Comprehensive assessment of the hydration status in patients with acute decompensated heart failure: clinical associations and prognostic significance

Vatsik-Gorodetskaya M.V.: Peoples' Friendship University of Russia (RUDN), Vinogradov City Clinical Hospital, Moscow, Russia

Tolkacheva V.: Russian People’s Friendship University (RUDN University), Moscow, Russia

Cabello Montoya Flora E.: Peoples' Friendship University of Russia (RUDN), Moscow

Sarlykov B.: Russian People’s Friendship University (RUDN University), Moscow, Russia

Nazarov L.: Russian People’s Friendship University (RUDN University), Moscow, Russia

Galochkin S.: Russian People’s Friendship University (RUDN University), Moscow, Russia

Khutsishvili N.: Russian People’s Friendship University (RUDN University), Moscow, Russia

Diane M.L.: Peoples’ Friendship University of Russia (RUDN), Moscow, Russia

Kobalava Zh.D.: Peoples Friendship University of Russia (PFUR), Vinogradov City Clinical Hospital, Moscow, Russia

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Summary

Aim

To evaluate the clinical and prognostic significance of a comprehensive assessment of the hydration status in patients with acute decompensation of chronic heart failure (ADCHF).

Material and methods

This single-center prospective study included 171 hospitalized patients with ADCHF. All patients underwent a standard physical exam, laboratory and instrumental investigations (NT-proBNP levels, lung ultrasound, transient elastography, bioimpedance vector analysis [BIVA]) on admission and at discharge. Clinical congestion was assessed in accordance with the HFA consensus document. The long-term clinical outcomes were evaluated by a structured telephone survey 1, 3, 6, 12 months after discharge. The combined rate of all-cause mortality and readmissions was used as the study endpoint.

Results

According to a comprehensive assessment (four methods) the state of euvolemia on standard therapy was achieved in 12% of patients, whereas subclinical and residual congestion persisted in 31% and 57% of patients, respectively. NT-proBNP>2336 pg/ml, the B lines count >5, liver density>9,7 kPa and impedance Z ≤479 Оm/m were independent predictors of death or re-admission. There was a significant increase in the risk of adverse outcomes in patients with congestion detected by two, three and four methods. Combinations of two methods (lung ultrasound + indirect fibroelastometry), three methods (lung ultrasound + indirect fibroelastometry + NT-proBNP) and in particular all four methods had the highest predictive values.

Conclusion

A comprehensive assessment of residual and subclinical congestion at discharge from the hospital is recommended for patients hospitalized with ADCHF. The implementation of an integrated assessment of congestion into routine practice will allow to identify a group of patients with high risk of death and repeated hospitalization who require intensified drug therapy and monitoring.

Key words

Acute decompensation of chronic heart failure, subclinical congestion, residual clinical congestion, comprehensive assessment of congestion.