The Relationship Between C-Reactive Protein to Albumin Ratio and Heart Failure in Patients with Atrial Fibrillation

INTRODUCTION: Heart failure (HF) is associated with morbidity, mortality, and diminished quality of life. One of the most common etiological factors for HF is atrial fibrillation (AFib). The development of HF during the course of AFib causes patients both to reveal HF’s ominous outcomes and the worsening of AFib. Previous studies have shown that HF is associated with systemic inflammation, elevated C-reactive protein (CRP), and decreased serum albumin (SA) levels; however, the predictive value of the CRP to SA ratio (CAR) for diagnosing HF in patients with AFib is not fully demonstrated. This study aims to elucidate the diagnostic value of CAR in predicting the development of HF in AFib patients.
METHODS: This retrospective study comprised 279 patients with permanent AFib attending our outpatient clinic. The study population was categorized into two groups based on left ventricular ejection fraction (LVEF): patients with LVEF <40% and those with LVEF ≥40%.
RESULTS: In the study cohort, 75 patients (26.9%) were identified with HF with reduced ejection fraction (HFrEF). Patients with HFrEF exhibited elevated levels of neutrophils, CRP, and CAR, along with increased left ventricular end-diastolic diameter (LVEDD) and left atrial volume index (LAVI). Multivariate analyses demonstrated that LVEDD, LAVI, CRP, and CAR (OR: 1.414, 95% CI: 1.182–1.692; p<0.001) were independent predictors of HFrEF in patients with AFib.
DISCUSSION AND CONCLUSION: The relationship between HF presence and CAR in AFib patients has been revealed in the present study. Evaluation of CAR may be useful in diagnosing or anticipating HF in the course of AFib.

Keywords: Albumin, atrial fibrillation, C-reactive protein, heart failure