Complementary cardiac functional assessment using systolic time intervals and bioelectrical impedance analysis.

Area of Science:

• Cardiology
• Biomedical Engineering
• Medical Diagnostics

Background:

• The Forrester classification is crucial for heart failure haemodynamics but requires invasive right heart catheterisation.
• A non-invasive, reproducible alternative is needed for clinical application.
• Bioelectrical impedance analysis (BIA) and pulse wave analysis (PWA) offer potential for non-invasive assessment.

Purpose of the Study:

• To develop and validate a novel, non-invasive method for haemodynamic assessment in heart failure.
• To integrate BIA and PWA for virtual Forrester profiling.
• To assess the prognostic value of this non-invasive profiling for major adverse cardiovascular events (MACEs).

Main Methods:

• Retrospective study of 558 heart failure patients (Jan 2020-Dec 2022).
• Integration of PWA-derived systolic time intervals (STIs) and BIA-based fluid status (ECW/TBW).
• Classification into four virtual Forrester profiles: Warm/Dry, Warm/Wet, Cold/Dry, Cold/Wet.
• Primary endpoint: MACEs, analyzed using Kaplan-Meier survival analysis.

Main Results:

• Patients were classified into the four virtual Forrester profiles.
• Significant differences in MACE-free survival were observed among the profiles (log-rank p=0.01).
• The 'Warm and Dry' profile demonstrated the most favourable prognosis, while 'Wet' and 'Cold' profiles were associated with poorer outcomes and specific clinical characteristics.

Conclusions:

• Virtual Forrester profiling using BIA and PWA provides a practical, quantitative, and reproducible non-invasive framework for haemodynamic assessment in heart failure.
• This method offers a valuable alternative to invasive assessments.
• The profiling effectively stratifies patients based on MACE risk.