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
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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 23, 2021
Accepted:
April 4,
2021
Received in revised form:
March 8,
2021
Received:
December 9,
2020
Editor: G AgnelliIdentification
Copyright
© 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
