According to current guidelines by the American Heart Association (AHA), the European Respiratory Council (ERC), and the European Society of Intensive Care Medicine (ESICM), the diagnosis of congestive heart failure is based on physical examination, laboratory assessment, and technological tests including echocardiography and chest X-ray. However, depending on different clinical variables, the assessment of BNP/NT-proBNP is generally recommended as the most sensitive method in making the diagnosis of congestive heart failure. Despite its high clinical utility, the measurement of BNP/NT-proBNP provides no information on the underlying pathophysiology or the hemodynamic state of the patient presenting. Impedance cardiography (ICG) enables clinicians to perform non-invasive continuous hemodynamic measurements to gain a more comprehensive view of the dynamics of heart failure. This systematic review and meta-analysis intend to investigate the relationship between different hemodynamic parameters measured with a bioimpedance device and levels of BNP/NT-proBNP to assess the usefulness of ICG in patients with acute heart failure. The present work was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P2015) guidelines. Electronic databases including PubMed, EMBASE, and GoogleScholar were searched for prospective studies investigating the relationship between BNP/NT-proBNP measurements and hemodynamic parameters in patients with heart failure. Statistical analysis including calculation of effect sizes, assessment of heterogeneity, and publication bias was performed using the software jamovi (jamovi project, 2024). From the initially identified 270 records, a total count of 11 articles met the eligibility criteria of the systematic review, of which nine studies were included in the meta-analysis. Summarizing the correlations between ICG parameters and BNP/NT-proBNP levels, a statistically significant relationship between the thoracic fluid content (TFC) (CC: 0.332, 95% CI: 0.184
0.479, p 0.001), the cardiac index (CI) (CC: -0.312, 95% CI: -0.469
-0.155, p<
0.001), stroke volume index (SVI) (CC: -0.369, 95% CI: -0.655
-0.083), and systolic time ratio (STR) (CC: 0.230, 95% CI: 0.117
0.342, p<
0.001) were observed. By summarizing the existing data on the relationship between hemodynamic parameters measured with ICG and levels of BNP/NT-proBNP, we could find substantial evidence for the utility of ICG in the diagnosis of heart failure. It seems to be particularly useful in differentiating shock states and guiding hemodynamic stabilization treatment with inotropes and vasopressors.