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Albumin-to-globulin ratio predicts clinical outcomes of heart failure with preserved ejection fraction in women

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Abstract

Despite advances in medicine, heart failure with preserved ejection fraction (HFpEF) remains an increasing health concern associated with a high mortality rate. Research has shown sex-based differences in the clinical characteristics of patients with HF; however, definitive biomarkers for poor clinical outcomes of HFpEF in women are unavailable. We focused on the albumin-to-globulin ratio (AGR), a biomarker for malnutrition and inflammation and investigated its usefulness as a predictor of clinical outcomes of HFpEF in women. We measured the AGR in consecutive 224 women with HFpEF and 249 men with HFpEF. There were 69 cardiac events in women with HFpEF and 69 cardiac events in men with HFpEF during the follow-up period. The AGR decreased with advancing New York Heart Association functional class in women with HFpEF. Patients were categorized into three groups based on AGR tertiles. Kaplan–Meier analysis showed that among the three groups, the risk for cardiac events and HF-associated rehospitalizations was the highest in the lowest tertile in women with HFpEF. Univariate and multivariate Cox proportional hazard regression analyses showed that after adjustment for confounding risk factors, the AGR was an independent predictor of cardiac events and HF-associated rehospitalizations in women with HFpEF, but not in men with HFpEF. The addition of AGR to the risk factors significantly improved the net reclassification and integrated discrimination indices in women with HFpEF. This is the first study that highlights the significant association between the AGR and the severity and clinical outcomes of HFpEF in women. Addition of AGR to the risk factors improved its prognostic value for clinical outcomes, which indicates that this variable may serve as a useful clinical biomarker for HFpEF in women.

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Funding

This study was supported in part by a Grant-in-aid for Scientific Research (No. 21K16076 and 20K08486) from the Ministry of Education Culture, Sports, Science, and Technology. We would like to thank Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, Japan

    Yoichiro Otaki, Tetsu Watanabe, Shingo Tachibana, Junya Sato, Yuta Kobayashi, Yuji Saito, Tomonori Aono, Harutoshi Tamura, Shigehiko Kato, Satoshi Nishiyama, Hiroki Takahashi, Takanori Arimoto & Masafumi Watanabe

  2. Faculty of Medicine, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, Japan

    Mari Shimizu

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  1. Yoichiro Otaki
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  2. Mari Shimizu
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Correspondence to Tetsu Watanabe.

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Otaki, Y., Shimizu, M., Watanabe, T. et al. Albumin-to-globulin ratio predicts clinical outcomes of heart failure with preserved ejection fraction in women. Heart Vessels 37, 1829–1840 (2022). https://doi.org/10.1007/s00380-022-02087-y

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