European Journal of Cardiovascular Medicine

Heart failure constitutes a multifaceted clinical syndrome defined by diminished cardiac output and steadily worsening functional status.[1] Albuminuria, characterized by abnormal albumin excretion in urine, has gained recognition as a prognostic indicator of heightened disease severity among heart failure patients.[2] Growing research attention focuses on albuminuria's correlations with core heart failure parameters, including ejection fraction subtypes, NYHA functional categories, and concurrent medical conditions.[3]

This retrospective study offers an in-depth evaluation of albuminuria's interplay with heart failure clinical features—spanning ejection fraction, NYHA grading, comorbidities, and key physical findings—in 120 patients from rural Bihar. Such analysis promises to clarify albuminuria's role as a prognostic tool and its implications for optimizing heart failure therapeutic approaches.

Study Design A retrospective observational study conducted after ethical clearance from the Institutional Ethics Committee (IEC). Sample Size Records of 120 heart failure patients were analyzed. Study Period Data spanning May to November 2025 were reviewed, covering a 7-month period. Place of Study The study utilized patient records from a medical college in rural Bihar. Inclusion and Exclusion Criteria Inclusion Criteria • Age above 18 years • Heart failure patients encompassing preserved, midrange, and reduced ejection fractions were included in the analysis. Exclusion Criteria Patients with end-stage renal disease (ESRD), sepsis, urinary tract infection (UTI), chronic obstructive pulmonary disease (COPD), or ASA class 1 were excluded from the study. Methodology Data Extraction Information retrieval employed standardized patient charts and clinical documentation from medical files. Baseline characteristics, past medical history, coexisting conditions, and pharmacotherapy profiles were meticulously documented for all 120 subjects. Proteinuria Evaluation Urinary specimens received laboratory processing for albumin excretion through the albumin/creatinine clearance quotient (ACR), stratifying findings into normoalbuminuric (<30 mg/g), microalbuminuric (30-299 mg/g), or macroalbuminuric (≥300 mg/g) ranges. Cardiac Ultrasound Assessment Echocardiogram findings supplied left ventricular ejection fraction values, grouping participants into preserved (≥50%), mid-range (40-49%), or diminished (<40%) systolic function cohorts. Physical Assessment Parameters Examination features—encompassing basal crepitations, lower limb pitting edema, hepatic enlargement, recumbent dyspnea, and elevated jugular venous pressure—were extracted from clinical records to gauge fluid overload extent and NYHA performance status.

Table 1: Distribution of Heart Failure Presentation Types

Among the 120 heart failure patients analyzed, new-onset cases comprised 40% while worsening presentations accounted for 60% of the cohort suggesting advanced disease burden in this rural cohort.

Table 2: Heart Failure Classification by Ejection Fraction

Midrange and preserved ejection fraction categories each comprised 40% of the cohort, demonstrating balanced representation of systolic function phenotypes in this rural heart failure population.

Table 3: Albuminuria Categories

Abnormal albumin excretion dominated, affecting 91.7% of patients with near-equal micro- and macroalbuminuria distribution.

Table 4: Heart Failure Types versus Albuminuria Categories

Preserved EF showed strongest macroalbuminuria association (p=0.0014) while midrange EF linked significantly to microalbuminuria (p=0.0018).

Table 5: NYHA Functional Class versus Albuminuria Categories

NYHA class IV patients exhibited significantly higher macroalbuminuria prevalence (62.7%, p=0.0231), indicating a strong correlation between advanced functional limitation and severe albuminuria.

Table 6: Comorbidities versus Albuminuria Categories

Hypertension, diabetes, and prior MI all showed significant albuminuria associations (p<0.05), with myocardial infarction demonstrating strongest correlation.

Table 7: Physical Findings versus Albuminuria Categories

All fluid overload indicators demonstrated highly significant correlations with macroalbuminuria (all p<0.005), with basal crepitations showing the strongest association (p=0.0003).

Table 8: BMI Categories versus Albuminuria Levels

Obese patients trended toward higher macroalbuminuria prevalence (65.7%), though BMI categories overall showed no statistically significant association with albuminuria severity (p>0.05 where tested).

This retrospective analysis revealed strong correlations between albuminuria severity and specific heart failure phenotypes, particularly noting macroalbuminuria predominance among preserved ejection fraction cases (p=0.0014). These observations align with T.O.P.C.A.T trial data showing elevated albuminuria rates (33.9%) in HFpEF populations.[4] Conversely, C.H.A.R.M findings indicated greater albuminuria burden in reduced EF cohorts (33%) versus preserved EF groups (23%).[5]

Advanced NYHA functional class IV demonstrated significant macroalbuminuria elevation (p=0.0231), underscoring albuminuria's potential as a marker of heart failure decompensation severity. GISSI-HF results similarly documented higher micro/macroalbuminuria prevalence in NYHA III-IV patients (22.3%) compared to milder classes I-II (14.1%).[6]

Coexisting conditions—including hypertension (p=0.0186), diabetes mellitus (p=0.0342), and prior myocardial infarction (p=0.0084)—exhibited robust statistical links to abnormal albumin excretion in this rural Bihar cohort. Such patterns mirror ANCHOR study observations, where albuminuric HF patients showed markedly higher diabetes (38%) and hypertension (76%) frequencies.[7]

Macroalbuminuria's strong correlation with preserved ejection fraction positions it as a valuable identifier for higher-risk HFpEF patients prone to poor outcomes. Elevated macroalbuminuria rates among NYHA class IV cases further establish its utility as an indicator of advanced symptomatic heart failure burden. Albuminuria's significant ties to diabetes mellitus, hypertension, and prior myocardial infarction emphasize the need for comprehensive comorbidity screening in affected heart failure cohorts. Concurrently, macroalbuminuria patients' frequent presentation with basal crepitations, lower limb edema, hepatic enlargement, recumbent dyspnea, and raised jugular venous pressure underscores its role as a congestion severity biomarker in progressive heart failure. Financial support and sponsorship: Nil. Conflicts of interest: None declared.