Impact and course of albuminuria in acute heart failure according to left or right sided heart failure phenotype

Abstract Introduction The presence of albuminuria is a risk factor for the development and progression of heart failure (HF). Recently, the urine albumin/creatinine ratio (UACR) has been established as a marker of congestion in HF. However, the course of albuminuria and its presentation in distint phenotypes according to left or right sided HF is poorly studied. Purpose To analyze the UACR course during acute heart failure (AHF) admission according to its clinical phenotype. Methods In this prospective and observational study, one hundred consecutive patients with AHF admitted to the Cardiology Department from February to June 2024 were included. Blood and urine tests were performed on admission, discharge, and two weeks after discharge. Patients were classified according to left sided HF (group 1) or mixed-right HF phenotype (group 2). Results A total of 59% had left HF and 41% had mixed-right HF phenotype. Both groups had similar aged patients, although there were more women in group 2. Group 2 had more comorbidities, without difference between baseline treatment groups. Patients in group 2 had significantly more UACR at admission compared to group 1 (p=0.046). We observed a decrease in UACR level at discharge in both groups, but group 2 had a rebound of UACR. This may be due to a greater susceptibility to congestion in the mixed-right phenotype of HF (Figure 1). In the analytical evaluation, group 2 had significantly more liver disfunction (hepatic colestasis enzimes) and higher CA 12.5 levels compared to group 1, that had higher NT-ProBNP levels. Regarding echocardiographic data, no differences in LVEF were observed, although group 2 had worse tricuspid annular plane systolic excursión (TAPSE), higher systolic pulmonary artery pressure (PAPs) levels and a lower TAPSE/PAPs ratio. Conclusions Patients with mixed or right-sided congestion have more comorbidities, higher albuminuria levels at admission, more liver disfunction and right ventricular disfunction. The presence of albuminuria decreases rapidly after decongestion, but an important worsening after two weeks is observed in the mixed-right HF phenotype. A longer follow-up is needed to determine the impact and prognostic role of albuminuria on different HF phenotypic profiles.