Urine albumin to creatinine ratio and echocardiographic left ventricular structure and function in patients with essential hypertension.
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 %.


CONCLUSIONS
In patients with uncomplicated essential hypertension, abnormal systolic and diastolic LV function and geometry cannot be effectively predicted by the appearance of microalbuminuria.
Internist and Cardiologist Sub Special, Faculty Of Medicine, Elam University Of Medical Sciences, Elam.
Rohola
R
Hemmati
Biochemistry Department, Isfahan Cardiovascular Research Center (WHO collaborating center in EMR), Isfahan Cardiovascular Research Isfahan University of Medical Science, PO Box 81465-1148, Isfahan, Iran. E: gharipour@crc.mui.ac.ir.
Mojgan
M
Gharipour
Cardiologist, Faculty of Medicine.
Hasan
H
Shemirani
Cardiologist, Hypertension Research Center.
Alireza
A
Khosravi
Hypertension Research Centre, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan.
Elham
E
Khosravi