Abstract 12552: A Novel Predictor of Weight Change During Hospitalization in Patients With Acute Heart Failure Syndromes in the Emergency Department

Abstract

Introduction: Recent data showed acute heart failure syndromes (AHFS) could occur without weight gain, and often be triggered by rather a redistribution of fluids to the lungs without systemic congestion. In this subtype of AHFS, excessive diuretic and vasodilator therapy as first-line decongestion therapy in the emergency department (ED) may lead to dehydration and hypotension, subsequently resulting in serous organ hypoperfusion. Therefore, an accurate assessment of body fluid status is essential in AHFS. Methods: We studied 196 consecutive AHFS patients (77±12 years, 54% men, left ventricular ejection fraction 37±15%), who discharged after restoration of clinical stability (length of hospital stay 18±8 days). We collected clinical, laboratory, imaging and weight information. Measurements of total body water (TBW) and extracellular water (ECW) using bio-impedance analysis (BIA) were performed immediately at admission to the ED. Patients were divided into 2 groups according to the median % weight change (%WC) during hospitalization. Results: Weight and brain natriuretic peptide levels significantly decreased following decongestion therapy (from 59.0±14.3 to 52.9±12.9 kg, and from 779 [508-1289] to 285 [151-547] pg/ml, respectively, both p<0.001). High-%WC group (≥9.4%) had lower systolic blood pressure (159±35 vs. 171±40 mmHg), and higher prevalence of day-time admission (79 vs. 54%), peripheral edema (82 vs. 43%) and pleural effusion on chest radiography (88 vs. 71%), and larger inferior vena cava diameter (20±5 vs. 17±5 mm) and lower tricuspid annular plane systolic excursion (14±4 vs. 16±4 mm) on echocardiography, and higher estimated glomerular filtration rate (eGFR) (58±29 vs. 46±21 ml/min/1.73m2), lower serum total protein level (6.5±0.6 vs. 6.8±0.7 g/dl), and higher ECW/TBW (0.423±0.015 vs. 0.405±0.013) compared with low-%WC group (p<0.01 for all). Multiple linear regression analysis revealed that pleural effusion, eGFR, and ECW/TBW were significantly associated with %WC. ECW/TBW correlated most strongly with %WC (r=0.61, p<0.0001). Conclusions: ECW/TBW helps enable emergency physicians to implement goal-directed treatment more rapidly and appropriately avoiding both dehydration and volume retention in AHFS.