Role of Serum Bio-Adrenomedullin (Bio-ADM) and Electrical Cardiometry in Evaluation of Heart Failure Decongestion Therapy

Background: Bio-active adrenomedullin (bio-ADM) represents a promising biomarker of tissue congestion. Electrical cardiometry (EC) non-invasively measures electric bio-impedance across the thorax allowing the assessment of the fluid status in HF patients. Objectives: This study aimed to assess the role of serum bio-active adrenomedullin (bio-ADM) and electrical cardiometry (EC) in monitoring decongestion during heart failure (HF) therapy. Patients and methods: This prospective observational study included 90 patients with decompensated HF admitted to Menoufia University Hospital and the National Heart Institute, Egypt. All patients underwent clinical evaluation with congestion scores, electrocardiography, chest X-ray, routine laboratory testing and echocardiography. Daily central venous pressure (CVP) and fluid balance were assessed. Serum bio-ADM and EC parameters using Osypka Medical EC ™ device were measured at admission and prior to clinically planned discharge. Results: Prior to clinically planned discharge, there was a decrease in congestion scores and CVP owing to net negative fluid balance achieved by HF decongestion therapy. Serum bio-ADM levels significantly decreased. EC showed a significant reduction in thoracic fluid content (TFC). Bio-ADM showed positive correlations with TFC in addition to CVP. Residual congestion was detected in 37 patients, which was identified by elevated TFC above normal device range in addition to slightly elevated bio-ADM levels despite apparent clinical improvement. This prompted delaying hospital discharge till normal TFC values were achieved. Conclusion: Serum bio-ADM and EC proved to be effective in more precise assessment of fluid status during HF decongestion therapy. EC provided valuable non-invasive guidance in managing fluid overload and detected residual congestion, which allowed better optimization of discharge timing.