Bioimpedance-Guided Diuretics and Cardiac Progression in Asymptomatic Heart Failure

Background and Objectives It has not been clearly elucidated whether volume control with diuretics is essential at an early stage in patients with heart failure (HF). The primary objective of this prospective study is to assess the effects of diuretic treatment in patients with systolic HF who exhibit no clinical signs of congestion but have hypervolemia as measured by bioimpedance analysis (BIA). Furthermore, the study aims to compare the clinical outcomes of these patients with a control group not receiving diuretic treatment.

Methods

This prospective study includes adult patients with systolic HF. The patients are assigned into two groups:

Negative Hydration Group: Patients receive diuretic therapy and are maintained in a state of negative hydration according to BIA measurements.

Positive Hydration Group: Patients are followed without diuretic therapy.

All patients are followed for a total duration of 1 year, with clinical evaluations and BIA measurements repeated at 4-month intervals.

Inclusion criteria

• Patients aged 18 years and older (regardless of gender)
• Confirmed diagnosis of heart failure (newly diagnosed or previously under follow-up in the internal medicine or cardiology outpatient clinic)
• Left ventricular ejection fraction (LVEF) < 40% as determined by echocardiography
• Patients who do not have hypervolemia detected on physical examination
• Fluid volume status (overhydration [OH]) value greater than zero, as measured by bioimpedance analysis, thereby classifying them as hypervolemic for the study
• Willingness to participate and ability to provide written informed consent prior to any study-related procedures

Exclusion criteria

• Patients under 18 years of age
• Pregnant women
• Patients with clinically evident decompensated heart failure requiring intravenous diuretic therapy
• Presence of edema, hepatomegaly, or ascites upon physical examination