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Uric Acid Predicts Recovery of Left Ventricular Function and Adverse Events in Heart Failure With Reduced Ejection
Xiqiang Wang1, Xiude Fan2,3,4, Qihui Wu5,6
1Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, China.
Frontiers in Cardiovascular Medicine
|August 1, 2022
Summary
Lower uric acid (UA) levels predict left ventricular ejection fraction (LVEF) recovery and better prognosis in heart failure with reduced ejection fraction (HFrEF) patients. This finding offers new insights into the relationship between hyperuricemia and HFrEF.
Area of Science:
- Cardiology
- Biochemistry
- Genetics
Background:
- Heart failure with reduced ejection fraction (HFrEF) presents a significant risk for persistent left ventricular ejection fraction (LVEF) decline despite optimal medical therapy.
- Effective tools for stratifying HFrEF patient recovery potential are currently lacking.
- Hyperuricemia, a condition of elevated uric acid (UA) levels, is being investigated for its potential role in HFrEF pathophysiology.
Purpose of the Study:
- To investigate whether uric acid (UA) can serve as a predictor for LVEF recovery in HFrEF patients.
- To assess the prognostic value of UA levels for adverse cardiovascular events in HFrEF.
- To explore the mechanistic links between hyperuricemia and HFrEF.
Main Methods:
- Analysis of HFrEF patients with hyperuricemia from the National Inpatient Sample (NIS) 2016-2018 and a prospective cohort study.
- Propensity score matching to adjust for confounding factors.
- Network-based analysis, including gene overlap and network proximity analysis, to elucidate underlying mechanisms.
Main Results:
- Hyperuricemia was identified as a determinant of HFrEF in the NIS dataset (OR 1.247, P < 0.001).
- In the prospective cohort, hyperuricemia independently predicted all-cause death (aHR 2.387), heart failure readmission (aHR 1.848), and composite events (aHR 1.706).
- A baseline UA cutoff of 312.5 μmmol/L predicted LVEF recovery (accuracy 0.668, P = 0.006), with a negative correlation between baseline UA and follow-up LVEF (r = -0.19, P = 0.046).
Conclusions:
- Lower baseline uric acid (UA) levels are associated with improved LVEF recovery and reduced long-term adverse events in HFrEF patients.
- These findings suggest UA is a valuable biomarker for predicting recovery and prognosis in HFrEF.
- The study provides novel insights into the mechanistic relationship between hyperuricemia and HFrEF.
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