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Evaluation of cardiovascular risk in stages of gout by a complex multimodal ultrasonography
Rada Gancheva1, Atanas Kundurdjiev2, Mariana Ivanova3
1Department of Internal Medicine, Medical Faculty, Clinic of Rheumatology, Medical University, University Hospital St. Iv. Rilski, 13, Urvich St., 1612, Sofia, Bulgaria. rada_ga@mail.bg.
Insights
Gout with tophi significantly increases the risk of carotid artery changes and intima-media thickness, indicating advanced cardiovascular risk. Earlier gout stages and asymptomatic hyperuricemia do not show these effects.
Area of Science:
- Cardiovascular Medicine
- Rheumatology
- Medical Imaging
Background:
- Gout is a metabolic disorder associated with increased cardiovascular (CV) risk.
- The progression of gout and its impact on CV risk markers require further investigation.
- Ultrasound imaging offers a non-invasive method to assess CV structures and risk.
Purpose of the Study:
- To evaluate ultrasound-assessed CV risk markers across different stages of gout.
- To determine the association between gout severity (asymptomatic hyperuricemia, gout without tophi, gout with tophi) and specific ultrasound parameters.
Main Methods:
- A cross-sectional multimodal ultrasound study included 169 patients stratified into four groups: asymptomatic hyperuricemia, gout without tophi, gout with tophi, and osteoarthritis controls.
- Key CV risk parameters measured included renal resistive index (RRI), left ventricular mass index (LVMi), mitral annulus early diastolic velocity (e'), intima-media thickness (IMT), and common carotid artery resistive index (CCARI).
- Multivariate analyses were employed to assess the influence of gout stages and traditional CV risk factors on ultrasound findings.
Main Results:
- Gout with tophi significantly increased the odds of having increased intima-media thickness (IMT >0.90 mm) (OR 11.51, p=0.003) and elevated common carotid artery resistive index (CCARI >0.70) (OR 11.18, p=0.001).
- Gout without tophi also raised the risk of increased IMT (OR 6.25, p=0.018) but did not affect CCARI.
- Asymptomatic hyperuricemia did not show a significant impact on IMT or CCARI. Gout stages did not influence LVMi, e', or RRI.
Conclusions:
- The presence of tophi in gout is strongly associated with worsened ultrasonographic parameters of target organ damage, particularly carotid artery changes.
- Tophi represent a significant risk factor for carotid artery alterations, independent of arterial hypertension.
- Early stages of gout and asymptomatic hyperuricemia do not appear to significantly impact these specific CV ultrasound markers.
Abstract:
The aim of our work was to assess ultrasound features of cardiovascular (CV) risk in stages of gout. Cross-sectional complex multimodal ultrasound study of 169 age-matched patients, with similar distribution of arterial hypertension, diabetes mellitus, obesity and chronic renal failure, was divided into four groups: 41 with asymptomatic hyperuricemia, 52 gout without tophi, 42 gouty tophi and 34 controls with osteoarthritis. Parameters independently associated with CV risk were measured: renal resistive index (RRI), left ventricular mass index (LVMi), mitral annulus early diastolic velocity (e'), intima-media thickness (IMT) and common carotid artery resistive index (CCARI). Multivariate analyses were performed to evaluate the impact of gout stages and CV risk factors on ultrasound alterations. Gouty tophi increased the risk of having IMT >0.90 mm with an OR 11.51 (95 % CI 2.32-57.21, p = 0.003), gout without tophi raised the risk with an OR 6.25 (95 % CI 1.37-28.44, p = 0.018), while asymptomatic hyperuricemia had no effect on IMT. The category of CCARI >0.70 was influenced by tophi with an OR 11.18 (95 % CI 2.61-47.83, p = 0.001) and by arterial hypertension with an OR 3.22 (95 % CI 1.11-9.36, p = 0.032). Neither asymptomatic hyperuricemia nor gout without tophi modified the development of abnormally high CCARI. Gout stages had no impact on LVMi, e' and RRI. Tophi are related to worsened ultrasonographic parameters evaluating target organs in gout, relative to earlier stages of the disease. They create a strong risk of carotid arteries' changes even beyond arterial hypertension.
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