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. 2022 Apr;118(4):703-709.
doi: 10.36660/abc.20201144.

Microalbuminuria and its Prognostic Significance in Patients with Acute Heart Failure with Preserved, Mid-Range, and Reduced Ejection Fraction

[Article in English, Portuguese]
Ömer Doğan Alataş  1 , Murat Biteker  2 , Ahmet Demir  1 , Birdal Yıldırım  1 , Ethem Acar  1 , Kemal Gökçek  1 , Aysel Gökçek  2
Affiliations

Microalbuminuria and its Prognostic Significance in Patients with Acute Heart Failure with Preserved, Mid-Range, and Reduced Ejection Fraction

[Article in English, Portuguese]
Ömer Doğan Alataş et al. Arq Bras Cardiol. 2022 Apr.

Abstract
in English, Portuguese

Background: The prevalence and significance of microalbuminuria have not been well studied in patients with different heart failure subtypes.

Objective: The prevalence and significance of microalbuminuria have not been well studied in patients with different heart failure subtypes. Therefore, we aimed to investigate the frequency and prognostic value of microalbuminuria in patients hospitalized for acute heart failure (AHF) with preserved ejection fraction (HFpEF), mid-range ejection fraction (HFmrEF), and reduced ejection fraction (HFrEF).

Methods: All consecutive adult patients referred to the hospital due to AHF between June 2016 and June 2019 were enrolled. Microalbuminuria is defined as urinary albumin to creatinine ratio (UACR) level in the range of 30-300 mg/g. Hospital mortality was the endpoint of this study.

Results: Of the 426 AHF patients (mean age 70.64 ± 10.03 years, 53.3 % female), 50% had HFrEF, 38.3% had HFpEF, and 11.7% had HFmrEF at presentation.The prevalence of microalbuminuria was 35.2%, 28.8%, and 28.0% in HFrEF, HFpEF, and HFmrEF, respectively. A total of 19 (4.5%) patients died during the in-hospital course, and in-hospital mortality was higher in HFrEF patients (6.6%) compared to patients with HFpEF (2.5%) and HFmrEF (2.0%). Multivariate analysis showed that the presence of microalbuminuria predicted in-hospital mortality in patients with HFrEF and HFmrEF but not in HFpEF.

Conclusion: Although microalbuminuria was common in all subgroups of AHF patients, it has been found to predict prognosis only in patients with HFrEF and HFmrEF.

Fundamento: A prevalência e o significado da microalbuminúria não foram bem estudados em pacientes com diferentes subtipos de insuficiência cardíaca.

Objetivo: A prevalência e o significado da microalbuminúria não foram bem estudados em pacientes com diferentes subtipos de insuficiência cardíaca. Portanto, nosso objetivo foi investigar a frequência e o valor prognóstico da microalbuminúria em pacientes hospitalizados por insuficiência cardíaca aguda (ICA) com fração de ejeção preservada (ICFEp), fração de ejeção de faixa média (ICFEfm) e fração de ejeção reduzida (ICFEr).

Métodos: Todos os pacientes adultos consecutivos encaminhados ao hospital devido a ICA entre junho de 2016 e junho de 2019 foram inscritos. A microalbuminúria é definida como o nível de albumina urinária para relação de creatinina (AURC) na faixa de 30–300 mg/g. A mortalidade hospitalar foi o critério de valoração deste estudo.

Resultados: Dos 426 pacientes com ICA (idade média de 70,64 ± 10,03 anos, 53,3% do sexo feminino), 50% tinham ICFEr, 38,3% tinham ICFEp e 11,7% tinham ICFEfm na apresentação. A prevalência de microalbuminúria foi de 35,2%, 28,8% e 28,0% em ICFEr, ICFEp e ICFEfm, respectivamente. Um total de 19 (4,5%) pacientes morreram durante o curso intra-hospitalar, e a mortalidade intra-hospitalar foi maior em pacientes com ICFEr (6,6%) em comparação com pacientes com ICFEr (2,5%) e ICFEfm (2,0%). A análise multivariada mostrou que a presença de microalbuminúria previu mortalidade intra-hospitalar em pacientes com ICFEr e ICFEfm, mas não em ICFEp.

Conclusão: Embora a microalbuminúria fosse comum em todos os subgrupos de pacientes com ICA, descobriu-se que ela prediz o prognóstico apenas em pacientes com ICFEr e ICFEfm.

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Conflict of interest statement

Potencial conflito de interesse

Não há conflito com o presente artigo

Figures

Figura 1
Figura 1. – Fluxograma do participante. NT-proBNP: peptídeo natriurético tipo B-N-Terminal; FEVE: fração de ejeção do ventrículo esquerdo; AURC: albumina urinária para relação de creatinina; ICFEr: insuficiência cardíaca com fração de ejeção reduzida; ICFEfm: insuficiência cardíaca com fração de ejeção de faixa média;ICFEp: insuficiência cardíaca com fração de ejeção preservada.
Figura 2
Figura 2. – Comparação da prevalência de normo-, micro- e macroalbuminúria em relação aos subtipos de insuficiência cardíaca. ICFEr: insuficiência cardíaca com fração de ejeção reduzida; ICFEfm: insuficiência cardíaca com fração de ejeção de faixa média;ICFEp: insuficiência cardíaca com fração de ejeção preservada.
Figure 1
Figure 1. – Participant flow chart. NT-proBNP: N-Terminal proB-Type Natriuretic Peptide; UACR: urinary albumin/creatinine ratio; LVEF: left ventricular ejection fraction; HfrEF: heart failure with reduced ejection fraction; HfmrEF: heart failure with mid-range ejection fraction; HfpEF: heart failure with preserved ejection fraction
Figure 2
Figure 2. – Comparison of the prevalence of normo-, micro- and macroalbuminuria in relation to heart failure subtypes. HfrEF: heart failure with reduced ejection fraction; HfmrEF: heart failure with mid-range ejection fraction; HfpEF: heart failure with preserved ejection fraction
See this image and copyright information in PMC

Comment in

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