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Effect of serum albumin levels in patients with heart failure with preserved ejection fraction (from the TOPCAT trial)

The American Journal of Cardiology Nov 29, 2019

Prenner SB, Kumar A, Zhao L, et al. - By utilizing data from 3,254 individuals enrolled the TOPCAT trial, researchers assessed the phenotypic correlates of albumin and its independent prognostic implications in Heart Failure with Preserved Ejection Fraction (HFpEF). They found the link of lower albumin with older age, black race, and greater prevalence of NYHA class III-IV, peripheral arterial disease, atrial fibrillation and diabetes mellitus. Increased levels of many inflammatory biomarkers, markers of liver fibrosis, albuminuria, and greater arterial stiffness, diastolic dysfunction and pulmonary hypertension were also observed in relation to lower albumin. They identified a strong link of lower albumin with a worse prognosis even well within normal ranges (> 3.5 g/dL), with a sharp rise in risk between 4.6 and 3.6 g/dL. Experts concluded albumin as an integrated marker of many adverse processes in HFpEF, including inflammation, subclinical liver disease, arterial stiffness and renal disease. Independent of conventional risk prediction models, albumin affords a powerful risk predictor even within normal ranges.
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