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Serum uric acid and outcomes in patients with chronic heart failure through the whole spectrum of ejection fraction phenotypes: Analysis of the ESC-EORP Heart Failure Long-Term (HF LT) Registry

Published:April 23, 2021DOI:https://doi.org/10.1016/j.ejim.2021.04.001

      Highlights

      • sUA contributes to microvascular inflammation and dysfunction in HF.
      • Elevated serum uric acid (sUA) levels predict poor outcome in heart failure (HF).
      • Role of sUA across left ventricular ejection fraction (LVEF) phenotypes is unknown.
      • Prognostic role of high sUA was shown in HF patients with reduced or preserved LVEF.

      Abstract

      Background

      Retrospective analyses of clinical trials indicate that elevated serum uric acid (sUA) predicts poor outcome in heart failure (HF). Uric acid can contribute to inflammation and microvascular dysfunction, which may differently affect different left ventricular ejection fraction (LVEF) phenotypes. However, role of sUA across LVEF phenotypes is unknown.

      Objectives

      We investigated sUA association with outcome in a prospective cohort of HF patients stratified according to LVEF.

      Methods

      Through the Heart Failure Long-Term Registry of the European Society of Cardiology (ESC-EORP-HF-LT), 4,438 outpatients were identified and classified into: reduced (<40% HFrEF), mid-range (40–49% HFmrEF), and preserved (≥50% HFpEF) LVEF. Endpoints were the composite of cardiovascular death/HF hospitalization, and individual components.

      Results

      Median sUA was 6.72 (IQ:5.48-8.20) mg/dl in HFrEF, 6.41 (5.02-7.77) in HFmrEF, and 6.30 (5.20-7.70) in HFpEF. At a median 372-day follow-up, the composite endpoint occurred in 648 (13.1%) patients, with 176 (3.6%) deaths and 538 (10.9%) HF hospitalizations. Compared with lowest sUA quartile (Q), Q-III and Q-IV were significantly associated with the composite endpoint (adjusted HR 1.68: 95% CI 1.11–2.54; 2.46: 95% CI 1.66–3.64, respectively). By univariable analyses, HFrEF and HFmrEF patients in Q-III and Q-IV, and HFpEF patients in Q-IV, showed increased risk for the composite endpoint (P<0.05 for all); after model-adjustment, significant association of sUA with outcome persisted among HFrEF in Q-IV, and HFpEF in Q-III-IV.

      Conclusions

      In a large, contemporary-treated cohort of HF outpatients, sUA is an independent prognosticator of adverse outcome, which can be appreciated in HErEF and HFpEF patients.

      Graphical abstract

      Keywords

      Abbreviations:

      sUA (serum uric acid), HF (heart failure), LVEF (left ventricular ejection fraction), HFrEF (heart failure with reduced ejection fraction), HFmrEF (heart failure with mid-range ejection fraction), HFpEF (heart failure with preserved ejection fraction), NYHA (New York Heart Association), MDRD (Modification of Diet in Renal Disease)
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