Bioelectrical impedance vector analysis (BIVA) in stable and non-stable heart failure patients: A pilot study

Abstract

Heart failure (HF) patients have a high morbidity and mortality and often require numerous visits and hospital readmissions related to fluid retention [ [1] Gonseth J. Guallar-Castillon P. Banegas J.R. Rodriguez-Artalejo F. The effectiveness of disease management programmes in reducing hospital re-admission in older patients with heart failure: a systematic review and meta-analysis of published reports. Eur Heart J. 2004; 18: 1570-1595 Crossref Scopus (366) Google Scholar ]. Biompedance is a method of body composition analysis studied in HF in different ways such as impedance cardiography [ [2] Thompson B. Drazner M.H. Dries D.L. Yancy C.W. Systolic time ratio by impedance cardiography to distinguish preserved vs impaired left ventricular systolic function in heart failure. Congest Heart Fail. 2008; 14: 261-265 Crossref PubMed Scopus (16) Google Scholar ] or as a home monitoring method in telemedicine systems [ [3] Radai M.M. Arad M. Zlochiver S. Krief H. Engelman T. Abboud S. A novel telemedicine system for monitoring congestive heart failure patients. Congest Heart Fail. 2008; 14: 239-244 Crossref PubMed Scopus (8) Google Scholar ], but little data exist about the analysis of the components of the impedance vector (BIVA-Bioimpedance Vector Analysis-) in HF. The result of a measurement using bioelectrical impedance is a vector (Z vector) in which the opposition of an alternating current flow through intra- and extra-cellular ionic solutions is resistance (R), and the capacitance of biological tissues, is reactance (Xc). The arc tangent of the vector is the phase angle (PA) [ [4] Grimnes S. Martinsen Ø.G. Bioimpedance and bioelectricity basics. in: Academic Press, London2000: 114-115 Google Scholar ]. BIVA is a validated method where the components of the impedance vector are normalized by the height (H) of the subjects (R/H and Xc/H) [ [5] Piccoli A. Pastori G. BIVA software. Department of Medical and Surgical Sciences, University of Padova, Italy2002 Google Scholar ]. They are represented on confidence and tolerance ellipses in an RXc-graph [ [6] Piccoli A. Rossi B. Pillon L. Bucciante G. A new method for monitoring body fluid variation by bioimpedance analysis: the RXc graph. Kidney Int. 1994; 46: 534-539 Crossref PubMed Scopus (502) Google Scholar ] separated by gender [ 7 Piccoli A. Nigrelli S. Caberlotto A. Bivariate normal values of the bioelectrical impedance vector in adult and elderly populations. Am J Clin Nutr. 1995; 61: 269-270 PubMed Google Scholar , 8 Piccoli A. Pillon L. Dumler F. Impedance vector distribution by sex, race, body mass index, and age in the United States: standard reference intervals as bivariate Z scores. Nutrition. 2002; 18: 156-170 Google Scholar ]. Many populations have already been characterized by BIVA [ 7 Piccoli A. Nigrelli S. Caberlotto A. Bivariate normal values of the bioelectrical impedance vector in adult and elderly populations. Am J Clin Nutr. 1995; 61: 269-270 PubMed Google Scholar , 8 Piccoli A. Pillon L. Dumler F. Impedance vector distribution by sex, race, body mass index, and age in the United States: standard reference intervals as bivariate Z scores. Nutrition. 2002; 18: 156-170 Google Scholar , 9 Piccoli A. Fanos V. Peruzzi L. et al. Reference values of the bioelectical impedance vector in neonates in the first week after birth. Nutrition. 2002; 18: 17-21 Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar , 10 De Palo T. Messina G. Edefonti A. et al. Normal values of the bioelectrical impedance vector in childhood and puberty. Nutrition. 2000; 16: 417-424 Abstract Full Text Full Text PDF PubMed Scopus (74) Google Scholar , 11 Piccoli A. Brunani A. Savia G. Discriminating between body fat and fluid changes in the obese adult using bioimpedance vector analysis. Int J Obes. 1998; 22: 97-104 Crossref PubMed Scopus (128) Google Scholar , 12 Nescolarde L. Piccoli A. Doñate T. Rosell J. Bioelectrical impedance vector analysis in haemodialysis patients: relation between oedema and mortality. Physiol Meas. 2004; 25: 1271-1280 Crossref PubMed Scopus (63) Google Scholar , 13 Nescolarde L. Doñate T. Piccoli A. Rosell J. Comparison of segmental with whole-body impedance measurements in peritoneal dialysis patients Med. Eng Phys. 2008; 30: 817-824 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar , 14 Toso S. Piccoli A. Gusella M. Menon D. Bononi A. Crepaldi G. Altered tissue electric properties in lung cancer patients as detected by bioelectric impedance vector analysis. Nutrition. 2000; 16: 120-124 Abstract Full Text Full Text PDF PubMed Scopus (160) Google Scholar ], but little data exist in HF. The aim of this pilot study was to assess the usefulness of BIVA in assessing the hydration state in stable and non-stable HF patients.