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Close linkage between serum uric acid and cardiac dysfunction in patients with ischemic heart disease according to
Yoshiro Tanaka1, Tomohisa Nagoshi2, Makoto Kawai1
1Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
Insights
High serum uric acid (UA) levels are a significant cause of reduced left ventricular (LV) dysfunction, independent of other factors. This study clarifies the direct link between elevated UA and impaired LV ejection fraction (LVEF) in heart disease patients.
Area of Science:
- Cardiology
- Biochemistry
- Medical Research
Background:
- High serum uric acid (UA) is a suspected risk factor for left ventricular (LV) dysfunction.
- The precise relationship and causal links are unclear due to confounding factors.
Purpose of the Study:
- To examine the precise relationship between serum UA levels and LV dysfunction.
- To elucidate the cause-and-effect relationship using structural equation models.
Main Methods:
- Structural equation modeling and covariance structure analysis.
- Analysis of 1432 ischemic heart disease patients undergoing cardiac catheterization.
- Multiple regression analyses to determine causal pathways.
Main Results:
- High UA was a significant independent cause of reduced LV ejection fraction (LVEF).
- High UA significantly affected atherosclerosis severity (number of diseased coronary vessels).
- Reduced LVEF was also identified as a significant cause of high UA.
Conclusions:
- A close link and bidirectional cause-and-effect relationship exist between high serum UA and LV dysfunction.
- Elevated UA directly contributes to reduced LVEF and indirectly via atherosclerosis progression.
- LV dysfunction can also lead to increased UA levels.
Abstract:
High serum uric acid (UA) level has been assumed to be a risk factor for left ventricular (LV) dysfunction; however, the precise relationship between these conditions has not been fully examined because many confounding factors are associated with UA level. We herein examined the precise relationship by proposing structural equation models. The study population consisted of 1432 cases with ischemic heart disease who underwent cardiac catheterization. Multiple regression analyses and covariance structure analyses were performed to elucidate the cause-and-effect relationship between UA level and LV ejection fraction (LVEF). A path model exploring the factors contributing to LVEF showed that high UA was a significant cause of reduced LVEF (P = 0.004), independent of other significant factors. The degree of atherosclerosis, as estimated by the number of diseased coronary vessels, was significantly affected by high UA (P = 0.005); and the number of diseased coronary vessels subsequently led to reduced LVEF (P < 0.001). Another path model exploring the factors contributing to UA level showed that LVEF was a significant cause of high UA (P = 0.001), while other risk factors were also independent contributing factors. This study clearly demonstrated that there was a close link between high UA and LV dysfunction, which was represented by possible cause-and-effect relationship.
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