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Serum Uric Acid is Independently Associated with Diastolic Dysfunction in Apparently Healthy Subjects with Essential
Georgios Georgiopoulos1, Costas Tsioufis1, Theodoros Kalos1
1First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece.
Insights
Uric acid (UA) independently predicts diastolic dysfunction (DD) in hypertensive individuals. While UA correlates with DD severity in women, it is associated with DD presence in both genders.
Area of Science:
- Cardiology
- Nephrology
- Hypertension Research
Background:
- Uric acid (UA) is increasingly recognized for its role in cardiovascular health, particularly in patients with chronic kidney disease and heart failure (HF).
- Previous studies suggest a link between UA, Left Ventricular Hypertrophy (LVH), and Diastolic Dysfunction (DD) in women with preserved Ejection Fraction (pEF), but not in men.
Purpose of the Study:
- To investigate whether UA can predict indices of diastolic dysfunction (DD) in hypertensive individuals with preserved Ejection Fraction (pEF), independent of gender.
- To assess the association between UA levels and markers of diastolic dysfunction in a cohort of hypertensive patients.
Main Methods:
- Recruited 382 hypertensive subjects (61.3% women, age 61.7±10.7 years, median EF 64%).
- Calculated Left Ventricular Mass indexed to body surface area (LVMI) for LVH assessment (men: >116g/m², women: >96 g/m²).
- Utilized the ratio of early transmitral peak velocity (E) to mitral annular early diastolic velocity (Em) (E/Em) as an approximation of mean left atrial pressure.
Main Results:
- Uric acid (UA) independently predicted E/Em, a marker of diastolic dysfunction (adjusted coefficient: 1.01, p=0.026).
- An interaction term between gender and UA was not significant (p=0.684), indicating a similar predictive value across genders.
- Women with elevated UA showed significantly increased odds (adjusted OR=2.54, p=0.005) of being classified in the upper range of a calculated DD score, which included E/Em, left atrium dilatation, and LVH.
Conclusions:
- In hypertensive individuals without heart failure, UA is independently associated with the presence of diastolic dysfunction (DD) in both men and women.
- UA levels correlate with the severity of DD specifically in women.
- Further research is needed to explore the association of UA with adverse cardiovascular outcomes in high-risk populations, including those with HF and pEF.
Objectives:
Accumulating evidence suggests a direct role of Uric Acid (UA) on Left Ventricular (LV) diastolic function in chronic kidney disease and Heart Failure (HF) patients. Recently, UA has been linked to LV Hypertrophy (LVH) and Diastolic Dysfunction (DD) in women with preserved Ejection Fraction (pEF) but not in corresponding men. We sought to assess if UA could predict indices of DD in hypertensive subjects with pEF independently of gender.
Method:
We consecutively recruited 382 apparently healthy hypertensive subjects (age: 61.7±10.7, women: 61.3%, median EF: 64%). In 318 patients in sinus rhythm, LV mass-indexed to body surface area-was calculated (LVMI). LVH was set as an LVMI >116g/m2 or 96 g/m2 in men and women, respectively. The ratio of early transmitral peak velocity (E) to the mitral annular early diastolic velocity (Em) was used as an approximation of mean left atrial pressure (E/Em).
Results:
UA [median (interquartile range): 5.4(2) mg/dl] independently predicted E/Em (adjusted coefficient: 1.01, p =0.026) while an interaction term between gender and UA was no significant (p=0.684). An ordinal score of DD was calculated taking into account increased E/Em, left atrium dilatation and LVH. Women with increased UA had 254% increased odds (adjusted OR=2.54, p=0.005) to be classified in the upper range of the DD score.
Conclusion:
In hypertensive subjects without HF, UA is independently associated with the presence of DD in both genders and correlates with its severity in women. Further prospective studies are warranted to evaluate the association of UA with adverse cardiovascular outcomes in high-risk populations such as HF with pEF.
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