Dynamic Urinary Albumin/Creatinine Ratio Patterns Predict Adverse Outcomes in HFpEF: TOPCAT Cohort Analysis

Area of Science:

• Cardiology
• Nephrology
• Clinical Trials

Background:

• Urinary albumin-to-creatinine ratio (uACR) is a known cardiovascular risk marker.
• Dynamic uACR changes in heart failure with preserved ejection fraction (HFpEF) are not well understood.

Purpose of the Study:

• To identify distinct uACR trajectory patterns in HFpEF patients.
• To investigate the association of these patterns with clinical outcomes.

Main Methods:

• Latent Class Trajectory Modeling was used to analyze uACR data from 746 HFpEF patients in the TOPCAT trial.
• Cox proportional hazards models assessed the link between identified uACR trajectories and adverse cardiovascular events.

Main Results:

• Three uACR patterns were identified: stable (70.5%), decreasing (16.5%), and fluctuating high (13.0%).
• The fluctuating high group had significantly higher rates of cardiovascular death, aborted cardiac arrest, or HF hospitalization.
• The decreasing trajectory group showed a potential association with myocardial infarction.

Conclusions:

• This study first identified distinct uACR trajectory patterns in HFpEF.
• A fluctuating high uACR trajectory is linked to increased cardiovascular risk and HF hospitalization.
• The association of a decreasing uACR trajectory with myocardial infarction requires further validation.