Abstract
In the management of Acute Heart Failure(AHF) patients ,current guidelines suggest to make a prompt clinical assessments that include patient’s congestion and perfusion status evaluation, in order to start appropriate treatments. Unfortunately ,so far, an accurate evaluation of haemodynamic and fluid status of AHF patients is only possible using invasive methods ;conseguently there is an unmeet need for noninvasive technologies to easly detect different phenotypes of AHF subjects based on different cardiac haemodynamic profiles . Technological advances such as: Biva,Nexfin or NICas could allow for routine noninvasive continuous monitoring of Cardiac Hemodymanics and Fluid content in Acute Heart Failure patients. These non invasive measurements may provide important information for improving diagnosis, developing individualized therapeutic management plans/disposition decisions and predicting short term mortality
Highlights
Acute heart failure (AHF) is defined as rapid, new-onset, or worsening presentation of the symptoms and signs of heart failure (HF) resulting from any structural or functional impairment of the left ventricle.[1]
In AHF, systemic congestion is both a cause and result of worsening cardiovascular function Being the total body fluid overload the consequence of the activation of the neurohormonal system that causes fluid redistribution and accumulation, increases systemic resistance, and reduces capacitance in large veins. These pathophysiological changes lead to clinical decompensation and are associated with elevations of b-type natriuretic peptides (NP’s).[2]
b-type natriuretic peptide (BNP) is internationally recognized to be associate with increased left ventricle pressure and volume overload, while the hydration index (HI), obtained using Bioimpedance vector analysis (BIVA), is proportional to total body fluid congestion.[15]
Summary
Acute heart failure (AHF) is defined as rapid, new-onset, or worsening presentation of the symptoms and signs of heart failure (HF) resulting from any structural or functional impairment of the left ventricle.[1]. BNP is internationally recognized to be associate with increased left ventricle pressure and volume overload, while the HI, obtained using BIVA, is proportional to total body fluid congestion.[15] As BNP and BIVA data provide information on different aspects of cardiovascular function, their combined measurement may lead to earlier and more accurate AHF diagnosis. This may be especially relevant when the BNP result is in the “gray zone”, between 100 and 400 pg/mL, where it has lower diagnostic accuracy.[16]. NIcas could provide a very good estimation of total body fluid content and could be considered the more appropriate tool for non-invasively evaluating Cardiac hemodynamics and congestion in AHF patients.[27,28,29,30]
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