Smeets Christophe J P, Lee Seulki, Groenendaal Willemijn, Squillace Gabriel, Vranken Julie, De Cannière Hélène, Van Hoof Chris, Grieten Lars, Mullens Wilfried, Nijst Petra, Vandervoort Pieter M
Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
Connected Health Solutions, Holst Centre/Interuniversity Microelectronics Center The Netherlands, Eindhoven, Netherlands.
JMIR Cardio. 2020 Mar 18;4(1):e12141. doi: 10.2196/12141.
Incomplete relief of congestion in acute decompensated heart failure (HF) is related to poor outcomes. However, congestion can be difficult to evaluate, stressing the urgent need for new objective approaches. Due to its inverse correlation with tissue hydration, continuous bioimpedance monitoring might be an effective method for serial fluid status assessments.
This study aimed to determine whether in-hospital bioimpedance monitoring can be used to track fluid changes (ie, the efficacy of decongestion therapy) and the relationships between bioimpedance changes and HF hospitalization and all-cause mortality.
A wearable bioimpedance monitoring device was used for thoracic impedance measurements. Thirty-six patients with signs of acute decompensated HF and volume overload were included. Changes in the resistance at 80 kHz (R) were analyzed, with fluid balance (fluid in/out) used as a reference. Patients were divided into two groups depending on the change in R during hospitalization: increase in R or decrease in R. Clinical outcomes in terms of HF rehospitalization and all-cause mortality were studied at 30 days and 1 year of follow-up.
During hospitalization, R increased for 24 patients, and decreased for 12 patients. For the total study sample, a moderate negative correlation was found between changes in fluid balance (in/out) and relative changes in R during hospitalization (rs=-0.51, P<.001). Clinical outcomes at both 30 days and 1 year of follow-up were significantly better for patients with an increase in R. At 1 year of follow-up, 88% (21/24) of patients with an increase in R were free from all-cause mortality, compared with 50% (6/12) of patients with a decrease in R (P=.01); 75% (18/24) and 25% (3/12) were free from all-cause mortality and HF hospitalization, respectively (P=.01). A decrease in R resulted in a significant hazard ratio of 4.96 (95% CI 1.82-14.37, P=.003) on the composite endpoint.
The wearable bioimpedance device was able to track changes in fluid status during hospitalization and is a convenient method to assess the efficacy of decongestion therapy during hospitalization. Patients who do not show an improvement in thoracic impedance tend to have worse clinical outcomes, indicating the potential use of thoracic impedance as a prognostic parameter.
急性失代偿性心力衰竭（HF）中充血缓解不完全与不良预后相关。然而，充血情况可能难以评估，这凸显了对新的客观评估方法的迫切需求。由于其与组织水化呈负相关，连续生物阻抗监测可能是一种用于系列评估液体状态的有效方法。
本研究旨在确定住院期间的生物阻抗监测是否可用于追踪液体变化（即去充血治疗的疗效）以及生物阻抗变化与HF住院和全因死亡率之间的关系。
使用可穿戴生物阻抗监测设备测量胸部阻抗。纳入36例有急性失代偿性HF体征和容量超负荷的患者。分析80kHz时电阻（R）的变化，并以液体平衡（液体出入量）作为参考。根据住院期间R的变化将患者分为两组：R增加组或R减少组。在随访30天和1年时研究HF再住院和全因死亡率方面的临床结局。
住院期间，24例患者的R增加，12例患者的R减少。对于整个研究样本，发现住院期间液体平衡（出入量）变化与R的相对变化之间存在中度负相关（rs=-0.51，P<.001）。R增加的患者在随访30天和1年时的临床结局均明显更好。在随访1年时，R增加的患者中有88%（21/24）无全因死亡，而R减少的患者中这一比例为50%（6/12）（P=0.01）；分别有75%（18/24）和25%（3/12）无全因死亡和HF住院（P=0.01）。R降低导致复合终点的显著风险比为4.96（95%CI 1.82-14.37，P=0.003）。
可穿戴生物阻抗设备能够追踪住院期间的液体状态变化，是评估住院期间去充血治疗疗效的便捷方法。胸部阻抗未改善的患者往往临床结局更差，这表明胸部阻抗有可能作为一个预后参数。
