Figure 1
ROC analysis of edema index (EI), intracellular water (ICW), extracellular water (ECW), and total body water (TBW) for predicting long-term all-cause and cardiovascular mortality.
Table 1
A comparison of baseline characteristics of the 2 groups.
| BASELINE CHARACTERISTICS | TOTAL | EI ≤ 0.397 | EI > 0.397 | p VALUE |
|---|---|---|---|---|
| n = 401 | n = 223 | n = 178 | ||
| Age (years) | 69.51 ± 13.74 | 66.02 ± 14.26 | 73.88 ± 11.70 | <0.001 |
| Male (%) | 249 (62.1) | 140 (62.8) | 109 (61.2) | 0.708 |
| BMI (kg/m2) | 23.97 ± 4.09 | 24.12 ± 3.69 | 23.76 ± 4.54 | 0.381 |
| Smoking (%) | 174 (43.4) | 97 (43.5) | 77 (43.3) | 0.962 |
| Alcohol drinking (%) | 134 (33.4) | 79 (35.4) | 55 (30.9) | 0.340 |
| Family History of CVD (%) | 52 (13.0) | 29 (13.0) | 23 (12.9) | 0.980 |
| Atrial Fibrillation (%) | 160 (39.9) | 71 (31.9) | 89 (50.0) | <0.001 |
| NYHA Class (%) | <0.001 | |||
| 1 | 29 (7.2) | 26 (11.7) | 3 (1.7) | |
| 2 | 94 (23.4) | 64 (28.7) | 30 (16.9) | |
| 3 | 185 (46.1) | 96 (43.0) | 89 (50.0) | |
| 4 | 93 (23.2) | 37 (16.6) | 56 (51.5) | |
| Ischemic Heart Disease (%) | 171 (42.7) | 100 (44.8) | 71 (39.9) | 0.319 |
| Dilated Cardiomyopathy (%) | 64 (16.0) | 43 (19.3) | 21 (11.8) | 0.042 |
| Medical histories (%) | ||||
| Hypertension | 206 (51.4) | 109 (48.9) | 97 (54.5) | 0.264 |
| Diabetes mellitus | 131 (32.7) | 61 (27.3) | 70 (39.4) | 0.040 |
| COPD | 29 (7.2) | 14 (6.3) | 15 (8.4) | 0.409 |
| Dyslipidemia | 39 (9.7) | 32 (14.3) | 7 (3.9) | <0.001 |
| Previous MI | 46 (11.5) | 27 (12.1) | 19 (10.7) | 0.654 |
| Previous PCI | 62 (15.5) | 31 (13.9) | 31 (17.4) | 0.333 |
| Previous CABG | 3 (0.7) | 2 (0.9) | 1 (0.6) | 0.699 |
| Chronic Kidney Disease | 104 (25.9) | 43 (19.3) | 61 (34.3) | <0.001 |
| Laboratory Parameters | ||||
| Cardiac Troponin I (ng/mL) | 0.05 (0.01–0.79) | 0.05 (0.02–1.10) | 0.05 (0.01–0.47) | 0.064 |
| NT-proBNP (pg/mL) | 1500 (599–4045) | 1.120 (450–3110) | 2035 (1003–4700) | 0.006 |
| D-dimer | 685 (233–1316) | 520 (206–1150) | 864 (430–1635) | 0.001 |
| Leukocyte (×109/L) | 6.56 (5.40–8.76) | 6.78 (5.60–8.95) | 6.36 (5.06–8.48) | 0.057 |
| Hemoglobin (g/L) | 130 (113–145) | 135.0 (123.0–147.5) | 121.5 (104.0–141.3) | <0.001 |
| Platelet (×109/L) | 172 (141–222) | 184.0 (151.5–236.5) | 164.5 (124.8–205.3) | <0.001 |
| Urea (mmol/L) | 8.1 (6.2–12.0) | 7.1 (5.9–10.0) | 9.8 (6.8–13.5) | <0.001 |
| Creatinine (μmol/L) | 93 (73–131) | 87.0 (72.0–112.5) | 105.5 (73.5–161.3) | 0.003 |
| Uric Acid (μmol/L) | 427.5 (335.5–561.5) | 410.5 (329.0–522.0) | 453.0 (348.3–595.0) | 0.003 |
| Echocardiography | ||||
| Right Atrium (mm) | 40.86 ± 6.98 | 39.43 ± 6.39 | 42.65 ± 7.29 | <0.001 |
| Right Ventricle (mm) | 22.43 ± 4.12 | 21.87 ± 3.50 | 23.14 ± 4.70 | 0.002 |
| Left Atrium (mm) | 41.06 ± 8.42 | 39.96 ± 8.05 | 42.43 ± 8.69 | 0.003 |
| LVEDD (mm) | 57.34 ± 10.27 | 57.61 ± 10.07 | 57.01 ± 10.53 | 0.565 |
| IVS (mm) | 10.58 ± 2.78 | 10.53 ± 2.47 | 10.65 ± 3.14 | 0.688 |
| Moderate to severe MR | 183 (45.6) | 89 (39.9) | 94 (52.8) | 0.010 |
| FS (%) | 24.16 ± 8.31 | 23.21 ± 7.54 | 25.41 ± 9.10 | 0.022 |
| EF (%) | 43.70 ± 12.87 | 42.74 ± 12.21 | 44.90 ± 13.59 | 0.096 |
[i] * EI: edema index; BMI: body mass index; CVD: cardiovascular diseases; NYHA: New York Heart Association Functional Classification; COPD: chronic obstructive pulmonary disease; MI: myocardial infarction; PCI: percutaneous coronary intervention; CABG: coronary artery bypass graft surgery; NT-proBNP: N-terminal prohormone of brain natriuretic peptide; LVEDD: left ventricular end-diastolic diameter; IVS: intraventricular septum; MR: mitral regurgitation; FS: fractional shortening; EF: ejection fraction.
Table 2
A comparison of bioelectrical impedance analysis of the 2 groups.
| TOTAL | EI ≤ 0.397 | EI > 0.397 | p VALUE | |
|---|---|---|---|---|
| n = 401 | n = 223 | n = 178 | ||
| Height (cm) | 160.96 ± 8.34 | 160.90 ± 8.14 | 161.03 ± 8.61 | 0.873 |
| Weight (kg) | 62.22 ± 13.05 | 62.95 ± 12.28 | 61.30 ± 13.93 | 0.210 |
| Waist Circumference (cm) | 77.12 ± 12.89 | 79.94 ± 12.57 | 73.60 ± 12.43 | <0.001 |
| Intracellular Water | 20.55 ± 4.86 | 21.02 ± 5.04 | 19.96 ± 4.56 | 0.509 |
| Extracellular Water | 13.45 ± 3.13 | 12.97 ± 2.89 | 14.05 ± 3.31 | 0.043 |
| Total Body Water | 34.00 ± 7.81 | 33.99 ± 7.80 | 34.00 ± 7.83 | 0.692 |
| Edema Index of upper extremities | 0.384 ± 0.012 | 0.378 ± 0.012 | 0.391 ± 0.008 | <0.001 |
| Edema Index of trunk | 0.396 ± 0.027 | 0.384 ± 0.015 | 0.415 ± 0.014 | <0.001 |
| Edema Index of lower extremities | 0.398 ± 0.025 | 0.383 ± 0.022 | 0.417 ± 0.014 | <0.001 |
| Protein | 8.89 ± 2.10 | 9.09 ± 2.18 | 8.62 ± 1.98 | 0.027 |
| Mineral | 2.83 ± 0.70 | 2.80 ± 0.74 | 2.87 ± 0.64 | 0.362 |
| Muscle Mass (kg) | 43.44 ± 10.01 | 43.64 ± 10.09 | 43.18 ± 9.93 | 0.652 |
| Lean Body Mass (kg) | 46.27 ± 10.61 | 46.44 ± 10.72 | 46.05 ± 10.50 | 0.713 |
| TBW/LBM (%) | 73.48 | 73.22 | 73.91 | <0.001 |
| Body Fat Mass (kg) | 15.95 ± 8.48 | 16.51 ± 7.90 | 15.26 ± 9.14 | 0.142 |
| Body Fat Percentage (%) | 25.06 | 25.92 | 23.99 | 0.089 |
[i] *EI: edema index; TBW: total body weight; LBM: lean body mass; TBW/LBM: total body weight to lean body mass ratio.
Figure 2
Correlation analysis. Figure 2A. Correlation analysis between age with intracellular water (ICW), extracellular water (ECW), total body water (TBW), and edema index (EI). Figure 2B Correlation between edema index (EI) with cardiac troponin I, left ventricular ejection fraction (LVEF), creatinine, and NT-proBNP.
Figure 3
Long-term all-cause and cardiovascular mortality according to the edema index (EI).
Figure 4
Kaplan-Meier curves for all-cause and cardiovascular mortality in patients with CHF.
Table 3
Univariate and multivariate cox regression analysis of all-cause mortality (A) and cardiovascular mortality (B).
| UNIVARIABLE | MULTIVARIABLE | |||
|---|---|---|---|---|
| HR (95% CI) | p | HR (95% CI) | p | |
| (A) All-cause Mortality | ||||
| Age (1 year increase) | 1.045 (1.028, 1.062) | <0.001 | 1.036 (1.018, 1.054) | <0.001 |
| Male | 1.367 (0.926, 2.018) | 0.116 | 1.633 (1.092, 2.441) | 0.017 |
| BMI | 0.920 (0.876, 0.968) | 0.001 | 0.947 (0.903, 0.994) | 0.029 |
| NYHA ≥ 3 | 2.773 (1.678, 4.583) | <0.001 | 2.148 (1.290, 3.578) | 0.003 |
| Atrial Fibrillation | 1.092 (0.755, 1.578) | 0.640 | ||
| NT-proBNP ≥ 450 pg/ml | 1.621 (0.943, 2.788) | 0.081 | ||
| LVEF ≤ 50% | 1.068 (0.711, 1.603) | 0.752 | ||
| Moderate-Severe MR | 1.386 (0.964, 1.992) | 0.078 | ||
| Intracellular Water | 0.952 (0.914, 0.992) | 0.018 | ||
| TBW/LBM | 1.452 (1.113, 1.895) | 0.006 | ||
| Edema Index > 0.397 | 2.961 (2.015, 4.351) | <0.001 | 1.959 (1.304, 2.944) | 0.001 |
| (B) Cardiovascular Mortality | ||||
| Age (1 year increase) | 1.031 (1.012, 1.050) | 0.001 | 1.026 (1.005, 1.047) | 0.016 |
| Male | 1.550 (0.964, 2.491) | 0.070 | ||
| BMI | 0.900 (0.848, 0.956) | 0.001 | 0.919 (0.866, 0.974) | 0.005 |
| NYHA ≥ 3 | 2.975 (1.613, 5.486) | <0.001 | 2.277 (1.223, 4.239) | 0.009 |
| Atrial Fibrillation | 1.090 (0.704, 1.688) | 0.700 | ||
| NT-proBNP ≥ 450 pg/ml | 1.555 (0.824, 2.933) | 0.173 | ||
| LVEF ≤ 50% | 1.683 (0.976, 2.904) | 0.061 | 2.203 (1.251, 3.882) | 0.006 |
| Moderate-Severe MR | 2.059 (1.320, 3.212) | 0.001 | ||
| Intracellular Water | 0.938 (0.892, 0.986) | 0.012 | ||
| TBW/LBM | 1.291 (0.941, 1.771) | 0.113 | ||
| Edema Index > 0.397 | 2.746 (1.747, 4.314) | <0.001 | 2.051 (1.276, 3.296) | 0.003 |
[i] *NYHA: New York Heart Association Functional Classification; NT-proBNP: N-terminal prohormone brain natriuretic peptide; LVEF: left ventricular ejection fraction; MR: mitral regurgitation; TBW/LBM: total body weight to lean body mass ratio.
Figure 5
Forest plot of primary outcome according to the demographic characteristics.