Predictive value of the integral assessment of congestion in patients with chronic heart failure
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| Format: | Artículo científico |
| Langue: | en |
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Sociedad Latinoamericana de Hipertensión
2022
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| _version_ | 1876431940966416384 |
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| author | Z. Kobalava |
| author_facet | Z. Kobalava |
| contents | Predictive value of the integral assessment of congestion in patients with chronic heart failure Z. Kobalava V. Tolkacheva F. Cabello-Montoya B. Sarlykov S. Galochkin Medicina NT BIVA proBNP survival prognosis Purpose: to assess the predictive value of NT-proBNP, В-lines according to ultrasound of the lungs, liver density according to indirect elastometry, reactance according to bioimpedance vector analysis (BIVA), performed at discharge from the hospital in patients with chronic heart failure (H.F.), on survival rates (overall mortality and readmission). Material and methods: the study included 105 patients (72% men, mean age 66.5 ± 11.5 years) with CHF. Arterial hypertension in the anamnesis had 94%, coronary heart disease - 60%, type 2 diabetes mellitus - 40% of patients. All patients underwent the following research: NT-proBNP, Ultrasound of the lungs (B-lines, 8 zones), liver density according to indirect elastometry, reactance according to bioimpedance vector analysis (BIVA) at discharge. Longterm clinical outcomes were assessed using a structured telephone survey method 1,3,6,12 months after discharge. The combined overall mortality and readmission rates were assessed as an endpoint. Threshold values were calculated for different methods for detecting congestion - the number of B lines according to ultrasound data> 5, NTproBNP> 3465 pg/mL, liver density (> 9.2 kPa), reactance according to BIVA data 23.8. Results: Identified 46 (44%) endpoints, 19 (18%) deaths within 190 days (IQR: 161-246). Significant direct associations of the NT-proBNP index with the number of B-lines according to lung ultrasound (r = 0.3; p <0.001), liver density (r = 0.2; p = 0.014) according to indirect elastometry and inverse with reactance were shown according to BIVA (r = -0.2; p = 0.01), as well as liver density and reactive resistance (BIVA) (r = -0.4; p <0.001). NT-proBNP level, the number of B-lines according to lung ultrasound, and liver density were significantly higher, and the reactance value was significantly lower in patients with endpoints. Cox univariate regression analysis demonstrated independent predictive value for the cumulative endpoint of all congestion markers assessed by different methods such as NT-proBNP, pulmonary ultrasound, indirect elastometry, and BIVA. Cox Multivariate Regression Analysis Confirmed Independent Predictive Significance for the Potential Endpoint Risk for the following - Reactance (HR 2,4 (1,1-5) p=0,016), the number of B-lines by ultrasound of the lungs (HR 2.1 (1.1-4.0), p = 0.015), NT-proBNP (HR 2.0 (1.0-4.1), p = 0.043). There was a significant increase in the risk of overall mortality in the presence of congestion, identified by three (RR 4.4 (1.2-16.6), p = 0.02) and four methods (RR 12.0 (3.4-41.7), p <0.001). Conclusion: NT-proBNP levels, the number of B lines by ultrasound of the lungs, liver density and reactive resistance according to the BIVA, performed at discharge from the hospital in patients with chronic heart failure, have an independent prognostic value, while the prognostic role of assessing the reactance according to the BIVA had maximum input. 2022 artículo científico 1856-4550 https://www.redalyc.org/articulo.oa?id=170278835002 en http://www.redalyc.org/revista.oa?id=1702 Revista Latinoamericana de Hipertensión application/pdf Sociedad Latinoamericana de Hipertensión Revista Latinoamericana de Hipertensión (República Bolivariana de Venezuela) Num.2 Vol.17 |
| format | Artículo científico |
| id | redalyc_170278835002 |
| institution | Redalyc |
| language | en |
| publishDate | 2022 |
| publisher | Sociedad Latinoamericana de Hipertensión |
| spellingShingle | Predictive value of the integral assessment of congestion in patients with chronic heart failure Z. Kobalava Medicina NT BIVA proBNP survival prognosis Predictive value of the integral assessment of congestion in patients with chronic heart failure Z. Kobalava V. Tolkacheva F. Cabello-Montoya B. Sarlykov S. Galochkin Medicina NT BIVA proBNP survival prognosis Purpose: to assess the predictive value of NT-proBNP, В-lines according to ultrasound of the lungs, liver density according to indirect elastometry, reactance according to bioimpedance vector analysis (BIVA), performed at discharge from the hospital in patients with chronic heart failure (H.F.), on survival rates (overall mortality and readmission). Material and methods: the study included 105 patients (72% men, mean age 66.5 ± 11.5 years) with CHF. Arterial hypertension in the anamnesis had 94%, coronary heart disease - 60%, type 2 diabetes mellitus - 40% of patients. All patients underwent the following research: NT-proBNP, Ultrasound of the lungs (B-lines, 8 zones), liver density according to indirect elastometry, reactance according to bioimpedance vector analysis (BIVA) at discharge. Longterm clinical outcomes were assessed using a structured telephone survey method 1,3,6,12 months after discharge. The combined overall mortality and readmission rates were assessed as an endpoint. Threshold values were calculated for different methods for detecting congestion - the number of B lines according to ultrasound data> 5, NTproBNP> 3465 pg/mL, liver density (> 9.2 kPa), reactance according to BIVA data 23.8. Results: Identified 46 (44%) endpoints, 19 (18%) deaths within 190 days (IQR: 161-246). Significant direct associations of the NT-proBNP index with the number of B-lines according to lung ultrasound (r = 0.3; p <0.001), liver density (r = 0.2; p = 0.014) according to indirect elastometry and inverse with reactance were shown according to BIVA (r = -0.2; p = 0.01), as well as liver density and reactive resistance (BIVA) (r = -0.4; p <0.001). NT-proBNP level, the number of B-lines according to lung ultrasound, and liver density were significantly higher, and the reactance value was significantly lower in patients with endpoints. Cox univariate regression analysis demonstrated independent predictive value for the cumulative endpoint of all congestion markers assessed by different methods such as NT-proBNP, pulmonary ultrasound, indirect elastometry, and BIVA. Cox Multivariate Regression Analysis Confirmed Independent Predictive Significance for the Potential Endpoint Risk for the following - Reactance (HR 2,4 (1,1-5) p=0,016), the number of B-lines by ultrasound of the lungs (HR 2.1 (1.1-4.0), p = 0.015), NT-proBNP (HR 2.0 (1.0-4.1), p = 0.043). There was a significant increase in the risk of overall mortality in the presence of congestion, identified by three (RR 4.4 (1.2-16.6), p = 0.02) and four methods (RR 12.0 (3.4-41.7), p <0.001). Conclusion: NT-proBNP levels, the number of B lines by ultrasound of the lungs, liver density and reactive resistance according to the BIVA, performed at discharge from the hospital in patients with chronic heart failure, have an independent prognostic value, while the prognostic role of assessing the reactance according to the BIVA had maximum input. 2022 artículo científico 1856-4550 https://www.redalyc.org/articulo.oa?id=170278835002 en http://www.redalyc.org/revista.oa?id=1702 Revista Latinoamericana de Hipertensión application/pdf Sociedad Latinoamericana de Hipertensión Revista Latinoamericana de Hipertensión (República Bolivariana de Venezuela) Num.2 Vol.17 |
| title | Predictive value of the integral assessment of congestion in patients with chronic heart failure |
| topic | Medicina NT BIVA proBNP survival prognosis |
| url | https://www.redalyc.org/articulo.oa?id=170278835002 |