• Heart failure is a complex clinical syndrome characterized by impaired cardiac function and progressive decline in functional capacity [1].
• Albuminuria, the presence of albumin in the urine, has been identified as a potential marker of disease severity and prognosis in patients with heart failure [2].
• The relationship between albuminuria and various clinical characteristics in heart failure patients, such as ejection fraction, NYHA class, and comorbidities, has been a topic of growing interest [3].
• This study aims to provide a comprehensive analysis of the association between albuminuria and the clinical profile of heart failure patients, including factors such as ejection fraction, NYHA class, comorbidities, and clinical signs.
• By investigating the relationship between albuminuria and heart failure clinical characteristics, this study may contribute to a better understanding of the prognostic value of albuminuria and its potential role in guiding heart failure management.

OBJECTIVES

• To investigate the prevalence of albuminuria in heart failure patients with different ejection fraction categories.
• To analyze the relationship between albuminuria and clinical characteristics such as NYHA class, comorbidities, and clinical signs in heart failure patients.
• To assess the prognostic significance of albuminuria in heart failure patients and its potential role in risk stratification and management.

MATERIALS AND METHODS

• Study Design A prospective observational study
• Sample Size A total of 64 heart failure patients were enrolled in the study
• Study Period The study was conducted for a 1-year duration.
• Place of Study The study was carried out at a tertiary care medical college hospital in Bangalore
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Inclusion Criteria: The study included heart failure patients with preserved, midrange, and reduced ejection fractions

Exclusion Criteria: Patients with End-stage renal disease, Sepsis , UTI, COPD, Age less than 18 years were excluded from the study

• Data collection was performed using a structured questionnaire and clinical examination.
• Patients' demographic information, medical history, and medication details were recorded.
• Urine samples were collected to assess albuminuria using the urine albumin/creatinine ratio.
• Echocardiography was performed to determine ejection fraction and categorize patients into preserved, midrange, or reduced ejection fraction groups.
• Clinical signs such as basilar rales, peripheral edema, hepatomegaly, orthopnea, and jugular venous distension were evaluated during physical examination

Table 1: Distribution of New onset HF and Worsening HF

Table 2: Types of HF

Table 3: Albuminuria classification

Table 4: Types of HF vs Albuminuria classification

Table 5: NYHA vs Albuminuria classification

Table 6: DM, HTN, History of MI, Smoking vs Albuminuria classification

Table 7: Clinical signs vs Albuminuria classification

Table 8: BMI vs Albuminuria classification

• The study found a significant association between albuminuria and heart failure (HF) types, with macroalbuminuria being more prevalent in patients with preserved ejection fraction (EF) (p=0.0014). This finding is consistent with the TOPCAT trial, which reported a higher prevalence of albuminuria (33.9%) in HF patients with preserved EF [4].
• In contrast, the CHARM study found a higher prevalence of albuminuria in HF patients with reduced EF (33%) compared to those with preserved EF (23%) [5].
• The current study found a significant association between albuminuria and NYHA class IV (p=0.0231), suggesting a link between albuminuria and HF severity.
• Similarly, the GISSI-HF trial reported a higher prevalence of albuminuria in patients with NYHA class III-IV (22.3%) compared to those with NYHA class I-II (14.1%) [6].
• Comorbidities such as diabetes mellitus (p=0.0342), hypertension (p=0.0186), and history of myocardial infarction (p=0.0084) were significantly associated with albuminuria in HF patients. These findings are consistent with the ANCHOR study, which found a higher prevalence of diabetes (38%) and hypertension (76%) in HF patients with albuminuria [7].

• The significant association between macroalbuminuria and preserved ejection fraction suggests that albuminuria may be a useful marker for identifying heart failure patients with preserved ejection fraction who are at higher risk of adverse outcomes.
• The higher prevalence of macroalbuminuria in NYHA class IV patients indicates that albuminuria is associated with more severe heart failure symptoms and may be used to assess disease severity.
• The significant associations between albuminuria and comorbidities such as diabetes mellitus, hypertension, and history of myocardial infarction highlight the importance of considering these risk factors when evaluating heart failure patients with albuminuria.
• The presence of clinical signs such as basilar rales, peripheral edema, hepatomegaly, orthopnea, and jugular venous distension in patients with macroalbuminuria suggests that albuminuria may be a marker of clinical congestion and more advanced heart failure.

1. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Eur J Heart Fail. 2016;18(8):891-975. doi:10.1002/ejhf.592
2. Brisco MA, Testani JM. Novel renal biomarkers to assess cardiorenal syndrome. Curr Heart Fail Rep. 2014;11(4):485-499. doi:10.1007/s11897-014-0226-4
3. Miura M, Shiba N, Nochioka K, et al. Urinary albumin excretion in heart failure with preserved ejection fraction: an interim analysis of the CHART 2 study. Eur J Heart Fail. 2012;14(4):367-376. doi:10.1093/eurjhf/hfs001
4. Shah AM, Claggett B, Sweitzer NK, et al. Cardiac structure and function and prognosis in heart failure with preserved ejection fraction: findings from the echocardiographic study of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) Trial. Circ Heart Fail. 2014;7(5):740-751. doi:10.1161/CIRCHEARTFAILURE.114.001583
5. Jackson CE, Solomon SD, Gerstein HC, et al. Albuminuria in chronic heart failure: prevalence and prognostic importance. Lancet. 2009;374(9689):543-550. doi:10.1016/S0140-6736(09)61378-7
6. Masson S, Latini R, Milani V, et al. Prevalence and prognostic value of elevated urinary albumin excretion in patients with chronic heart failure: data from the GISSI-Heart Failure trial. Circ Heart Fail. 2010;3(1):65-72. doi:10.1161/CIRCHEARTFAILURE.109.881805
7. Filippatos GS, Ahmed MI, Gladden JD, et al. Hypervolemia, renin-angiotensin-aldosterone system activation, and outcomes in heart failure with preserved ejection fraction: Findings from the ANCHOR study. Int J Cardiol. 2020;309:47-55. doi:10.1016/j.ijcard.2020.02.018