Microalbuminuria is an independent prognostic marker in patients with chronic heart failure

Background: Microalbuminuria has been described as a risk factor for progressive cardiovascular and renal diseases. Little is known about its prognostic value in patients (pts) with established heart failure (HF). Objective: To assess the role of microalbuminuria as a prognostic marker in patients with chronic HF receiving standard medication. Methods: From January 2008 through September 2009, 92 pts with chronic HF, were prospectively included. Mean age was 63.7 +/- 12.2 and 37 (40.7%) were male. Mean left ventricular ejection fraction (LVEF) was 52.5 +/- 17.5%. Pts under dialysis were excluded. Urinary albumin concentration (UAC) was determined in first morning spot sample of urine. Time to first event (HF hospitalization, emergency department visit for HF or cardiovascular death) was defined as endpoint. Mean follow-up was 11 +/- 6.1 months. Results: At the time of inclusion in the study, 38 (41.3%) pts had microalbuminuria and no patient had overt albuminuria. Pts with microalbuminuria had lower left ventricular ejection fraction than the rest of the individuals (47.9 +/- 18.5 vs 54.5 +/- 17.7%, p=0.08). UAC was higher in patients with events (median 59.8 vs 18 mg/L, p=0.0005). Event-free survival was lower in pts with microalbuminuria as compared with normoalbuminuria (p<0.0001). Independent variables related to cardiac events were UAC (p<0.0001, hazard ratio=1.02, 95% CI=1.01 to 1.03 per 1-U increase of UAC), and previous myocardial infarction (p=0.025, HR=3.11, 95% CI=1.15 to 8.41). Conclusion: Microalbuminuria is an independent prognostic marker in pts with chronic HF. Pts with microalbuminuria had a trend for lower LVEF. (Arq Bras Cardiol 2012;98(1):62-69)