Abstract
Background
Both Framingham criteria and natriuretic peptides (NPs) may worsen their diagnostic
validity for acute decompensated heart failure (ADHF) in elderly patients with comorbidities,
mainly renal failure. Ultrasound of inferior vena cava (IVCu) and bioelectrical impedance
analysis (BIA) are useful tools for detecting ADHF, although their utility compared
with NP is not fully established.
Methods and Results
We conducted a prospective study with 96 patients who presented at the emergency department
with dyspnea and were classified as ADHF and non-ADHF groups. Inferior vena cava ultrasonography
measured maximum and minimum inferior vena cava diameters and collapsibility index
(CIx), whereas BIA calculated resistance (Rz) and reactance (Xc). The primary goal
was to compare amino-terminal pro–B-type NP (NT-proBNP), IVCu, and BIA for identifying
ADHF. The ADHF group showed significantly (P < .001) higher NT-proBNP values (5801 vs 599 pg/mL), higher maximum IVC diameter (2.26
vs 1.58 cm), higher minimum IVC diameter (1.67 vs 0,7 cm), and lower CIx (27% vs 59%),
as well as lower Rz (458.8 vs 627.1 Ohm) and lower Xc (23.5 vs 38.4 Ohm) compared
with the non-ADHF group. The estimated area under the curve for ADHF diagnosis was
0.84 for NT-proBNP, 0.90 for maximum IVC diameter, 0.93 for minimum IVC diameter,
and 0.90 for CIx, as well as 0.83 and 0.80 for Rz and Xc respectively, without finding
significant difference. Cutoff values for diagnosis of ADHF with IVCu and BIA are
proposed. Amino-terminal pro–B-type NP values significantly varied in patients with
renal impairment, independently of ADHF status, whereas neither IVCu nor BIA did.
Conclusions
Inferior vena cava ultrasonography and BIA analysis are as useful as NT-proBNP to
ADHF diagnosis, validated in an elderly population with kidney disease.
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Article Info
Publication History
Published online: June 13, 2016
Accepted:
June 9,
2016
Received in revised form:
June 7,
2016
Received:
February 8,
2016
Footnotes
☆Conflict of interest: None.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
