» Articles » PMID: 24077169

Association of Low-grade Albuminuria with Adverse Cardiac Mechanics: Findings from the Hypertension Genetic Epidemiology Network (HyperGEN) Study

Abstract

Background: Albuminuria is a marker of endothelial dysfunction and has been associated with adverse cardiovascular outcomes. The reasons for this association are unclear but may be attributable to the relationship between endothelial dysfunction and intrinsic myocardial dysfunction.

Methods And Results: In the Hypertension Genetic Epidemiology Network (HyperGEN) Study, a population- and family-based study of hypertension, we examined the relationship between urine albumin-to-creatinine ratio (UACR) and cardiac mechanics (n=1894, all of whom had normal left ventricular ejection fraction and wall motion). We performed speckle-tracking echocardiographic analysis to quantify global longitudinal, circumferential, and radial strain, and early diastolic (e') tissue velocities. We used E/e' ratio as a marker of increased left ventricular filling pressures. We used multivariable-adjusted linear mixed effect models to determine independent associations between UACR and cardiac mechanics. The mean age was 50±14 years, 59% were female, and 46% were black. Comorbidities were increasingly prevalent among higher UACR quartiles. Albuminuria was associated with global longitudinal strain, global circumferential strain, global radial strain, e' velocity, and E/e' ratio on unadjusted analyses. After adjustment for covariates, UACR was independently associated with lower absolute global longitudinal strain (multivariable-adjusted mean global longitudinal strain [95% confidence interval] for UACR Quartile 1 = 15.3 [15.0-15.5]% versus UACR Q4 = 14.6 [14.3-14.9]%, P for trend <0.001) and increased E/e' ratio (Q1 = 25.3 [23.5-27.1] versus Q4 = 29.0 [27.0-31.0], P=0.003). The association between UACR and global longitudinal strain was present even in participants with UACR < 30 mg/g (P<0.001 after multivariable adjustment).

Conclusions: Albuminuria, even at low levels, is associated with adverse cardiac mechanics and higher E/e' ratio.

Citing Articles

The relationship between low levels of albuminuria and mortality among adults without major cardiovascular risk factors.

Claudel S, Waikar S, Schmidt I, Vasan R, Verma A Eur J Prev Cardiol. 2024; 31(17):2046-2055.

PMID: 38825979 PMC: 11629963. DOI: 10.1093/eurjpc/zwae189.


The role of aetiology in cardiac manifestations of chronic kidney disease: the CPH-CKD ECHO study.

Christensen J, Landler N, Olsen F, Sorensen I, Bjergfelt S, Ballegaard E Int J Cardiovasc Imaging. 2024; 40(6):1221-1233.

PMID: 38687429 PMC: 11213755. DOI: 10.1007/s10554-024-03092-0.


Multi-Ethnic Study of Atherosclerosis Early Heart Failure Study: Rationale, Design, and Baseline Characteristics.

Beussink-Nelson L, Freed B, Chirinos J, Brubaker P, Kitzman D, Yeboah J Circ Heart Fail. 2024; 17(3):e010289.

PMID: 38456289 PMC: 11073782. DOI: 10.1161/CIRCHEARTFAILURE.122.010289.


The relationship between low levels of albuminuria and cardiovascular mortality among apparently healthy adults.

Claudel S, Waikar S, Schmidt I, Vasan R, Verma A medRxiv. 2024; .

PMID: 38196576 PMC: 10775339. DOI: 10.1101/2023.12.21.23300378.


Association of Thyroid Dysfunction in Individuals ≥ 65 Years of Age With Subclinical Cardiac Abnormalities.

Barasch E, Gottdiener J, Buzkova P, Cappola A, Shah S, deFilippi C J Clin Endocrinol Metab. 2024; 109(10):e1847-e1856.

PMID: 38183678 PMC: 11403323. DOI: 10.1210/clinem/dgae001.


References
1.
Djousse L, Kochar J, Hunt S, North K, Gu C, Tang W . Relation of albuminuria to left ventricular mass (from the HyperGEN Study). Am J Cardiol. 2008; 101(2):212-6. DOI: 10.1016/j.amjcard.2007.07.065. View

2.
Smilde T, Damman K, van der Harst P, Navis G, Westenbrink B, Voors A . Differential associations between renal function and "modifiable" risk factors in patients with chronic heart failure. Clin Res Cardiol. 2008; 98(2):121-9. DOI: 10.1007/s00392-008-0732-z. View

3.
Wang T, Evans J, Meigs J, Rifai N, Fox C, DAgostino R . Low-grade albuminuria and the risks of hypertension and blood pressure progression. Circulation. 2005; 111(11):1370-6. DOI: 10.1161/01.CIR.0000158434.69180.2D. View

4.
Jensen J, Borch-Johnsen K, Jensen G, Feldt-Rasmussen B . Microalbuminuria reflects a generalized transvascular albumin leakiness in clinically healthy subjects. Clin Sci (Lond). 1995; 88(6):629-33. DOI: 10.1042/cs0880629. View

5.
Deckert T, Yokoyama H, Mathiesen E, Ronn B, Jensen T, Feldt-Rasmussen B . Cohort study of predictive value of urinary albumin excretion for atherosclerotic vascular disease in patients with insulin dependent diabetes. BMJ. 1996; 312(7035):871-4. PMC: 2350594. DOI: 10.1136/bmj.312.7035.871. View