Heart & lung : the journal of critical care · 2020
Congestion and nutrition as determinants of bioelectrical phase angle in heart failure.
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Scicchitano Pietro, Ciccone Marco Matteo, Passantino Andrea, Valle Roberto, De Palo Micaela, Sasanelli Paolo, Sanasi Mariella, Piscopo Assunta, Guida Piero, Caldarola Pasquale, Massari Francesco
Аннотация
BACKGROUND: The whole-body bioelectrical phase-angle (PhA) is emerging as a new tool in stratifying prognosis in patients with both acute (AHF) and chronic heart failure (CHF).
OBJECTIVE: To evaluate the determinants of PhA in HF patients.
METHODS: We analyzed data from 900 patients with AHF or CHF (mean age: 76±10 years, 54% AHF). Clinical, serum biochemical, echocardiographic and bioelectrical measurements were collected from all of patients. PhA was quantified in degrees. Congestion was assessed by a multiparametric approach, including the presence of peripheral edema, brain natriuretic peptides (BNP) plasma levels, blood urea nitrogen to creatinine ratio (BUN/Cr), and relative plasma volume status (PVS) calculated by Kaplan-Hakim's formula. Geriatric Nutritional Risk Index (GNRI) was adopted as indicator for nutritional status.
RESULTS: At univariate analysis, PhA was significantly lower in females, in patients with peripheral edema, and AHF. PhA significantly correlates age, BNP, PVS, BUN/Cr, and GNRI. At multivariate analysis, congestion biomarkers emerged as the major determinant of PhA as they explained the 34% of data variability, while age, GNRI, and gender only explained 6%, 0.5%, and 0.5%, respectively (adjusted R2 = 0.41). In particular, PVS (regression of coefficient B=-0.17) explained the 20% of PhA variability, while peripheral congestion (B=-0.27) and BNP (B=-0.15) contributed to 10% and 2%, respectively.
CONCLUSIONS: The main determinant of bioelectrical PhA in patients with HF is congestion and PVS in particular, while nutritional status has marginal impact.
OBJECTIVE: To evaluate the determinants of PhA in HF patients.
METHODS: We analyzed data from 900 patients with AHF or CHF (mean age: 76±10 years, 54% AHF). Clinical, serum biochemical, echocardiographic and bioelectrical measurements were collected from all of patients. PhA was quantified in degrees. Congestion was assessed by a multiparametric approach, including the presence of peripheral edema, brain natriuretic peptides (BNP) plasma levels, blood urea nitrogen to creatinine ratio (BUN/Cr), and relative plasma volume status (PVS) calculated by Kaplan-Hakim's formula. Geriatric Nutritional Risk Index (GNRI) was adopted as indicator for nutritional status.
RESULTS: At univariate analysis, PhA was significantly lower in females, in patients with peripheral edema, and AHF. PhA significantly correlates age, BNP, PVS, BUN/Cr, and GNRI. At multivariate analysis, congestion biomarkers emerged as the major determinant of PhA as they explained the 34% of data variability, while age, GNRI, and gender only explained 6%, 0.5%, and 0.5%, respectively (adjusted R2 = 0.41). In particular, PVS (regression of coefficient B=-0.17) explained the 20% of PhA variability, while peripheral congestion (B=-0.27) and BNP (B=-0.15) contributed to 10% and 2%, respectively.
CONCLUSIONS: The main determinant of bioelectrical PhA in patients with HF is congestion and PVS in particular, while nutritional status has marginal impact.