Background
Hypoalbuminemia is frequently observed in patients with established left heart failure (LHF) and is independently associated with increased mortality risk. The aim of the present study is to determine the impact of pulmonary hypertension (PH) secondary to LHF, on hepatic synthetic function, and the relationship between serum albumin levels and survival.
Methods and Results
Of 431 patients with chronic LHF who underwent right heart catheterization, 292 presented with PH. Right atrial pressures (RAP) were higher (13.3±6.6 mmHg vs. 5.8±3.1 mmHg, p = 0.0001), while albumin serum levels were lower (3.55±0.53 mg/dl vs. 3.75±0.52 mg/dl, p = 0.009) in patients with PH as compared with those without PH.
During the follow-up (median 33.9 months), 41.7% of patients with PH died, as compared with only 18.4% in the HF and no-PH group. In an univariate Cox proportional model, the hazard ratio (HR) for all-cause mortality for serum albumin level, as a continuous variable, was 0.54 (95% confidence interval (95%CI) 0.38-0.78, p = 0.001). After adjustment for age, gender, RAP, pulmonary capillary wedge pressure, estimated GFR and pulmonary hypertension, the HR was 0.57 (95%CI 0.38-0.87, p = 0.001), indicating a 43% increase in all-cause mortality for every 1 gm/dl reduction in serum albumin level.
Conclusion
In patients with chronic left heart failure and pulmonary hypertension, elevated right heart filling pressures may affect the hepatic synthetic function. Albumin serum levels have significant consequences on the outcome of these patients.
