Albuminuria Is Independently Associated With Cardiac Remodeling, Abnormal Right and Left Ventricular Function, and Worse Outcomes in Heart Failure With Preserved Ejection Fraction

Abstract Objectives The purpose of this study was to determine the relationship between albuminuria and cardiac structure/function in heart failure with preserved ejection fraction (HFpEF). Background Albuminuria, a marker of endothelial dysfunction, has been associated with adverse cardiovascular o...

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Published in:JACC. Heart failure 2014-12, Vol.2 (6), p.586-596
Main Authors: Katz, Daniel H., MD, Burns, Jacob A., BA, Aguilar, Frank G., MPH, Beussink, Lauren, MHS, RDCS, Shah, Sanjiv J., MD
Format: Article
Language:English
Subjects:
Aged
albuminuria
Albuminuria - complications
Albuminuria - physiopathology
Cardiovascular
Creatinine - urine
diastolic heart failure
endothelial dysfunction
Female
Heart Failure - etiology
Heart Failure - physiopathology
Heart Failure - urine
Humans
Kaplan-Meier Estimate
Male
Prognosis
Prospective Studies
Stroke Volume - physiology
Ventricular Dysfunction, Left - physiopathology
Ventricular Dysfunction, Left - urine
Ventricular Dysfunction, Right - physiopathology
Ventricular Dysfunction, Right - urine
ventricular function
ventricular remodeling
Ventricular Remodeling - physiology
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Summary:Abstract Objectives The purpose of this study was to determine the relationship between albuminuria and cardiac structure/function in heart failure with preserved ejection fraction (HFpEF). Background Albuminuria, a marker of endothelial dysfunction, has been associated with adverse cardiovascular outcomes in HFpEF. However, the relationship between albuminuria and cardiac structure/function in HFpEF has not been well studied. Methods We measured urinary albumin-to-creatinine ratio (UACR) and performed comprehensive echocardiography, including tissue Doppler imaging and right ventricular (RV) evaluation, in a prospective study of 144 patients with HFpEF. Multivariable-adjusted linear regression was used to determine the association between UACR and echocardiographic parameters. Cox proportional hazards analyses were used to determine the association between UACR and outcomes. Results The mean age was 66 ± 11 years, 62% were female, and 42% were African American. Higher UACR was associated with greater left ventricular mass, lower preload-recruitable stroke work, and lower global longitudinal strain. Higher UACR was also significantly associated with RV remodeling (for each doubling of UACR, RV wall thickness was 0.9 mm higher [95% confidence interval: 0.05 to 0.14 mm; p = 0.001, adjusted p = 0.01]) and worse RV systolic function (for each doubling of UACR, RV fractional area change was 0.56% lower [95% confidence interval: 0.14 to 0.98%; p = 0.01, adjusted p = 0.03]. The association between UACR and RV parameters persisted after the exclusion of patients with macroalbuminuria (UACR >300 mg/g). Increased UACR was also independently associated with worse outcomes. Conclusions In HFpEF, increased UACR is a prognostic marker and is associated with increased RV and left ventricular remodeling and longitudinal systolic dysfunction. (Classification of Heart Failure With Preserved Ejection Fraction; NCT01030991 )
ISSN:2213-1779
2213-1787
DOI:10.1016/j.jchf.2014.05.016