#5787 ALBUMINURIA IN PATIENTS ADMITTED WITH HEART FAILURE IS ASSOCIATED WITH MORE SYSTEMIC CONGESTION ASSESSED BY ULTRASOUND
Authors: Kontareva Natalia , Khruleva Yulia , Andriamanohery Robinson Tsimine , Misan Irina , Aslan Rena , Efremovtseva Marina , Galochkin Svyatoslav , Kobalava Zhanna 
Published: June 2023

Abstract

Background and Aims
Albuminuria is frequently observed in patients with heart failure (HF) and is associated with worse outcomes. New instrumental methods of congestion assessment in HF are superior in accuracy to physical examination and, therefore, are becoming the new standards for congestion registration. The relationship of albuminuria with congestion assessed by ultrasound in HF population is unclear. We aimed to investigate the relationship between albuminuria level and congestion measured by lung ultrasound (LUS) and Venous Excess Ultrasound (VExUS) at admission in patients with ADHF.

Method
In this prospective study we included 58 patients which were admitted with ADHF (typical signs and symptoms with NT-proBNP &gt; 300 pg/ml). Patients with end-stage chronic kidney disease (CKD), malignancy were excluded. Routine clinical examination and laboratory tests, echocardiography, eight-zone LUS, and VExUS assessment of veins: cava inferior, hepatic, portal, and renal were performed. Patients were divided into two groups according to albumin/creatinine ratio at hospitalization: without albuminuria (uACR&lt;30 mg/gCr) and with albuminuria (uACR&gt;30 mg/gCr).

Results
72% were male, mean age was 72 (55;79) (Me (IQR) years, 52% (n = 30) had reduced ejection fraction (EF), 77% - hypertension (HTN), 66% - atrial fibrillation (AF), 37% - diabetes mellites (DM), 58% - coronary artery disease (CAD), 17% (n = 10) - previously known CKD. On physical examination at admission 67% (n = 39) patients had orthopnea,69% (n = 40) - exertional dyspnea, 53.4% (n = 31) - elevated jugular venous pressure, 91.4% (n = 53) - ankle edema, 50% (n = 29) - hepatomegaly and 82.8% (n = 48) pulmonary crepitations. Mean NT-proBNP was 2062 (13443248) (Me (IQR)) pg/ml. 49 (84%) had pulmonary congestion assessed by LUS (mean number of B-lines 34 (25;48)), 86% (n = 50) – congestion by VExUS, from which the majority of patients had the most severe, 3rd, grade (1st – 32%, 2nd – 16%, 3rd – 52%). The prevalence of albuminuria was 65.5% (n = 38): 92% (n = 35/38) patients had albuminuria categories A2 and 8% (n = 3/38) had A3 category. Groups with and without albuminuria were similar in gender, age, prevalence of EF&lt;40%, comorbidities, exertional dyspnea, orthopnea, elevated jugular venous pressure, hepatomegaly, pulmonary crepitations, levels of NT-proBNP and serum creatinine. Differences between groups with and without albuminuria were detected in the frequency of ankle swelling (100%(n = 38/38) vs 75% (n = 15/20), p = 0.003). Patients with albuminuria had a trend to more frequently having pulmonary congestion than without albuminuria (89% (n = 34/38) and 75% (n = 15/20), p = 0.15 respectively). The prevalence of congestion assessed by VExUS was higher in patients with albuminuria (95% (n = 36/38) and 70% (n = 14/20), p = 0.009 respectively).

Conclusion
In patients hospitalized with ADHF albuminuria is associated with systemic congestion assessed by VExUS. The relationship between pulmonary congestion by LUS and albuminuria should be a matter of future studies.