Prognostic value of albuminuria in heart failure with preserved ejection fraction: A systematic review

Albuminuria has emerged as a potential marker of cardiorenal and microvascular dysfunction in heart failure with preserved ejection fraction (HFpEF). We conducted a systematic review to evaluate its prognostic significance in this population.

A systematic search of PubMed, Embase, and Scopus was performed according to PRISMA recommendations. Studies evaluating albuminuria, proteinuria, or related urinary biomarkers in adults with HFpEF and reporting clinical outcomes were included.

Fourteen studies were identified, including post hoc analyses of randomized trials and observational cohorts. Albuminuria was consistently associated with higher risks of mortality, heart failure hospitalization, and adverse cardiovascular outcomes. Several studies also demonstrated associations with incident HFpEF, myocardial remodeling, and cardiorenal dysfunction. The prognostic value of albuminuria was independent of renal function and was observed across different methods of urinary protein assessment.

Albuminuria is a robust marker of adverse prognosis in HFpEF and may reflect underlying cardiorenal and microvascular dysfunction. Its routine assessment could improve risk stratification and facilitate identification of high-risk phenotypes.