PATIENTS WITH SUBCLINICAL CONGESTION

Session: Sessão de Posters 18 - Insuficiência cardíaca - Fatores preditores
Speaker: Bruno Bragança

Congress: CPC 2024
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.6 Chronic Heart Failure - Clinical
Session Type: Cartazes
FP Number: ---
Authors: Bruno Bragança; Rafaela G. Lopes; Mauro Moreira; Inês G. Campos; Ricardo Barbosa; Licínia Aguiar; Sónia Apolinário; Patrícia Silva; Magda Silva; Aurora Andrade

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif">Background:</span></strong><span style="font-family:&quot;Arial&quot;,sans-serif"> Achieving sustained euvolemia is the main goal to improve symptoms in heart failure (HF) patients. Insidious increase of interstitial fluid that precedes HF decompensation is often missed from clinical examination with a negative impact on the patient&rsquo;s prognosis and health costs<sup>1</sup>. Despite the advances in the assessment of subclinical congestion with new biomarkers and imaging techniques, failure to identify subclinical congestion remains a problem in the daily management of HF patients<sup>2</sup>. </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:&quot;Arial&quot;,sans-serif">Methods: </span></strong><span style="font-family:&quot;Arial&quot;,sans-serif">Fifty-six adult outpatients under guideline-directed medical therapy for HF with reduced ejection fraction (HFrEF) included in a single-center prospective study underwent comprehensive characterization of body&rsquo;s composition by multi-frequency bioimpedance spectroscopy (BIS, InBody BWA 2.0). BIS parameters were correlated with clinical, biochemical, and echocardiographic data. Subclinical hypervolemia was defined as a raised extracellular fluid (ECF) adjusted to total body water (ECF/TBW) above 38.6% (1<sup>st</sup> quartile) despite the absence of congestion signs by EVEREST score<sup>3</sup>. Clinical evaluation of HF patients was blinded for BIS data. Data is presented as mean&plusmn;sd.</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:&quot;Arial&quot;,sans-serif">Results: </span></strong><span style="font-family:&quot;Arial&quot;,sans-serif">Hypervolemia was identified in 37 patients (66%), with 29 patients of them (52%) having no evidence of clinical congestion. NT-proBNP levels were significantly lower in euvolemic (EUV) than in subclinical (SUB) congestion group (476&plusmn;509 vs 4490&plusmn;6908pg/mL, <em>p</em>=0.037); left ventricular ejection fraction was equivalent between these two groups (36&plusmn;19 vs 34&plusmn;10%). In comparison with EUV patients, SUB patients were older (71&plusmn;10 vs 58&plusmn;9&nbsp; years, <em>p</em>&lt;0.001); had a higher prevalence of diabetes (52 vs 16%, <em>p</em>=0.012), hypertension (72 vs 42%, <em>p</em>=0.036), coronary artery disease (16 vs 5%, <em>p</em>=0.049); and also lower levels of hemoglobin (13.4&plusmn;1.5 vs 14.6&plusmn;1.8 g/dL, <em>p</em>=0.023). Regarding other clinical variables of interest, no significant differences were identified between EUV and SUB groups for sex, chronic kidney disease, serum sodium or blood urea nitrogen. In segmental body composition analysis, SUB patients exhibited both lower fat-free mass (50.6&plusmn;10 vs 56.6&plusmn;10 kg, <em>p</em>=0.044) and skeletal muscle mass (27.1&plusmn;5.5 vs 31.8&plusmn;6.1 kg, <em>p</em>=0.009) in comparison with EUV patients, with no differences being found for body mass index (27.0&plusmn;3.8 vs 28.0&plusmn;3.9 kg/m2, <em>p</em>=0.37) or body fat mass (21.8&plusmn;8.2 vs 23.2&plusmn;10 kg/m2, <em>p</em>=0.60).&nbsp;&nbsp; </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">&nbsp;</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:&quot;Arial&quot;,sans-serif">Conclusions:</span></strong><span style="font-family:&quot;Arial&quot;,sans-serif"> Older and metabolic unhealthy patients with low muscle mass characterize the phenotype with a higher prevalence of subclinical congestion. A careful and multimodal evaluation of this patient&rsquo;s phenotype will possibly improve the detection of hypervolemia and avoid HF decompensation.</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:&quot;Arial&quot;,sans-serif">1 - A Lala, et al., Circulation Heart Failure, 2015 | 2 - W. Mullens, et al. European Journal of Heart Failure, 2019 &nbsp;| 3 - A. Ambrosy, et al. European Heart Journal, 2013</span></span></span></span></p>