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Usefulness of combining galectin-3 and BIVA assessments in predicting short- and long-term events in patients admitted for acute heart failure. BIOMED RESEARCH INTERNATIONAL 2014; 2014:983098. [PMID: 25101304 PMCID: PMC4101236 DOI: 10.1155/2014/983098] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/15/2014] [Accepted: 05/16/2014] [Indexed: 12/02/2022]
Abstract
Introduction. Acute heart failure (AHF) is associated with a higher risk for the occurrence of rehospitalization and death. Galectin-3 (GAL3) is elevated in AHF patients and is an indicator in predicting short-term mortality. The total body water using bioimpedance vector analysis (BIVA) is able to identify mortality within AHF patients. The aim of this study was to evaluate the short- and long-term predictive value of GAL3, BIVA, and the combination of both in AHF patients in Emergency Department (ED). Methods. 205 ED patients with AHF were evaluated by testing for B type natriuretic peptide (BNP) and GAL3. The primary endpoint was death and rehospitalization at 30, 60, 90, and 180 days and 12 and 18 months. AHF patients were evaluated at the moment of ED arrival with clinical judgment and GAL3 and BIVA measurement. Results. GAL3 level was significantly higher in patients >71 years old, and with eGFR < 30 cc/min. The area under the curve (AUC) of GAL3 + BIVA, GAL3 and BIVA for death and rehospitalization both when considered in total and when considered serially for the follow-up period showed that the combination has a better prognostic value. Kaplan-Meier survival curve for GAL3 values >17.8 ng/mL shows significant survival difference. At multivariate Cox regression analysis GAL3 is an independent variable to predict death + rehospitalization with a value of 32.24 ng/mL at 30 days (P < 0.005). Conclusion. In patients admitted for AHF an early assessment of GAL3 and BIVA seems to be useful in identifying patients at high risk for death and rehospitalization at short and long term. Combining the biomarker and the device could be of great utility since they monitor the severity of two pathophysiological different mechanisms: heart fibrosis and fluid overload.
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Alves FD, Souza GC, Aliti GB, Rabelo-Silva ER, Clausell N, Biolo A. Dynamic changes in bioelectrical impedance vector analysis and phase angle in acute decompensated heart failure. Nutrition 2014; 31:84-9. [PMID: 25466653 DOI: 10.1016/j.nut.2014.05.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 05/12/2014] [Accepted: 05/16/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To evaluate whether changes in hydration status (reflecting fluid retention) would be detected by bioelectrical impedance vector analysis (BIVA) and phase angle during hospitalization for acute decompensated heart failure (ADHF) and after clinical stabilization. METHODS Patients admitted to ADHF were evaluated at admission, discharge and after clinical stabilization (3 mo after discharge) for dyspnea, weight, brain natriuretic peptide, bioelectrical impedance resistance, reactance, and phase angle. Generalized estimating equations and chi-square detected variations among the three time points of evaluation. RESULTS Were included 57 patients: Mean age was 61 ± 13 y, 65% were male, LVEF was 25 ± 8%. During hospitalization there were improvements in clinical parameters and increase in resistance/height (from 250 ± 72 to 302 ± 59 Ohms/m, P < 0.001), reactance/height (from 24 ± 10 to 31 ± 9 Ohms/m, P < 0.001), and phase angle (from 5.3 ± 1.6 to 6 ± 1.6°, P = 0.007). From discharge to chronic stability, both clinical and BIVA parameters remained stable. At admission, 61% of patients had significant congestion by BIVA, and they lost more weight and had higher improvement in dyspnea during hospitalization (P < 0.05). At discharge, more patients were in the upper half of the graph (characterizing some degree of dehydration) while at chronic stability normal hydration status was more prevalent (P < 0.001). CONCLUSIONS BIVA and phase angle were able to detect significant changes in hydration status during ADHF, which paralleled the clinical course of recompensation, both acutely and chronically. The classification of congestion by BIVA at admission identified patients with more pronounced changes in weight and dyspnea during compensation.
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Affiliation(s)
- Fernanda Donner Alves
- Postgraduate Program in Cardiovascular Sciences, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Gabriela Corrêa Souza
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Internal Medicine, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Graziella Badin Aliti
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; School of Nursing, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Eneida Rejane Rabelo-Silva
- Postgraduate Program in Cardiovascular Sciences, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; School of Nursing, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Nadine Clausell
- Postgraduate Program in Cardiovascular Sciences, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Internal Medicine, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Andréia Biolo
- Postgraduate Program in Cardiovascular Sciences, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Internal Medicine, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
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Medina L, Del Rey JM, Escobar C, Santiago JL, Yebra M, Cornide L, Ribas N, Manzano L. Importance of Bnp changes during the follow-up in elderly outpatients with heart failure. Clin Biochem 2014; 47:1010-4. [PMID: 24751686 DOI: 10.1016/j.clinbiochem.2014.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 04/08/2014] [Accepted: 04/10/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND The aim of the present study was to analyze whether absolute BNP and relative BNP change values during follow-up of elderly patients with chronic HF could predict the development of acute decompensated episodes. METHODS AND RESULTS A total population of 108 elderly outpatients with the diagnosis of HF was retrospectively reviewed. Available BNP levels after at least one stable visit and one acute decompensated episode were required. Follow-up period was 12 months (343 visits, 42.6% decompensated HF episodes). Relative BNP changes were analyzed: "CC period" (patients who remained stable) and "CD period" (patient who suffered from a decompensated HF episode). Changes in BNP levels were significantly higher in CD than in CC periods (mean and median differences 138% and 85%, vs 16% and 0%, respectively; p<0.001). The clinical model (AUC=0.83) had a sensitivity of 67.06%, and a specificity of 80.36%. Relative BNP change (29%) showed by itself, a similar AUC (0.83) and specificity (79%) and an improved sensitivity (0.80) than the clinical model. When relative BNP change was introduced at the clinical model, a similar specificity was obtained and the diagnostic accuracy, AUC (0.89 vs 0.83, p=0.01) and sensitivity were improved. Absolute BNP changes showed worse AUC than that derived from relative BNP changes or clinical assessment. CONCLUSIONS Percent BNP change values during the follow-up showed better results than absolute BNP values and improved the clinical assessment for diagnostic of decompensated HF episodes in elderly outpatients.
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Affiliation(s)
- Laura Medina
- Ramón y Cajal University Hospital, Clinical Biochemistry Department, Spain
| | | | - Carlos Escobar
- La Paz University Hospital, Cardiology Department, Spain
| | - José Luis Santiago
- Ramón y Cajal University Hospital, Heart Failure and Vascular Risk Unit, Internal Medicine Department, Spain
| | - Miguel Yebra
- Ramón y Cajal University Hospital, Heart Failure and Vascular Risk Unit, Internal Medicine Department, Spain
| | - Luis Cornide
- Ramón y Cajal University Hospital, Heart Failure and Vascular Risk Unit, Internal Medicine Department, Spain
| | - Nuria Ribas
- Ramón y Cajal University Hospital, Heart Failure and Vascular Risk Unit, Internal Medicine Department, Spain
| | - Luis Manzano
- Ramón y Cajal University Hospital, Heart Failure and Vascular Risk Unit, Internal Medicine Department, Spain.
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Alves FD, Souza GC, Biolo A, Clausell N. Comparison of two bioelectrical impedance devices and dual-energy X-ray absorptiometry to evaluate body composition in heart failure. J Hum Nutr Diet 2014; 27:632-8. [DOI: 10.1111/jhn.12218] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- F. D. Alves
- Post-Graduate Program in Cardiovascular Sciences; Faculty of Medicine; Federal University of Rio Grande do Sul; Porto, Alegre Brazil
- Department of Internal Medicine; Faculty of Medicine; Federal University of Rio Grande do Sul; Porto, Alegre Brazil
| | - G. C. Souza
- Department of Internal Medicine; Faculty of Medicine; Federal University of Rio Grande do Sul; Porto, Alegre Brazil
- Department of Cardiology; Hospital de Clínicas de Porto Alegre; Porto Alegre Brazil
| | - A. Biolo
- Post-Graduate Program in Cardiovascular Sciences; Faculty of Medicine; Federal University of Rio Grande do Sul; Porto, Alegre Brazil
- Department of Internal Medicine; Faculty of Medicine; Federal University of Rio Grande do Sul; Porto, Alegre Brazil
- Department of Cardiology; Hospital de Clínicas de Porto Alegre; Porto Alegre Brazil
| | - N. Clausell
- Post-Graduate Program in Cardiovascular Sciences; Faculty of Medicine; Federal University of Rio Grande do Sul; Porto, Alegre Brazil
- Department of Internal Medicine; Faculty of Medicine; Federal University of Rio Grande do Sul; Porto, Alegre Brazil
- Department of Cardiology; Hospital de Clínicas de Porto Alegre; Porto Alegre Brazil
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Bioimpedance Vector Analysis (BIVA) for Diagnosis and Management of Acute Heart Failure. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2014. [DOI: 10.1007/s40138-014-0043-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Di Somma S, Lalle I, Magrini L, Russo V, Navarin S, Castello L, Avanzi GC, Di Stasio E, Maisel A. Additive diagnostic and prognostic value of bioelectrical impedance vector analysis (BIVA) to brain natriuretic peptide 'grey-zone' in patients with acute heart failure in the emergency department. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2014; 3:167-75. [PMID: 24477201 DOI: 10.1177/2048872614521756] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Few data are available on diagnostic and prognostic role of quantitative fluid retention evaluated by bioelectrical impedance vector analysis (BIVA) in acute heart failure (AHF) patients at the moment of emergency department presentation. METHODS AND RESULTS Point vectors and hydration index (HI) by BIVA were obtained in 381 patients referring to an emergency department. For evaluating cardiovascular events, a 30-day follow-up was performed. Patients were divided into AHF (n=270; 70.8%) and no-AHF groups, (n=111; 29.2%). Compared with the no-AHF cohort, the HI value resulted significantly higher in the AHF group (81.2% ± 6.7 vs. 72.9 ± 3.6%, p<0.001). HI showed a significant diagnostic power for AHF (cut-off 73.4%, area under curve (AUC) 0.87, sensitivity 90%, specificity 54%) and also showed a significant prognostic value both by univariate (odds ratio 1.03 (1-1.07), p =0.025) and multivariate analysis (odds ratio 1.96 (1.05-3.66) p= 0.034) for cardiac events at 30 days. Although in the overall population BIVA did not increase diagnostic accuracy provided by brain natriuretic peptide (BNP), for AHF patients in BNP 'grey values' (100-400 pg/ml) HI showed a significant additive improvement for diagnosis (net reclassification improvement (NRI) 77%) and prognosis (NRI 45%). CONCLUSIONS While in the overall population BIVA did not increase diagnostic accuracy provided by BNP, in AHF patients a quantitative evaluation of fluid congestion obtained by BIVA at the time of emergency department arrival provides significant additive diagnostic and 30-day prognostic value to BNP, particularly in the BNP 'grey-zone'. This could lead to a better management of these patients with possible improvement in reducing subsequent cardiovascular events.
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Affiliation(s)
- Salvatore Di Somma
- Department of Medical Sciences and Translational Medicine, University of Rome Sapienza, Sant'Andrea Hospital, Italy
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Abstract
Heart failure is a major burden to the health care system in terms of not only cost, but also morbidity and mortality. Appropriate use of biomarkers is critically important to allow rapid identification and optimal risk stratification and management of patients with both acute and chronic heart failure. This review will discuss the biomarkers that have the most diagnostic, prognostic, and therapeutic value in patients with heart failure. We will discuss established biomarkers such as natriuretic peptides as well as emerging biomarkers reflective of myocyte stress, myocyte injury, extracellular matrix injury, and both neurohormonal and cardio-renal physiology.
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Austin J, Hockey D, Williams WR, Hutchison S. Assessing parenteral diuretic treatment of decompensated heart failure in the community. Br J Community Nurs 2013; 18:528-534. [PMID: 24471224 DOI: 10.12968/bjcn.2013.18.11.528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Referrals of 46 patients with decompensated end-stage heart failure were reviewed by a community heart-failure specialist nurse as part of a pilot study to determine patient numbers suitable for parenteral diuretic treatment at home, and the appropriateness of the Mini Nutritional Assessment (MNA), Edmonton Symptom Assessment System (ESAS) and Carer's Stress Scales. Triage of patients resulted in the following care pathways: 14 (30%) received intravenous therapy, 11 (24%) received subcutaneous therapy, 9 (20%) required adjustment of medication, 8 (17%) could not be treated because of limited staffing resource, 4 (9%) met study exemption criteria. There were no adverse events following furosemide infusion. The majority of intravenous and subcutaneous treatments took 1-7 days (total 187 days). Parenteral diuretic therapy prevented admissions and reduced the severity heart failure symptoms in particular oedema. Patients and carers appreciated the service, which had a positive effect on carers stress. Of the nursing tools, the ESAS and the Carer's Stress Scales proved useful in the management of patients.
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Affiliation(s)
- Jackie Austin
- Heart Failure Services and Cardiac Rehabilitation, Aneurin Bevan University Health Board, Nevill Hall Hospital, Abergavenny.
| | | | - W Robert Williams
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd
| | - Stephen Hutchison
- Aneurin Bevan University Health Board, Nevill Hall Hospital, Abergavenny
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Pascual-Figal DA, Caballero L, Sanchez-Mas J, Lax A. Prognostic markers for acute heart failure. ACTA ACUST UNITED AC 2013; 7:379-92. [DOI: 10.1517/17530059.2013.814638] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Evolution of bioimpedance: a circuitous journey from estimation of physiological function to assessment of body composition and a return to clinical research. Eur J Clin Nutr 2013; 67 Suppl 1:S2-9. [PMID: 23299867 DOI: 10.1038/ejcn.2012.149] [Citation(s) in RCA: 175] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND/OBJECTIVES Bioimpedance is the collective term that describes safe, non-invasive methods to measure the electrical responses to the introduction of a low-level, alternating current into a living organism, and the biophysical models to estimate body composition from bioelectrical measurements. Although bioimpedance techniques have been used for more than 100 years to monitor assorted biological components, the desire to translate bioelectrical measurements into physiological variables advanced the creation of empirical prediction models that produced inconsistent results. SUBJECTS/METHODS This paper succinctly reviews the origin, and critically evaluates the conceptual models and the implementation of bioimpedance in clinical research, including indirect assessment of assorted physiological functions and body composition (fluid volumes and fat-free mass), classification of hydration, regional fluid accumulation, prognosis in disease and wound healing. RESULTS Despite widespread and mounting interest in the use of bioimpedance to characterise body structure and function, most experimental findings reveal the limitations of existing physical models and reliance on multiple regression models for use in assessments of an individual. CONCLUSIONS Contemporary applications of bioimpedance emphasise the value of bioimpedance variables per se in some novel biomedical applications with the objective of identifying opportunities for future outcome-based research.
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Ledwidge MT, O'Hanlon R, Lalor L, Travers B, Edwards N, Kelly D, Voon V, McDonald KM. Can individualized weight monitoring using the HeartPhone algorithm improve sensitivity for clinical deterioration of heart failure? Eur J Heart Fail 2012. [PMID: 23204211 DOI: 10.1093/eurjhf/hfs186] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
AIMS Previous studies have demonstrated poor sensitivity of guideline weight monitoring in predicting clinical deterioration of heart failure (HF). This study aimed to evaluate patterns of remotely transmitted daily weights in a high-risk HF population and also to compare guideline weight monitoring and an individualized weight monitoring algorithm. METHODS AND RESULTS Consenting, consecutive, high-risk patients were provided with a mobile phone-based remote weight telemonitoring device. We aimed to evaluate population vs. individual weight variability, weight patterns pre- and post-events of clinical deterioration of HF, and to compare guideline weight thresholds with the HeartPhone algorithm in terms of sensitivity and specificity for such events. Of 87 patients recruited and followed for an average of 23.9 ± 12 weeks, 19 patients experienced 28 evaluable episodes of clinical deterioration of HF. Following a post-discharge decline, the population average weight remained stable for the follow-up period, yet the 7-day moving average of individual patients exceeded 2 kg in three-quarters of patients. Significant increases in weight were observed up to 4 days before HF events. The HeartPhone algorithm was significantly more sensitive (82%) in predicting HF events than guideline weight thresholds of 2 kg over 2-3 days (21%) and a 'rule of thumb' threshold of 1.36 kg over 1 day (46%). CONCLUSIONS An individualized approach to weight monitoring in HF with the HeartPhone algorithm improved prediction of HF deterioration. Further evaluation of HeartPhone with and without other biomarkers of HF deterioration is warranted.
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Affiliation(s)
- Mark T Ledwidge
- Heart failure Unit, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
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Palazzuoli A, Ronco C, McCullough PA. Letter by Palazzuoli et al Regarding Article, “Is Worsening Renal Function an Ominous Prognostic Sign in Patients With Acute Heart Failure? The Role of Congestion and Its Interaction With Renal Function”. Circ Heart Fail 2012; 5:e79; author reply e80. [DOI: 10.1161/circheartfailure.112.968354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alberto Palazzuoli
- Department of Internal Medicine and Metabolic Diseases, Cardiology Section, S. Maria alle Scotte Hospital University of Siena, Italy (A.P.); Department of Nephrology, St. Bortolo Hospital, Vicenza, Italy (C.R.); St. John Providence Health System, Detroit, MI (P.A.M.)
| | - Claudio Ronco
- Department of Internal Medicine and Metabolic Diseases, Cardiology Section, S. Maria alle Scotte Hospital University of Siena, Italy (A.P.); Department of Nephrology, St. Bortolo Hospital, Vicenza, Italy (C.R.); St. John Providence Health System, Detroit, MI (P.A.M.)
| | - Peter A. McCullough
- Department of Internal Medicine and Metabolic Diseases, Cardiology Section, S. Maria alle Scotte Hospital University of Siena, Italy (A.P.); Department of Nephrology, St. Bortolo Hospital, Vicenza, Italy (C.R.); St. John Providence Health System, Detroit, MI (P.A.M.)
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Maisel AS, Daniels LB. Breathing Not Properly 10 Years Later. J Am Coll Cardiol 2012; 60:277-82. [DOI: 10.1016/j.jacc.2012.03.057] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 03/12/2012] [Accepted: 03/19/2012] [Indexed: 12/22/2022]
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Abstract
The role of biomarkers in the management of patients with acute heart failure (HF) has evolved rapidly in the past several years. Representing a major burden on health systems, acute HF has increased the need for earlier diagnosis, better risk stratification, and cost-effective treatment to reduce rates of hospitalization. Biomarker-guided diagnosis and treatment have become essential, especially in the acute setting to which the majority of the patients with acute HF initially present. Studies clearly demonstrate the complexity of these patients, who commonly have multiple comorbidities necessitating an integrative approach. Several groundbreaking studies conducted in the past decade have demonstrated how biomarkers, individually or in combination, can outperform conventional laboratory tests used in the emergency department as well as in hospitalized patients with acute HF. In this Review, we will provide an update on biomarkers considered state of the art in the diagnosis and management of patients with acute HF.
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Affiliation(s)
- Alan S Maisel
- Department of Medicine, Division of Cardiology, San Diego Veterans Affairs Medical Center, 3350 La Jolla Village Drive, San Diego, CA 92161, USA.
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Aspromonte N, Cruz DN, Ronco C, Valle R. Role of Bioimpedance Vectorial Analysis in Cardio-Renal Syndromes. Semin Nephrol 2012; 32:93-9. [DOI: 10.1016/j.semnephrol.2011.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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The emerging role of biomarkers and bio-impedance in evaluating hydration status in patients with acute heart failure. Clin Chem Lab Med 2012; 50:2093-105. [DOI: 10.1515/cclm-2012-0289] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 07/22/2012] [Indexed: 01/03/2023]
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Costanzo MR, Cozzolino M, Aspromonte N, Mistrorigo F, Valle R, Ronco C. Extracorporeal Ultrafiltration in Heart Failure and Cardio-Renal Syndromes. Semin Nephrol 2012; 32:100-11. [DOI: 10.1016/j.semnephrol.2011.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ronco C, Cruz D, Noland BW. Neutrophil Gelatinase-Associated Lipocalin Curve and Neutrophil Gelatinase-Associated Lipocalin Extended-Range Assay: A New Biomarker Approach in the Early Diagnosis of Acute Kidney Injury and Cardio-Renal Syndrome. Semin Nephrol 2012; 32:121-8. [DOI: 10.1016/j.semnephrol.2011.11.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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