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Microalbuminuria as a Marker of Clinical Instability in Chronic Heart Failure
Session:
Sessão de Posters 55 - Congestão, instabilidade e marcadores prognósticos na insuficiência cardíaca avançada
Speaker:
Patrícia Bernardes
Congress:
CPC 2026
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Patrícia Bernardes; Sara Gonçalves; Jéni Quintal; Tatiana Duarte; Margarida Madeira; Ana Sousa; Crisálida Ferreira; Sofia Senhorinho; Andreia Soares; Dina Ferreira; Filipe Seixo
Abstract
<p style="text-align:justify"><span style="font-size:18px"><span style="font-family:"Times New Roman",serif"><strong><span style="font-family:"Calibri",sans-serif">Background</span></strong><br /> <span style="font-family:"Calibri",sans-serif">Microalbuminuria (MA) reflects endothelial dysfunction and renal congestion — mechanisms closely linked to heart failure (HF) progression. Its role as a marker of recurrent decompensations in contemporary outpatient management remains uncertain.</span></span></span></p> <p style="text-align:justify"><span style="font-size:18px"><span style="font-family:"Times New Roman",serif"><strong><span style="font-family:"Calibri",sans-serif">Purpose</span></strong><br /> <span style="font-family:"Calibri",sans-serif">This study aimed to evaluate whether MA predicts HF events and mortality in a real-world same-day HF clinic cohort.</span></span></span></p> <p style="text-align:justify"><span style="font-size:18px"><span style="font-family:"Times New Roman",serif"><strong><span style="font-family:"Calibri",sans-serif">Methods</span></strong><br /> <span style="font-family:"Calibri",sans-serif">We retrospectively analysed 114 patients with chronic HF followed in a same-day HF clinic between January 2020 and December 2024. MA was defined as a urine albumin-to-creatinine ratio (UACR) ≥30 mg/g assessed in spot urine samples. MA was assessed opportunistically during clinically stable outpatient visits, a median of 5 months after inclusion (IQR 2–9). Median follow-up was 21 months (IQR 12–31). The primary endpoint was the total number of HF events, defined as unplanned visits or HF-related hospitalisations, during follow-up. Secondary endpoints included all-cause mortality. Associations were analysed using non-parametric tests and multivariable Poisson regression adjusted for age, sex, left ventricular ejection fraction (LVEF), diabetes, hypertension, and estimated glomerular filtration rate (eGFR).</span></span></span></p> <p style="text-align:justify"><span style="font-size:18px"><span style="font-family:"Times New Roman",serif"><strong><span style="font-family:"Calibri",sans-serif">Results</span></strong><br /> <span style="font-family:"Calibri",sans-serif">The cohort had a mean age of 71 ± 9.8 years, and 61% were male. MA was present in 39% of patients. Patients with MA had lower eGFR (49 ± 13 vs. 56 ± 14 mL/min/1.73 m²; p = 0.012) and higher NT-proBNP levels (median 3288 [1100–5483] vs. 2881 [1048–4700] pg/mL; p = 0.002) compared with those without MA. Patients with MA more frequently experienced at least one HF decompensation (78% vs. 58%, p = 0.029) and accumulated a higher total number of unplanned visits or hospitalisations (p = 0.016). In multivariable Poisson regression, MA remained an independent predictor of the composite endpoint (IRR = 1.39, 95% CI 1.01–1.92; p = 0.042), whereas age, sex, LVEF, diabetes, hypertension, and eGFR were not significant predictors. All-cause mortality was low (9.6%) and did not differ between groups (11.1% vs. 8.7%, p = 0.669).</span></span></span></p> <p style="text-align:justify"><span style="font-size:18px"><span style="font-family:"Times New Roman",serif"><strong><span style="font-family:"Calibri",sans-serif">Conclusion</span></strong><br /> <span style="font-family:"Calibri",sans-serif">In this real-world HF clinic cohort, microalbuminuria was independently associated with a higher incidence of unplanned visits and hospitalisations, identifying patients at increased risk of recurrent decompensations. MA may represent a simple, low-cost biomarker of clinical instability in ambulatory heart failure management.</span></span></span></p>
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