Turkiye Klinikleri Cardiovascular Sciences

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Serum Uric Acid is Associated with Right Heart Failure in Patients with Heart Failure with Reduced Ejection Fraction: A Cross-Sectional Study
Serum Ürik Asit Seviyesi, Düşük Ejeksiyon Fraksiyonlu Kalp Yetersizliği Hastalarında Sağ Kalp Yetersizliği ile İlişkilidir: Kesitsel Çalışma
Rengin Çetin GÜVENÇa , Abdurrahman NASERb
aDepartment of Cardiology, İstanbul Okan University Faculty of Medicine, İstanbul, Türkiye
bClinic of Cardiology, VM Medical Park Pendik Hospital, İstanbul, Türkiye
Turkiye Klinikleri J Cardiovasc Sci. 2023;35(2):48-57
doi: 10.5336/cardiosci.2023-96729
Article Language: EN
Full Text
ABSTRACT
 Objective: Serum uric acid (UA), which is the final product of purine metabolism, is a predictor of left-sided heart failure (HF), as well as being a marker of outcomes and survival in patients with heart failure with reduced ejection fraction (HFrEF). Right-sided HF may or may not accompany HFrEF, but is associated with worse prognosis and increased morbidity and mortality when present. All available data for the association between RHF and UA are derived from patients with pulmonary arterial hypertension, and virtually no data is available for patients with HFrEF. Our aim was to understand the relationships between UA, echocardiographic markers of right ventricular systolic function and RHF in patients with HFrEF. Material and Methods: A total of 45 patients with an ejection fraction <40% and signs of HF were included. Patients were divided into tertiles according to serum UA concentration. RHF was defined according to the modified Interagency Registry for Mechanically Assisted Circulatory Support criteria. Results: Compared to patients within the lowest UA tertile, patients within the 3rd tertile had a significantly higher incidence of RHF (50.0% vs. 0.0%, Bonferroni-corrected p=0.009) and a significantly lower tricuspid annular plane systolic excursion (20.5±4.4 vs. 16.1±4.4, p=0.02). After adjusting for relevant clinical, demographic, laboratory and echocardiographic variables, serum UA remained a significant predictor of RHF [odds ratio: 2.89, 95% confidence interval (CI): 1.21-6.91, p=0.017]. For serum UA, the c-statistic for determination of RHF was 0.83 (95% CI: 0.71-0.96). Conclusion: Serum UA is associated with the occurrence of RHF in patients with HFrEF.

Keywords: Heart failure with reduced ejection fraction; right heart failure; echocardiography; uric acid
ÖZET
 Amaç: Pürin metabolizmasının nihai ürünü olan ürik asit (ÜA), sol taraflı kalp yetersizliğinin bir prediktörü ve düşük ejeksiyon fraksiyonlu kalp yetersizliğinde (DEFKY) sonlanım ve sağkalımın bir göstergesidir. Sağ taraflı kalp yetersizliği (SğKY) sol kalp yetersizliği ile beraber görülebilir veya görülmeyebilir, ancak görüldüğü taktirde kötü prognoz ve artmış morbidite ve mortalite ile ilişkilidir. SğKY ve ÜA arasındaki ilişkiyi araştıran çalışmaların tamamı pulmoner hipertansiyonlu hastalar üzerinde yapılmıştır ve DEFKY'li hasta grubunda olası bir ilişkiyi gösteren veri yoktur. Bu çalışmada amacımız, DEF-KY'li hastalarda serum ÜA, sağ ventrikül fonksiyonunun ekokardiyografik göstergeleri ve SğKY arasındaki ilişki araştırılmaktır. Gereç ve Yöntemler: Ejeksiyon fraksiyonunun 40%'ın altında olduğu ve kalp yetersizliği bulguları olan 45 DEFKY hastası çalışmaya dahil edilmiştir. Hastalar serum ÜA seviyelerine göre üç eşit gruba ayrılmışlardır. SğKY''nin tanımlanması için, modifiye edilmiş ''Interagency Registry for Mechanically Assisted Circulatory Support'' kriterleri kullanılmıştır. Bulgular: En düşük ÜA grubu ile karşılaştırıldığında, 3. gruptaki hastalarsa SğKY sıklığı anlamlı olarak daha fazla bulunmuştur (50.0% - 0.0%, Bonferroni-düzeltilmiş p=0.009) ve aynı grupta triküspit düzlem sistolik hareketi anlamlı olarak azdır (20.5 ± 4.4 - 16.1 ± 4.4, p=0.02). Klinik, demografik, laboratuvar ve ekokardiyografik değişkenler istatistiksel olarak düzeltildikten sonra dahi, serum ÜA düzeyi SğKY için istatistiksel olarak anlamlı bir öngördürücü olmuştur (OO:2.89, 95%GA:1.21 -6.91, p=0.017). SğKY''nin belirlenmesi için serum ÜA''nın c-istatistiği 0.83'tür (95%GA: 0.71 - 0.96). Sonuç: Serum ÜA, DEFKY hastalarında SğKY ile ilişkili bulunmuştur.

Anahtar Kelimeler: Düşük ejeksiyon fraksiyonlu kalp yetersizliği; sağ kalp yetersizliği; ekokardiyografi; ürik asit
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