Elia Nunzio Maria Salerno (1), Isabella Fumarulo (1), Barbara Garramone (1), Marcello Vaccarella (1), Francesco Burzotta (1), Nadia Aspromonte (1)

(1) Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.

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Background: Acute Heart Failure represents a life-threatening condition requiring early diagnosis, risk stratification and adequate treatment. In this context, systemic congestion can be identified as a cause and result of worsening cardiovascular function, caused by the activation of the neurohormonal system and resulting in fluid redistribution and accumulation. After the acute phase, patients often develop a chronic condition (Chronic Heart Failure), requiring variable dosis of diuretics. Total body fluid overload and systemic congestion are known to be associated with unpreventable hospitalization and worse prognosis. Being able to identify correctly the hemodynamic status of the patient can surely address the therapeutic process with early treatment adjustments. However, nowadays the gold standard for the identification of subclinical or clinical congestion and intravascular fluid overload includes invasive measurements (Right Heart Catheterization, RHC). As an alternative, NiCas represents a valid new non-invasive technology based on regional bioimpedance and able to identify cardiac hemodynamic data including total body fluid content.

Purpose: We aim to assess the usefulness of Nicas in the therapeutic management of patients with Heart Failure.

Methods: We conducted our analysis on thirty patients who came to our Day Hospital with a diagnosis of Chronic Heart Failure (CHF). All patients underwent several measurements of cardiac parameters using Nicas, upon admission and shortly before discharge. Measurements recorded by NiCas were stroke volume, stroke index, cardiac output, cardiac index, total body water, total peripheral resistance, cardiac power index and granov-goor index. Based on the data obtained, integrating it with blood chemistry tests, we adjusted the diuretic therapy, personalizing it for each patient.

Results: We analized data from 30 patients affected by CHF (16 HFrEF, 9 HFmrEF, 5 HFpEF), requiring periodic cycles of i.v. diuretics. The average dosis of “home” diuretics was 175 mg of Furosemide p.o. daily. The analysis of data obtained from non-invasive measurements allowed therapeutic decisions to be modified with significant adjustments that could not have been made based on clinical evaluation alone. As a more illustrative example, an 83-year-old obese male patient diagnosed with ischemic heart failure with preserved ejection fraction, diabetes, chronic kidney disease and permanent atrial fibrillation was admitted to our day hospital for mild dyspnoea and lower limb edema. While clinical assessment suggested that diuretics should be administered, non-invasive assessment using Nicas showed low levels of total body water compared to high levels of body mass index. Therefore, focusing exclusively on clinical assessment, the use of diuretics would have had a negative effect on the patient's clinical condition. In this context, both the presence of lower limb oedema and dyspnoea could be explained by the patient's obesity and possible venous insufficiency.On the other hand, this system proved to be useful in detecting significant amounts of fluid in a 75-year-old patient with heart failure and reduced ejection fraction, in order to determine the amount of diuretics to be administered.

Conclusions: The NiCas is a new non-invasive system which has been demonstrated to be very useful in the therapeutic management of patients with Heart Failure. Thanks to the use of this technology, it is possible not only to personalise patient treatment but also to detect subclinical conditions, thereby preventing all worsening and hospitalisations. The non-invasive nature and easy reproducibility of the non-operator-dependent examination would allow for large-scale use, extending it to all patients in their clinical follow-up.