Evaluation of the Relationship Between Uric Acid Levels and Etiology in Patients With Heart Failure

Abstract

Background: Uric acid is the final product of purine metabolism in humans, and its relationship with cardiovascular diseases has been investigated in many studies. However, there are limited studies evaluating serum uric acid levels in patients with ischemic and dilated cardiomyopathy. The aim of this study is to compare serum uric acid levels in patients with ischemic (ICMP) and dilated cardiomyopathy (DCMP).

Methods: A total of 115 patients with low ejection fraction heart failure who were admitted to our clinic between January 2016 and June 2018 and 55 age-sex matched control were included in this study. Patients with low ejection fraction heart failure were divided into two groups as follows: ICMP (n = 69) and DCMP (n = 46).

Results: There was no statistically significant difference between ICMP and DCMP groups in terms of gender, body mass index, used drugs and frequency of arrhythmias. However, age, the frequency of hypertension, hyperlipidemia, coronary artery disease (CAD), history of familial CAD and smoking were significantly higher in ICMP group. When both groups were compared in terms of laboratory characteristics, it was found observed that uric acid value was significantly higher in ICMP group (6.9 ± 1.9 vs. 6.3 ± 1.2, p=0.029).

Conclusion: In our study, it was found that serum uric acid level was significantly higher in heart failure patients with ICMP compared to patients with DCMP.

Kalp Yetersizliği Hastalarında Ürik Asit seviyeleri ile Etiyoloji arasındaki İlişkinin Değerlendirilmesi

Abstract

Amaç: Ürik asit, insanlarda pürin metabolizması sonucunda meydana gelen son üründür ve pek çok çalışmada kardiyovasküler hastalıklar ile ilişkisi incelenmiştir. Ancak, iskemik ve dilate kardiyomiyopati hastalarında serum ürik asit seviyelerinin değerlendirildiği çalışmalar sınırlıdır. Çalışmamızın amacı, iskemik (İKMP) ve dilate kardiyomiyopati (DKMP) hastalarında serum ürik asit seviyelerini karşılaştırmaktır.

Materyal ve Metod: Bu çalışmaya kliniğimizde Ocak 2016 ile Haziran 2018 tarihleri arasında düşük ejeksiyonfraksiyonlu kalp yetersizliği nedeniyle yatmış olan 115 hasta ve yaş-cinsiyet eşleştirmesi yapılan 55 kontrol hastası alındı. DEFKY’li hastalar İKMP olanlar (n=69) ve DKMP olan hastalar (n=46) olarak iki gruba ayrıldı.

Bulgular: İKMP ve DKMP grupları arasında; cinsiyet, vücut kitle indeksi, kullanılan ilaçlar ve aritmi görülme sıklığı açısından anlamlı bir farklılık saptanmadı. Ancak, İKMP grubunda yaş, hipertansiyon, hiperlipidemi, koroner arter hastalığı (KAH) varlığı, ailede KAH öyküsü ve sigara içiciliği sıklığı anlamlı olarak daha fazla idi. Her iki grup, laboratuvar özellikleri açısından karşılaştırıldıklarında; İKMP grubunda ürik asit değerinin anlamlı olarak daha yüksek olduğu saptandı (6.9 ± 1.9’a karşın 6.3 ± 1.2, p=0.029).

Sonuç: Çalışmamızda, İKMP’li kalp yetersizliği hastalarında serum ürik asit düzeyinin DKMP‘li kalp yetersizliği hastalarına göre anlamlı olarak yüksek olduğu tespit edildi.

Keywords

• Kalp yetersizliği,Kardiyomiyopati

References

1. KAYNAKLAR1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. ESC Scientific Document Group. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016 14;37(27): 2129-200.2. Redfield MM, Jacobsen SJ, Burnett JC, Mahoney DW, Bailey KR, Rodeheffer RJ. Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA 2003;289:194–202.3. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Colvin MM, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Card Fail. 2017 23(8):628-51.4. Baig K, Mahon N, McKenna WJ, Caforio AL, Bonow RO, Francis GS, et al. The pathophysiology of advanced heart failure. Am Heart J 1998;135:216-30.5. Braunwald E. Congestive Heart Failure: a half century perspective. Eur Heart J 2001;22: 825-36.6. Gertler MM, Garn SM, Levıne SA. Serum uric acid in relation to age and AQ5 physique in health and in coronary heart disease. Ann Intern Med 1951; 34: 1421–31. 7. Verdecchia P, Schillaci G, Reboldi G, Santeusanio F, Porcellati C, Brunetti P. Relation between serum uric acid and risk of cardiovascular disease in essential hypertension. The PIUMA study. Hypertension 2000; 36: 1072–8. 8. Fang J, Alderman MH. Serum uric acid and cardiovascular mortality the NHANES I epidemiologic follow-up study, 1971–1992. National Health and Nutrition Examination Survey. JAMA 2000; 283:2404–10. 9. Liese AD, Hense HW, Löwel H, Döring A, Tietze M, Keil U. Association of serum uric acid with all-cause and cardiovascular disease mortality and incident myocardial infarction in the MONICA Augsburg cohort. World Health Organization Monitoring Trends and Determinants in Cardiovascular Diseases. Epidemiology 1999; 10: 391–7.10. Baker JF, Krishnan E, Chen L, Schumacher HR. Serum uric acid and cardiovascular disease: recent developments, and where do they leave us. Am J Med. 2005;118:816-26. 11. Khan A, Shah MH, Khan S, Shamim U, Arshad S. Serum Uric Acid level in the severity of Congestive Heart Failure (CHF). Pak J Med Sci. 2017;33(2):330-4.12. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015 28(1):1-39.e14.13. D.I. Feig, D.H. Kang, R.J. Johnson. Uric acid and cardiovascular risk, N. Engl. J. Med. 359 (2008) 1811–21.14. K. Ogino, M. Kato, Y. Furuse, Kinugasa Y, Ishida K, Osaki S, et al. Uric acid-lowering treatment with benzbromarone in patients with heart failure: a double-blind placebo controlled crossover preliminary study, Circ. Heart Fail. 3 (2010) 73–81.15. Amado LC, Saliaris AP, Raju SV, Lehrke S, St John M, Xie J, et al. Xanthine oxidase inhibition ameliorates cardiovascular dysfunction in dogs with pacing-induced heart failure. J Mol Cell Cardiol. 2005 39(3):531-6.16. Minhas KM, Saraiva RM, Schuleri KH, Lehrke S, Zheng M, Saliaris AP, et al. Xanthine oxidoreductase inhibition causes reverse remodeling in rats with dilated cardiomyopathy. Circ Res. 2006 3;98(2):271-9.17. Ponikowski P, Jankowska EA. Patogenia y presentacio´n clı´nica de la insuficiencia cardiaca aguda. Rev Esp Cardiol. 2015;68: 331–7.18. Leyva F, Anker SD, Godsland IF, Teixeira M, Hellewell PG, Kox WJ, et al. Uric acid in chronic heart failure: a marker of chronic inflammation. Eur Hear J. 1998;19: 1814-22.19. Anker SD, Doehner W, Rauchhaus M, Sharma R, Francis D, Knosalla C, et al. Uric acid and survival in chronic heart failure: validation and application in metabolic, functional, and hemodynamic staging. Circulation. 2003 22;107(15):1991-7.20. E. Krishnan, Gout and the risk for incident heart failure and systolic dysfunction, BMJ Open 2 (2012) e000282.21. Patetsios P, Song M, Shutze WP, Pappas C, Rodino W, Ramirez JA, et al. Identification of uric acid and xanthine oxidase in atherosclerotic plaque. Am J Cardiol. 2001 15;88(2):188-91. 22. Athyros VG, Elisaf M, Papageorgiou AA, Symeonidis AN, Pehlivanidis AN, Bouloukos VI, et al. Effect of statins versus untreated dyslipidemia on serum uric acid levels in patients with coronary heart disease: a subgroup analysis of the GREek Atorvastatin and Coronary-heart-disease Evaluation (GREACE) study. Am J Kidney Dis 2004;43: 589-99 GREACE Study Collaborative Group.23. Hoieggen A, Alderman MH, Kjeldsen SE, Julius S, Devereux RB, De Faire U, et al. LIFE Study Group. The impact of serum uric acid on cardiovascular outcomes in the LIFE study. Kidney Int. 2004 65(3):1041-9. 24. Raja R, Kavita F, Amreek F, Shah A, Sayeed KA, Sehar A. Hyperuricemia Associated with Thiazide Diuretics in Hypertensive Adults. Cureus. 2019 22;11(8):e5457.