Name: evaluation of hydration status by bioelectrical impedance vector analysis in patients with ischemic heart disease undergoing exercise stress test
Uploaded: 2023-09-22T13:50:00
Description: Watch this Scientific Journal Video about Evaluation of Hydration Status by Bioelectrical Impedance Vector Analysis in Patients with Ischemic Heart Disease Undergoing Exercise Stress Test at JoVE.com

To Consejo Nacional de Ciencia y Tecnolog&#237;a (CONACyT) that sponsored the scholarship CVU 1004551 for Dulce Mar&#237;a Navarrete de la O during her MSc degree.

The Institutional Research Ethics Committee from Centro M&#233;dico Nacional &#34;20 de Noviembre&#34;, ISSSTE, approved this protocol (ID 383.2019). All enrolled patients signed written informed consent.
1. Before bioelectrical impedance analysis (BIA) measurement
NOTE: The BIA protocol procedure is measured using a single-frequency bioelectrical impedance device (Table of Materials). This device provides two values (resistance and r...

<ol>
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Although BIA is considered a safe, practical, and noninvasive method, which overcomes the limitations of other methods to measure body composition and body water19,23, it is relevant to consider the potential bias occurring regarding the type of bioelectrical impedance (the method described here is specific for a single-frequency bioelectrical impedance device), or the variation in the steps and technique verification methods.
It has b...

Ischemic heart disease (IHD) represents a group of clinical syndromes characterized by myocardial ischemia, a mismatch in the myocardial blood supply and demand. The underlying pathophysiological defect includes inadequate perfusion, mainly due to atherosclerotic disease of epicardial coronary arteries1,2,3. In general, the presence of cardiovascular disease (CVD) is common, showing poor survival worldwide4. Particularly in 2015, IHD contributed to approximately 9 million deaths and more than 160 million disability-adjusted life years, and nowadays, IHD remains one of the main causes of mortality, and it favors the heart disease burden around the world5.
To evaluate both the presence and prognosis of IHD, some non-invasive procedures like the exercise stress test (EST) are routinely used. EST provides an assessment of the overall performance of cardiovascular, muscular, pulmonary, hematopoietic, neurosensory, and skeletal systems when the maximum tolerable stress appears under the EST6.
Under normal conditions, physiological adaptations would be expected while exercising. During exercise, several changes occur, like a dynamic change of fluid in blood within the vascular compartment, the reduction of plasma and blood volume, and the increase in hematocrit and plasma metabolite concentrations. Reduced plasma volume normalizes approximately 1 h after exercise, which may also vary depending on individual training level and water replenishment7.
However, IHD may lead to an acute impaired response to exercise, affecting EST performance in some variables comprising aerobic capacity and exercise tolerance, such as oxygen uptake (VO2) and heart rate/oxygen pulse (HR/O2)8. Recently, hydration status (HS), a measure of the water contained in the body1, has been proposed as a factor linked to plasma volume, able to modify blood flow and viscosity. HS has also been related to systolic volume, heart rate, and arteriovenous oxygen difference, determinants of VO2. Furthermore, some studies describe the relation of HS with a lower cardiopulmonary response (cardiac chronotropic and inotropic, VO2 and HR/O2)9.
In addition, several factors like age, environmental conditions, the level of physical activity/exercise, and dietary factors like fluid intake have been described to participate in HS balance10. Likewise, pathophysiological conditions such as IHD and its progression may influence HS11.
Although HS closely relates to cardiopulmonary, biological-environmental responses or lifestyle factors, the particular association of IHD in population with previous conditions has been scantily addressed; and it represents a significant challenge for clinical research, specifically due to the assessment of early stages, as well as the requirement for reliable and standardized methods to evaluate the HS.
To address this, bioelectrical impedance analysis (BIA), a practical, non-invasive, and cost-effective method, can be used to estimate body composition within a clinical setting but also has been proposed as an alternative method to evaluate HS showing advantages over other methods like biomarkers tests (urinary or plasma osmolality) due to the presence of high variability in the results and even over the gold standard method (isotope dilution) due to the complexity of the technique that requires specific training and highly cost equipment, becoming clinically impractical12,13,14,15.
The conventional BIA method applies an alternating, low electric current intensity (below the perceptual thresholds), entering the human body and crossing internal tissues. Then, based on the principle that body organs may act as electric conductors or dielectrics, we may obtain a register of electric impedance (or bioelectrical impedance [Z]) that reflects the opposition of the organs to the free applied electric flow (EF), depending on their composition (fat or muscle mass, bone, water, etc.)12. Here, Z sources are resistance (R) and reactance (Xc). The former is related to the opposition of the EF throughout cellular ionic solutions (intracellular and extracellular), while the latter is a capacitive component of tissue interfaces, cell membranes, and organelles12.
In addition, bioelectrical impedance vector analysis (BIVA) is an alternative BIA method approach that uses spatial relationships between R and Xc (both adjusted by height) to assess soft tissue hydration. The R and Xc data are plotted on a bivariate resistance-reactance graph, which allows visualizing body composition and HS12,16.
Considering the less explored field of HS balance associated with cardiopulmonary, as well as the growing interest to characterize new applications of methods like BIVA in the evaluation of HS, this study aims to determine HS by BIVA method and to analyze HS relation with VO2 and HR/O2 in ambulatory patients with IHD.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>BIVA Tolerance</td>
			<td>BIVA SOFTWARE 2002</td>
			<td></td>
			<td>Piccoli A, Pastori G: BIVA software. Department of Medical and Surgical Sciences, University of Padova, Padova, Italy, 2002 (available at E-mail:apiccoli@unipd.it).</td>
		</tr>
		<tr>
			<td>Cardiopoint ECG C600</td>
			<td>BTL</td>
			<td>407-80MANEN03100</td>
			<td>ELECTROCARDIOGRAPH</td>
		</tr>
		<tr>
			<td>Cardiopoint Trolley</td>
			<td>BTL</td>
			<td>40700B000240</td>
			<td>TROLLEY</td>
		</tr>
		<tr>
			<td>Portable Digital Flat Scale</td>
			<td>SECA</td>
			<td>813</td>
			<td>DIGITAL FLAT SCALE</td>
		</tr>
		<tr>
			<td>Portable Stadiometer</td>
			<td>SECA</td>
			<td>213</td>
			<td>STADIOMETER</td>
		</tr>
		<tr>
			<td>Quantum IV</td>
			<td>RJL SYSTEMS</td>
			<td>Q4B-2405</td>
			<td>BIOELECTRIC IMPEDANCE ANALYZER</td>
		</tr>
		<tr>
			<td>Treadmill Clinical</td>
			<td>BTL</td>
			<td>216A18</td>
			<td>TREADMILL</td>
		</tr>
	</tbody>
</table>

evaluation of hydration status by bioelectrical impedance vector analysis in patients with ischemic heart disease undergoing exercise stress test

Ischemic heart disease (IHD) represents a group of clinical syndromes characterized by myocardial ischemia, leading to an impairment in the myocardial blood supply and compromised perfusion. Several clinical variables assessed through a stress test, such as oxygen uptake (VO2) and heart rate oxygen pulse (HR/O2), have been attributed as cardiopulmonary prognostic factors in patients with IHD. However, other factors like hydration status (HS), potentially affecting the cardiopulmonary response, have been barely addressed. Unbalanced HS has a short-term effect on plasma volume and the sympathetic nervous system, which impacts blood volume, and lowers VO2 and HR/O2. Recently, bioelectrical impedance analysis (BIA), a method based on the opposition of body tissues (including fluid volume) to a low electrical current, has been widely used to assess HS by obtaining two components: resistance (R) and reactance (Xc) and using prediction formulas. However, several limitations as chronic illness or abnormal fluid status, may affect the results. In this sense, alternative BIA methods, such as bioelectrical impedance vector analysis (BIVA), have become relevant. R and Xc (adjusted by height) result in a vector plotted on the R/Xc graph, which allows interpreting the HS as normal or abnormal according to the distance of the mean vector. This study aims to describe how to determine HS by BIVA using a single-frequency device and compare the results with the cardiopulmonary response in patients with IHD.

First, R and Xc (both adjusted by patient&#180;s height) data registered from the single frequency (SF-BIA) device was used to obtain the BIVA R/Xc graph. Second, we classified hydration status as euhydration, hyperhydration, and hypohydration. Representative hydration data from male patients plotted with circle and triangle, aged 66 years and 67 years, weighing 72.2 kg and 72.3 kg, height 169 cm and 163 cm, are shown (Figure 2). In addition, impedance data are shown R/H= 280.7, Xc/H= 23.6 &...

Watch this Scientific Journal Video about Evaluation of Hydration Status by Bioelectrical Impedance Vector Analysis in Patients with Ischemic Heart Disease Undergoing Exercise Stress Test at JoVE.com

Evaluation of Hydration Status by Bioelectrical Impedance Vector Analysis in Patients with Ischemic Heart Disease Undergoing Exercise Stress Test

Hydration status imbalances can have a short-term effect on direct and indirect determinants of oxygen uptake and pulse, and morbidity and mortality prognostic factors in ischemic heart disease. This protocol describes the technique for assessment of hydration status through bioelectrical impedance vector analysis and cardiopulmonary response during exercise stress test.

Ischemic heart disease (IHD) represents a group of clinical syndromes characterized by myocardial ischemia, leading to an impairment in the myocardial ...

Our protocol aims to clinically demonstrate the utility of evaluating hydration status using biological impedance analysis in patients with ischemic heart disease, and how the hydration status can be compared with cardiopulmonary response, evaluated by exercise stress test. Recently, hydration status has been proposed as a factor linked to plasma volume, able to modify blood flow and viscosity, impacting systolic volume, heart rate, and arteriovenous oxygen difference, which are determinants of oxygen uptake. Considering the less explored fields of hydration status, balance, and cardiopulmonary response in patients with ischemic heart disease, the applications of alternative methods, like bioelectrical impedance analysis in evaluating hydration status become relevant.According to our results, the relevance of understanding the complex role of altered hydration status related to an empiric cardiopulmonary response and physical performance could compromise disease prognosis in patients with ischemic heart disease. Demonstrating the procedure will be Pablo Zermeno-Ugalde and Alexandra Rodriguez-Guillen, Master of Science Students, and Hugo Radillo-Alba, a highly specialized cardiologist in cardio rehabilitation for my laboratory. To begin, explain the procedure to the patient, and collect information about gender, age, weight, and height.Instruct the patient to remove any metal objects, such as watches, rings, bracelets, necklaces, shoes, and socks. Place the patient in a supine position on a stretcher bed. Ensure that arms and legs maintain an angular separation of 30 to 45 degrees, and the palms of the hands face upwards.Clean the area using a pad soaked with 70%ethyl alcohol. To place the proximal electrodes on the hand, first place one electrode on the wrist, just between the lunate-scaphoid carpal joint and the ulna-radius joint. Then place another electrode on the middle finger, just behind the metacarpophalangeal joint.Ensure a distance of at least five to 10 centimeters between the electrodes to avoid electrode-electrode interaction. Next place the distal electrodes on the foot, one electrode on the ankle at the joint between the internal and external malleoli and astragalus, and another electrode between the metatarsal-phalangeal joints of the third finger, while keeping the electrodes at a distance from each other. First, connect the circular outlet of the leads to the back of the device.Attach the hand guide leads by connecting the red clip on the wrist and the black clip on the middle finger. Then connect the foot guide leads of the distal electrodes by placing the red clip on the ankle and the black clip on the third finger. Verify that all clips are placed on the edge of the skin electrode.Turn on the device by pressing the on button. Observe the values on the screen immediately and wait 30 to 60 seconds for resistance and reactance data to stabilize. Then register the resistance and reactance values.Turn off the device by pressing the off button. Once the measurement is done, remove the red and black clips for the hand and the foot. Then carefully remove the skin electrodes and discard them.Download and open the BIVA software. In the RXE population sheet, select the complete line, according to the population to be evaluated. Copy the selected data and paste them into the second row.Click the subjects sheet and fill in the information located in the second row, such as patient ID in column one. In column two, the value for Seq should always be one. In columns three and four, indicate the surname and name of the patient.Indicate the sex of the patient in column five. Add values of resistance and reactance in columns six and seven. Insert the height of the patient in column eight and the weight in column nine.In column 10, population code, indicate a value, between one to 13, that appears in the first column of the reference population sheet. In column 11, group code, add a value between one to 10 to select the patient to be evaluated. Next, indicate the age of the patient in column 12.Click the complement option in the main menu and click calculate to obtain the resistance and reactance values, adjusted by height in columns 13 and 14. Then click the point graph sheet and the resistance reactance graph will be displayed. In the dialogue box named Select Groups, select the group option and click OK.Interpret the hydration status from the plot.Before the experiment, ensure that the patient complies with the prerequisites of the test and ask the patient to wear comfortable clothing. Explain the EST protocol to the patient, and register the gender, age, weight, and height into the EST system. Next, fix a size-fit EST mask to the patient's face.Wait for the EST equipment gas analysis elements to calibrate automatically, ensuring the environmental CO2 does not exceed 1, 200 PPM. To connect the 12-lead electrocardiographic electrodes on the patient's chest, first place four electrodes on the arms, one on the right arm over the acromion bone, one on the left arm over the acromion bone, one on the right costal margin, and one on the left costal margin. Then place six electrodes on the chest, V1 on the second intercostal space and over the right border of the sternum, V2 on the second intercostal space and the left border of the sternum.Place V4 on the fourth intercostal space, crossing with the left midclavicular line, V3 between V2 and V4, V5 on the fifth intercostal space, at the level of the left anterior axillary line, and V6 six on the sixth intercostal space at the level of the left middle axillary line. Perform a resting spirometry by instructing the patient to inhale deeply as much as possible. Then indicate to exhale as fast and forcefully as possible, trying to maintain at least six seconds in the breath-out effort.Evaluate the forced expiratory volume in one second and the forced vital capacity parameters provided in the EST system and choose the best values achieved by the patient. Evaluate the cardiac conditions, such as baseline electrocardiogram, heart rate, and blood pressure to ensure the patient does not present limiting factors before starting the EST, and observe the patient's gait, making sure that they do not present a walking disorder. Monitor and evaluate the EST with attention to blood pressure, heart rate, and electrocardiographic trace changes every three minutes.Continue monitoring the perception of any symptoms and the perceived physical effort by the Borg scale. After EST is finished, monitor the patient's blood pressure, heart rate, and EKG during the recovery period. Ensure these parameters return to baseline values.Extract and register cardiopulmonary data, such as metabolic equivalents, oxygen uptake, and heart rate oxygen pulse from the EST software. Resistance reactance graph obtained using this protocol was used to classify hydration status as euhydration, hyperhydration, and hypohydration. Representative impedance data from two patients classified their hydration status as hyperhydration and hypohydration.EST values for these patients suggest that abnormal hydration status may induce a lower cardiopulmonary response, shown by lower values of metabolic equivalents, oxygen uptake, and heart rate oxygen pulse. Bioelectrical impedance analysis is a practical, non-invasive, and cost-effective method that can be used to estimate body composition within a clinical setting. But it has also been proposed as an alternative method to evaluate hydration status, showing advantages over other methods, such as biomarker test or isotope dilution.Our representative results suggest that abnormal hydration status may induce a lower cardiopulmonary response, as was observed in oxygen uptake, especially when hyperhydration occurs. Although hydration status can be closely related to cardiopulmonary response in patients with ischemic heart disease, using bioelectrical impedance analysis to evaluate hydration status represent a reliable and standardized method in clinical research.

Research

JoVE Journal

Medicine

Computerized Dynamic Posturography for Postural Control Assessment in Patients with Intermittent Claudication

Computerized dynamic posturography with the EquiTest is an objective technique for measuring postural strategies under challenging static and dynamic ...

Assessment of Vascular Function in Patients With Chronic Kidney Disease

Patients with chronic kidney disease (CKD) have significantly increased risk of cardiovascular disease (CVD) compared to the general population, and this ...

Implantation of Total Artificial Heart in Congenital Heart Disease

In patients with end-stage heart failure (HF), a total artificial heart (TAH) may be implanted as a bridge to cardiac transplant. However, in congenital ...

Characterization of Metabolic Status in Nonhuman Primates with the Intravenous Glucose Tolerance Test

The intravenous glucose tolerance test (IVGTT) plays a key role in the characterization of glucose homeostasis. When taken together with serum biochemical ...

Integration of Brain Tissue Saturation Monitoring in Cardiopulmonary Exercise Testing in Patients with Heart Failure

Cerebral hypo-oxygenation during rest or exercise negatively impacts the exercise capacity of patients with heart failure with reduced ejection fraction ...

Novel Percutaneous Approach for Deployment of 3D Printed Coronary Stenosis Implants in Swine Models of Ischemic Heart Disease

Minimally invasive methods for creating models of focal coronary narrowing in large animals are challenging. Rapid prototyping using three-dimensionally ...

Model of Ischemic Heart Disease and Video-Based Comparison of Cardiomyocyte Contraction Using hiPSC-Derived Cardiomyocytes

Ischemic heart disease is a significant cause of death worldwide. It has therefore been the subject of a tremendous amount of research, often with ...

Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis

Near-infrared spectroscopy (NIRS) has recently been applied as a tool to measure regional oxygen saturation (rSO2), a marker of tissue oxygenation, in ...

Evaluation of Fluid Overload by Bioelectrical Impedance Vectorial Analysis

Early detection and management of fluid overload are critically important in acute illness, as the impact of therapeutic intervention can result in ...

Predicting Prognosis in Acute Heart Failure Using Phase Angle & BIVA Z-Scores

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

Author Spotlight: Unveiling Prognostic Indicators in Heart Failure - The Role of Phase Angle and Bioelectrical Impedance Analysis 

Acute heart failure is characterized by neurohormonal activation, which leads to sodium and water retention and causes alterations in body composition, ...