Internal and Emergency Medicine

, Volume 12, Issue 4, pp 445–451 | Cite as

Usefulness of combining admission brain natriuretic peptide (BNP) plus hospital discharge bioelectrical impedance vector analysis (BIVA) in predicting 90 days cardiovascular mortality in patients with acute heart failure

  • Simona Santarelli
  • Veronica Russo
  • Irene Lalle
  • Benedetta De Berardinis
  • Silvia Navarin
  • Laura Magrini
  • Antonio Piccoli
  • Marta Codognotto
  • Luigi Maria Castello
  • Gian Carlo Avanzi
  • Humberto Villacorta
  • Bernardo Luiz Campanário Precht
  • Pilar Barreto de Araújo Porto
  • Aline Sterque Villacorta
  • Salvatore Di Somma
  • On Behalf of Great Network
IM - ORIGINAL
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Abstract

Heart failure is a disease characterized by high prevalence and mortality, and frequent rehospitalizations. The aim of this study is to investigate the prognostic power of combining brain natriuretic peptide (BNP) and congestion status detected by bioelectrical impedance vector analysis (BIVA) in acute heart failure patients. This is an observational, prospective, and a multicentre study. BNP assessment was measured upon hospital arrival, while BIVA analysis was obtained at the time of discharge. Cardiovascular deaths were evaluated at 90 days by a follow up phone call. 292 patients were enrolled. Compared to survivors, BNP was higher in the non-survivors group (mean value 838 vs 515 pg/ml, p < 0.001). At discharge, BIVA shows a statistically significant difference in hydration status between survivors and non-survivors [respectively, hydration index (HI) 85 vs 74, p < 0.001; reactance (Xc) 26.7 vs 37, p < 0.001; resistance (R) 445 vs 503, p < 0.01)]. Discharge BIVA shows a prognostic value in predicting cardiovascular death [HI: area under the curve (AUC) 0.715, 95% confidence interval (95% CI) 0.65–0.76; p < 0.004; Xc: AUC 0.712, 95% CI 0.655–0.76, p < 0.007; R: AUC 0.65, 95% CI 0.29–0.706, p < 0.0247]. The combination of BIVA with BNP gives a greater prognostic power for cardiovascular mortality [combined receiving operating characteristic (ROC): AUC 0.74; 95% CI 0.68–0.79; p < 0.001]. In acute heart failure patients, higher BNP levels upon hospital admission, and congestion detected by BIVA at discharge have a significant predictive value for 90 days cardiovascular mortality. The combined use of admission BNP and BIVA discharge seems to be a useful tool for increasing prognostic power in these patients.

Keywords

Acute heart failure Brain natriuretic peptide Bioelectrical impedance vector analysis Prognosis 
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Notes

Acknowledgements

This paper is the result of the work of the GREAT Network team that we thank for its cooperation.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests (financial, political, personal, religious, ideological, academic, intellectual, or any other) to declare in relation to this manuscript.

Statement of human and animal rights

The research protocol was reviewed by the human research Committee from Sant’Andrea Hospital in Rome as coordinating center and it was consequently approved in all participating centers. The study protocol was conform to the ethical guidelines of Declaration of Helsinki.

Informed consent

Informed written consent was obtained from patients before enrollment.

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Copyright information

© SIMI 2016

Authors and Affiliations

  • Simona Santarelli
    • 1
  • Veronica Russo
    • 1
  • Irene Lalle
    • 1
  • Benedetta De Berardinis
    • 1
  • Silvia Navarin
    • 1
  • Laura Magrini
    • 1
  • Antonio Piccoli
    • 2
  • Marta Codognotto
    • 2
  • Luigi Maria Castello
    • 3
  • Gian Carlo Avanzi
    • 3
  • Humberto Villacorta
    • 4
    • 5
  • Bernardo Luiz Campanário Precht
    • 4
  • Pilar Barreto de Araújo Porto
    • 4
  • Aline Sterque Villacorta
    • 4
  • Salvatore Di Somma
    • 1
  • On Behalf of Great Network
  1. 1.Department of Medical-Surgery Sciences and Translational Medicine, Emergency Medicine, Postgraduate School of Emergency MedicineUniversity La SapienzaRomeItaly
  2. 2.Department of MedicineUniversity of PadovaPaduaItaly
  3. 3.Department of Translational MedicineUniversity of Piemonte OrientaleNovaraItaly
  4. 4.Department of CardiologyFluminense Federal UniversityNiteroiBrazil
  5. 5.Hospital Unimed RioRio de JaneiroBrazil

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