Giuseppe Ambrosio1, Marisa G Crespo Leiro2, Lars H Lund3, Stefano Coiro4, Andrea Cardona4, Gerasimos Filippatos5, Roberto Ferrari6, Massimo F Piepoli7, Andrew J S Coats8, Stefan D Anker9, Cécile Laroche10, Luis Almenar-Bonet11, Pentti Poder12, David Bierge Valero13, Anna Frisinghelli14, Aldo P Maggioni15. 1. Division of Cardiology, and Centro per la Ricerca Clinica e Traslazionale-CERICLET, University of Perugia School of Medicine, Perugia, Italy. Electronic address: giuseppe.ambrosio@ospedale.perugia.it. 2. Unidad .de Insuficiencia Cardiaca y Trasplante Cardiaco, Complexo Hospitalario Universitario A Coruna (CHUAC), INIBIC, UDC, CIBERCV, La Coruna, Spain. 3. Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden. 4. Division of Cardiology, and Centro per la Ricerca Clinica e Traslazionale-CERICLET, University of Perugia School of Medicine, Perugia, Italy. 5. School of Medicine, University of Cyprus & Heart Failure Unit, Department of Cardiology, University Hospital Attikon, National and Kapodistrian Univeristy of Athens, Athens, Greece. 6. Centro Cardiologico Universitario, University of Ferrara, Italy; Maria Cecilia Hospital, GVM Care&Research, Cotignola, Italy. 7. Heart Failure Unit, Cardiac Department, Guglielmo da Saliceto Hospital, AUSL Piacenza, Italy. 8. IRCCS San Raffaele, Pisana, Rome, Italy. 9. Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Germany. 10. EURObservational Research Programme, European Society of Cardiology, Biot, France. 11. Heart Failure and Transplant Unit. University and Polytechnic Hospital La Fe, Faculty of Medicine of the University of Valencia, Spain. 12. North Estonia Regional Hospital Foundation, Tallinn, Estonia. 13. Royo Villanova Hospital in Zaragoza, Zaragoza, Spain. 14. UOS Cardiologia Riabilitativa, ASST RHODENSE - Ospedale Passirana, Rho Milan, Italy. 15. EURObservational Research Programme, European Society of Cardiology, Biot, France; Maria Cecilia Hospital, GVM Care&Research, Cotignola, Italy.
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.
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.
Authors: Ching-Lan Cheng; Chi-Tai Yen; Chien-Chou Su; Cheng-Han Lee; Chien-Huei Huang; Yea-Huei Kao Yang Journal: Front Cardiovasc Med Date: 2022-08-11
Authors: Kirsty McDowell; Paul Welsh; Kieran F Docherty; David A Morrow; Pardeep S Jhund; Rudolf A de Boer; Eileen O'Meara; Silvio E Inzucchi; Lars Køber; Mikhail N Kosiborod; Felipe A Martinez; Piotr Ponikowski; Ann Hammarstedt; Anna Maria Langkilde; Mikaela Sjöstrand; Daniel Lindholm; Scott D Solomon; Naveed Sattar; Marc S Sabatine; John J V McMurray Journal: Eur J Heart Fail Date: 2022-02-06 Impact factor: 17.349