Does the BUN/Cr Ratio Confer a Worse Prognosis in All Ejection Fraction Spectra?

Neurohormonal activation is one of the most relevant pathophysiological features in Heart Failure (HF), promoting long-term deleterious effects that contribute to the development of cardiorenal syndrome. This hyperactivation is associated with the prognosis of acute heart failure; therefore, it is plausible to hypothesize that its activity is associated with the prognosis of heart failure.

The current universal classification of heart failure, updated in 2021, modified the classification of HF according to ejection fraction (EF), replacing the mid-range EF (HFmrEF) with mildly reduced EF for those with an EF of 41% to 49%, maintaining the classification of reduced ejection fraction (HFrEF) for those with EF less than 40% and preserved (HFpEF) for patients with EF above 50%. The most used classification system today is based on this categorization of patients into groups based on left ventricular ejection fraction (LVEF), and this model has become the main model used by guidelines to provide recommendations for treatment.

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