Abstract 11365: Bioelectrical Impedance Analysis is Useful for the Management of Heart Failure and Prediction of Cardiac Events in Adult Patients with Congenital Heart Disease

Introduction: Since decompensated heart failure generally leads to fluid volume overload, the ability to recognize and quantify fluid retention is critical for the treatment of heart failure. Bioelectrical impedance analysis (BIA) is a safe, non-invasive, and rapid assessment method, but little has been reported on the role of BIA in the management of patients with congenital heart disease (CHD). Hypothesis: We assessed the hypothesis that BIA is useful for the management of heart failure in adult patients with congenital heart disease. Methods: We performed a retrospective single-center study of 173 consecutive adult patients with congenital heart disease who were admitted to our institute between April 2013 and December 2015. We retrospectively reviewed the medical records of the patients to evaluate the relationship between the BIA parameters (intracellular water, extracellular water, protein, mineral, fat, edema index (EI, ratio of extracellular water to total body water)) and the laboratory values, echocardiographic parameters, and prevalence of cardiac events. Results: The patients in functional classes 3 and 4 had a higher EI compared with the patients in functional classes 1 and 2 (0.395 vs. 0.384, p < 0.001). In the multivariate analysis, the EI was significantly related to serum albumin, BUN, and BNP. In addition, the reduction in body weight (BW) achieved during the hospitalization was significantly related to the reduction in EI; using a generally defined upper limit of EI as 0.39, we developed this model equation: Required BW reduction (kg) = 98.1(EI - 0.39) + 2.26(Protein) - 4.14(Mineral) - 0.04(BUN) - 1.86. During the median follow-up period of 36 months, the Kaplan-Meier analysis revealed that an EI of more than 0.39 was significantly associated with an increased prevalence of cardiac events. Using the Cox hazard model, we determined that the hazard ratio of cardiac events in patients with an EI ≧0.39 compared to patients with an EI <0.39 was 3.9 (95%CI 2.0-7.9). In patients who had undergone a Fontan operation, the hazard ratio was 7.0(95%CI 1.4-77.1). Conclusions: The Edema index determined by BIA is a useful marker for the treatment of heart failure and the prediction of cardiac events in adult patients with congenital heart disease.