Clinical Application of Phase Angle and BIVA Z-Score Analyses in Patients Admitted to an Emergency Department with Acute Heart Failure

Summary

In this protocol, we explain how to obtain and interpret phase angle values and bioelectrical impedance vectorial analysis (BIVA) Z-score obtained by bioelectrical impedance in patients with acute heart failure admitted to the Emergency Department and their clinical applicability as a predictive marker for the prognosis of a 90-day event.

Abstract

Acute heart failure is characterized by neurohormonal activation, which leads to sodium and water retention and causes alterations in body composition, such as increased body fluid congestion or systemic congestion. This condition is one of the most common reasons for hospital admission and has been associated with poor outcomes. The phase angle indirectly measures intracellular status, cellular integrity, vitality, and the distribution of spaces between intracellular and extracellular body water. This parameter has been found to be a predictor of health status and an indicator of survival and other clinical outcomes. In addition, phase angle values of <4.8° upon admission were associated with higher mortality in patients with acute heart failure. However, low phase angle values may be due to alterations-such as the shifting of fluids from an intracellular body water (ICW) compartment to an ECW (extracellular body water) compartment and a concurrent decrease in body-cell mass (which can reflect malnutrition)-that are present in heart failure. Thus, a low phase angle may be due to overhydration and/or malnutrition. BIVA provides additional information about the body-cell mass and congestion status with a graphical vector (R-Xc graph). In addition, a BIVA Z-score analysis (the number of standard deviations from the mean value of the reference group) that has the same pattern as that of the ellipses for the percentiles on the original R-Xc graph can be used to detect changes in soft-tissue mass or tissue hydration and can help researchers compare changes in different study populations. This protocol explains how to obtain and interpret phase angle values and BIVA Z-score analyses, their clinical applicability, and their usefulness as a predictive marker for the prognosis of a 90-day event in patients admitted to an emergency department with acute heart failure.

Introduction

Acute heart failure (AHF) results from the rapid onset of signs, symptoms, and exacerbation of derivates of HF and a combination of clinical, hemodynamic, and neurohormonal abnormalities, including systemic inflammatory activation, which leads to sodium and water retention¹. This long-term accumulation causes the interstitial glycosaminoglycan (GAG) networks to become dysfunctional, resulting in reduced buffering capacity and changing the form and function of the GAG networks^1,2. This contributes to alterations in body composition due to the shifting of fluids from intracellular to....

Protocol

The protocol was approved by the Research Ethics Committee of the National Institute of Medical Sciences and Nutrition Salvador Zubirán (REF. 3057). To conduct BIA measurements, tetrapolar multiple-frequency equipment was used (see Table of Materials). This equipment provided accurate raw values for the resistance (R), reactance (Xc), and phase angle (PhA) at a frequency of 50 kHz, which allowed the impedance to be measured with the best signal-to-noise ratio. The adhesive electrodes used needed to .......

Discussion

This protocol describes the utility of using R-Xc Z-score analysis in clinical practice for patients admitted to an emergency department with AHF. Considering that in patients with AHF, the main reason for hospital admission is congestion, its quick and accurate detection, and evaluation are crucial for patients' outcomes⁶.

This article illustrates the variety of clinical manifestations of AHF and how BIVA Z-score analysis (congestion status and BCM) can be used to .......

Materials

Name	Company	Catalog Number	Comments
Alcohol 70% swabs	NA	NA	Any brand can be used
BIVA software 2002	NA	NA	Is a sofware created for academic use, can be download in http:// www.renalgate.it/formule_calcolatori/ bioimpedenza.htm in "LE FORMULE DEL Prof. Piccoli" section
Chlorhexidine Wipes	NA	NA	Any brand can be used
Examination table	NA	NA	Any brand can be used
Leadwires square socket	BodyStat	SQ-WIRES
Long Bodystat 0525 electrodes	BodyStat	BS-EL4000
Quadscan 4000 equipment	BodyStat	BS-4000	Impedance measuring range: 20 - 1300 Ω ohms Test Current: 620 μA Frequency: 5, 50, 100, 200 kHz Accuracy: Impedance 5 kHz: +/- 2 Ω Impedance 50 kHz: +/- 2 Ω Impedance 100 kHz: +/- 3 Ω Impedance 200 kHz: +/- 3 Ω Resistance 50 kHz: +/- 2 Ω Reactance 50 kHz: +/- 1 Ω Phase Angle 50 kHz: +/- 0.2° Calibration: A resistor is supplied for independent verification from time to time. The impedance value should read between 496 and 503 Ω.