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In addition, excess CysC may promote myocardial fibrosis and ventricular hypertrophy and increase atrial volume.135,136 CysC is a strong risk factor for new onset HFpEF ( Table 3 ),137 and it is significantly associated with the NYHA classification, even after adjustment for eGFR.138 Besides, CysC is a strong and independent predictor of an unfavourable outcome on admission in HFpEF.139 In chronic HFpEF, CysC tended to be associated with death or HF admission, but without meeting significance in the multivariable analysis ( Table 3 ).116 Urinary Albumin Excretion Increased urinary albumin excretion (UAE) is considered to be an early marker of kidney damage