Original Contribution
Am Heart Hosp J. 2011;9(2):90–4
Urine Albumin to Creatinine Ratio and Echocardiographic Left Ventricular Structure and Function in Patients with Essential Hypertension
Rohola Hemmati, MD,1 Alireza Khosravi, MD4
Mojgan Gharipour, MSc,2 and Elham Khosravi, MD5
Hasan Shemirani, MD,3
Background: Appearance of microalbuminuria, particularly in patients with hypertension, might be associated with a higher prevalence of left ventricular (LV) dysfunction and geometric abnormalities. This study was undertaken to determine whether high urine albumin to creatinine ratio (UACR) as a sensitive marker for microalbuminuria can be associated with LV hypertrophy (LVH) and systolic and diastolic LV dysfunction. Methods: The study population consisted of 125 consecutive patients with essential uncomplicated hypertension. Urine albumin and creatinine concentration was determined by standard methods. LVH was defined as a LV mass index >100 g/m2 of body surface area in women and >130 g/m2 in men. Echocardiographic LV systolic and diastolic parameters were measured. Results: The prevalence of microalbuminuria in patients with essential hypertension was 5.6 %. UACR was significantly no different in patients with LVH than in patients with normal LV geometry (21.26 ± 31.55 versus 17.80 ± 24.52 mg/mmol). No significant correlation was found between UACR measurement and systolic and diastolic function parameters, including early to late diastolic peak velocity (E/A) ratio (R=-0.192, p=0.038), early diastolic peak velocity to early mitral annulus velocity (E/E’) ratio (R=-0.025, p=0.794), LV ejection fraction (R=0.008, p=0.929), and LV mass (R=-0.132, p=0.154). According to the receiver operator characteristic (ROC) curve analysis, UACR measurement was not an acceptable indicator of LVH with areas under the ROC curves 0.514 (95 % confidence interval 0.394–0.634). The optimal cut-off value for UACR for predicting LVH was identified at 9.4, yielding a sensitivity of 51.6 % and a specificity of 48.3 %. Conclusion: In patients with uncomplicated essential hypertension, abnormal systolic and diastolic LV function and geometry cannot be effectively predicted by the appearance of microalbuminuria.
E
levation of urine albumin to creatinine ratio (UACR) as a sensitive marker for microalbuminuria is associated with increased heart diseases risk.1–3 Like other risk factors for coronary artery disease such as advanced age, diabetes mellitus, and systolic hypertension, microalbuminuria has been associated with atherosclerotic risk factors,4,5
increased cardiovascular morbidity and mortality.8 and colleagues9,10
Jensen demonstrated that an increased UACR
was a risk factor for arteriosclerosis in patients with hypertension and in healthy subjects because they had an increased transcapillary albumin escape rate.11
and is thought to reflect microvascular damage in the glomeruli and in the systemic vasculature6 with increasing risk of lipid insudation and development of atherosclerosis.7
However, albuminuria, reflecting
systemic microvascular damage, and left ventricular (LV) geometric abnormalities have been shown to predict
Albuminuria-related cardiovascular risk is potentially extended to patients with hypertension and LV hypertrophy (LVH). Some studies reported that patients with microalbuminuria, particularly hypertensive groups, have a higher prevalence of LVH,12
which might also contribute to the increased cardiovascular mortality observed in patients
• 1. Internist and Cardiologist Sub Special, Faculty Of Medicine, Elam University Of Medical Sciences, Elam; 2. Biochemistry Department, Isfahan Cardiovascular Research Centre; 3. Cardiologist, Faculty of Medicine; 4. Cardiologist, Hypertension Research Center; 5. Hypertension Research Centre, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan.
• Correspondence: Mojgan Gharipour, MSc, Isfahan Cardiovascular Research Center (WHO collaborating center in EMR), Isfahan Cardiovascular Research Institute, Isfahan University of Medical Science, PO Box 81465-1148, Isfahan, Iran. E:
gharipour@crc.mui.ac.ir
90 Urine Albumin to Creatinine Ratio and Echocardiographic Left Ventricular Structure and Function in Patients with Hypertension Winter 2011
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