الفهرس 
Congestion in Heart FailureOnly 14 pages are availabe for public view
 |  | from | 170 |  |  |
| | | from | 170 | | |
Abstract
Acute heart failure is characterized by fluid overload and signs and symptoms of congestion in 95% of the patients. As a result, diuretic therapy is the primary aim of treatment. Assessment of residual congestion before patient discharge is difficult. So, there is an increasing need to assess congestion status objectively for better discharge planning including diuretics dose titration and post-discharge follow-up (3, 4, 5).
Bio-ADM has a prominent role in maintaining the barrier function of the endothelium, The loss of this barrier function results in vascular leakage and subsequently pulmonary and systemic oedema Accordingly, higher plasma levels of biologically active adrenomedullin are indicative of increased accumulation of interstitial fluid, and circulating levels of biologically active adrenomedullin are elevated in patients with heart failure (7, 8).
Electrical cardiometry is a noninvasive method that estimates cardiac parameters by measuring changes in thoracic electrical bioimpedance during the cardiac cycle. The ICON (electrical cardiometry device) estimates CO, cardiac index (CI), stroke volume (SV), stroke volume variation (SVV), systemic vascular resistance (SVR), thoracic fluid content (TFC) and a variety of other cardiac parameters. Increased TFC is associated with higher alveolar permeability which is the sum of interstitial, alveolar, intracellular and lymphatic fluids, but not pleural effusion. Intra-alveolar fluid is generally elevated in Heart failure and TFC and decreased impedance are considered markers of heart failure severity (12,152).
Aim of the study:
The aim of this study is to evaluate the value of Adrenomedullin as a biomarker in assessment of residual congestion in correlation to electrical cardiometry in hospitalized decompensated heart failure patients.
Subjects: This prospective observational study was carried out on ninety subjects in the cardiology department of the faculty of medicine, Menoufia University and National heart institute. During the period between December 2021 and December 2022, the patients enrolled were identified as individuals with acute decompensated heart failure admitted for the management of congestion and heart failure. The patients were evaluated on admission and on discharge. Subjects were included in this study after obtaining their written informed consent and acquiring the approval of the Ethics Committee of the Menoufia University.
Methods:
Full medical history and clinical examination done to all patients. Serum bio-ADM withdrawn to all patients on admission and discharge. Electrical cardiometry (ICON) data obtained to all patients on admission and discharge.
Results:
The age of the studied patients ranged from 27 to 75 years with a mean value of 56.2 (± 12.49 SD) years Regarding sex, there were 49 (54.44%) males and 41 (45.56%) females.
Our results showed that higher levels of serum bio-ADM are associated with more signs and symptoms of congestion and increased use of loop diuretics. Also associated with high thoracic fluid content and lower stroke volume variation by electrical cardiometry.
In this study, there was statistically significant difference between admission and discharge findings as regarding dyspnea score, orthopnea score, rales score and peripheral oedema score. These all were significantly lower at discharge with mean ± SD (1 ± 0.81), (0.8 ± 0.85), (1.4 ± 1.03) (1.1 ± 0.81) respectively than admission with mean ± SD for dyspnea score, orthopnea score and rales score (2.5 ± 0.5) and for peripheral edema score mean ± SD (1.9 ± 0.78). This finding is supported by decongestion of the patient with loop diuretics achieving good negative balance.
There was statistically significant difference between admission and discharge findings as regarding Heart rate, respiratory rate, CVP, serum bioADM, diuresis usage and weight of the patient. These all were significantly lower at discharge than admission. The mean ± SD of bio-ADM levels between study patients on admission was 21.8 ± 15.84 ng/L and at discharge 15.5 ± 7.34 ng/L, TFC was 56 ± 12.68 kOhm-1 on admission and 33.8 ± 11.83 kOhm-1 at discharge and CVP was 20.8 ± 4.72 cmH2O on admission and 11.5 ± 2.63 cmH2O at discharge, in a positive correlation. While SVV was 9.2 ± 3.79 % on admission and 20.9 ± 4.43 % at discharge in a negative correlation with bio-ADM, TFC and CVP.
These findings support our hypothesis that on admission the patient was congested and overloaded. With effective heart failure decongestive therapy with intense diuresis the intravascular volume decreased with subsequent decrease in CVP and TFC and increase in intrathoracic respiratory variations in SV (SVV). Also, the tissue congestion decreased and as a result the bio-ADM level decreased.
Conclusion:
In conclusion, our data suggests that bio-ADM can be used as a congestion marker in heart failure. The diagnostic and prognostic ability of bio-ADM was correlated and supported by the findings of the electrical cardiometry which is used more widely in follow-up in heart failure patients. It used to measure several hemodynamic parameters and its results showed that TFC was significantly lower at discharge than admission in a positive correlation with bio-ADM levels. While SVV were significantly higher at discharge than admission in a negative correlation with bio-ADM.