Abstract 11877: Novel Method to Quantify the Degree of Fluid Accumulation and Its Prognostic Implication in Patients With Acute Decompensated Heart Failure

Abstract

Introduction: Fluid accumulation is an important therapeutic target in acute decompensated heart failure (ADHF). Our objective was to develop a non-invasive and repeatable clinical method to quantify the degree of fluid accumulation in ADHF patients, and investigate its prognostic implications. Methods: We measured extracellular water (ECW) volume using bioelectrical impedance analysis (BIA) in 60 control subjects without heart failure (aged 75±7 years). The reliability of the measured values was assessed through comparisons with ECW estimates from Moore’s regression equations based on multiple isotope dilution. We then developed original regression equations to predict ECW values from multivariate analyses that incorporate patient height, body weight, age and sex. ECW values on admission and at discharge in 120 ADHF patients (aged 73±11 years) were measured, and the ratios of measured to predicted ECW values (M/P ratios) were calculated. The primary endpoint was the occurrence of cardiac death or readmission for ADHF. Results: In the control subjects, BIA-measured ECW values correlated with those estimated by Moore’s equations (r 2 =0.72, p<0.001), and showed even stronger correlations with estimates from our equations (r 2 =0.86, p<0.001). In ADHF patients, measured ECW was significantly reduced during hospitalization (15.4±6.2L to 12.1±4.7L, p<0.001), and M/P ratios were approximately 100% at discharge (126±26% to 104±19%, p<0.001). Patients whose M/P ratios remained higher than 100% at discharge showed higher 3-month cardiac death or readmission rates than patients with lower M/P ratios (50% vs 17%, hazard ratio 3.69; 95% confidence interval 1.935-7.048, p<0.001). Conclusions: We successfully quantified the degree of fluid accumulation using BIA, and the predicted ECW estimates from our regression equations can be a treatment goal in ADHF patients. This BIA-guided therapy may provide better clinical outcomes in the management of ADHF.