Impact of low-grade albuminuria on left ventricular diastolic dysfunction

Albuminuria is an established risk factor for mortality and cardiovascular events in high-risk populations. However, few studies have evaluated the relationship between normoalbuminuria and left ventricular (LV) diastolic function. The present study evaluated the impact of the low-grade albuminuria on LV diastolic function in patients with coronary artery disease (CAD). A cross-sectional study was conducted in 202 chronic CAD patients with normal urinary albumin levels. Subjects were divided into 3 tertiles according to sex-specific urinary albumin-to-creatinine concentration ratio (UACR) cut-off points. Subjects in the upper tertile were classified as having low-grade albuminuria. To evaluate the LV function, all subjects underwent echocardiography. LV diastolic dysfunction was defined as E/e′ > 15 or 8 < E/e′ < 15, with an E/A < 0.5, a deceleration time > 280 ms, and a LV mass index > 122 g/m2 for women or > 149 g/m2 for men. Among the 202 patients, 76 patients (37.6%) had LV diastolic dysfunction. The prevalence of LV diastolic dysfunction in the upper tertile was significantly greater than that in the middle and lower tertiles (49.3%, 32.3% and 29.2%, respectively; p for trend = 0.029). Adjusting for confounding factors, the presence of low-grade albuminuria independently associated with LV diastolic dysfunction (odds ratio 2.22, 95% confidence interval: 1.05–4.71, p = 0.037). A high UACR level that is still below the current microalbuminuria threshold is significantly associated with an increased prevalence of LV diastolic dysfunction in CAD patients. Our data suggest that low-grade albuminuria in high-risk populations may provide greater cardiovascular risk stratification.