Determinants and Prognostic Impact of Hyperuricemia in Hospitalization for Acute Heart Failure

Huang, Wei; Hsu, Powen; Cheng, Hao Min; Lu, Dai Yin; Cheng, Yu; Guo, Chao-Yu; Sung, Shih Hsien; Yu, Wen Chung

doi:10.1253/circj.cj-15-0964

Cited by 27 publications

(26 citation statements)

References 28 publications

(19 reference statements)

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“…We previously have demonstrated that hyperuricemia was correlated with increased mortality, independent of traditional risk factors and NT‐proBNP in patients hospitalized for AHF with either HFrEF or HFpEF 8. In this study, uric acid remained correlated with all‐cause mortality, independent of AHEAD score and comorbidities.…”

Section: Discussionsupporting

confidence: 50%

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Performance of AHEAD Score in an Asian Cohort of Acute Heart Failure With Either Preserved or Reduced Left Ventricular Systolic Function

Chen

Sung

Cheng

et al. 2017

JAHA

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Background AHEAD (A: atrial fibrillation; H: hemoglobin; E: elderly; A: abnormal renal parameters; D: diabetes mellitus) score has been related to clinical outcomes of acute heart failure. However, the prognostic value of the AHEAD score in acute heart failure patients with either reduced or preserved left ventricular ejection fraction (HFrEF and HFpEF) remain to be elucidated.Methods and ResultsThe study population consisted of 2143 patients (age 77±12 years, 68% men, 38% HFrEF) hospitalized primarily for acute heart failure with a median follow‐up of 23.75 months. The performance of the AHEAD score (atrial fibrillation, hemoglobin <13 mg/dL for men and 12 mg/dL for women, age >70 years, creatinine >130 μmol/L, and diabetes mellitus) was evaluated by Cox's regression analysis for predicting cardiovascular and all‐cause mortality. The mean AHEAD scores were 2.7±1.2 in the total study population, 2.6±1.3 in the HFrEF group, and 2.7±1.1 in the HFpEF group. After accounting for sex, sodium, uric acid, and medications, the AHEAD score remained significantly associated with all‐cause and cardiovascular mortality (hazard ratio and 95% CI: 1.49, 1.38–1.60 and 1.48, 1.33–1.64), respectively. The associations of AHEAD score with mortality remained significant in the subgroups of HFrEF (1.63, 1.47–1.82) and HFpEF (1.34, 1.22–1.48). Moreover, when we calculated a new AHEAD‐U score by considering uric acid (>8.6 mg/dL) in addition to the AHEAD score, the net reclassification was improved by 19.7% and 20.1% for predicting all‐cause and cardiovascular mortality, respectively.ConclusionsThe AHEAD score was useful in predicting long‐term mortality in the Asian acute heart failure cohort with either HFrEF or HFpEF. The new AHEAD‐U score may further improve risk stratification.

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Section: Discussionsupporting

confidence: 50%

“…Consecutive AHF patients with New York Heart Association functional class III or IV symptoms, compatible presentations of chest radiograph, and responses to diuretics, were enrolled 8, 9. Subjects with acute coronary syndrome, severe hepatic disease, or severe infection were excluded from this analysis.…”

Section: Methodsmentioning

confidence: 99%

Performance of AHEAD Score in an Asian Cohort of Acute Heart Failure With Either Preserved or Reduced Left Ventricular Systolic Function

Chen

Sung

Cheng

et al. 2017

JAHA

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“…These data are also observed in HF patients with preserved ejection fraction [164] and in patients hospitalized with severely decompensated acute HF [165], [166]. The relation of SUA with acute HF outcome is weakened with deterioration of kidney function [167]. The association between SUA and ischemic stroke is debatable.…”

Section: Uric Acid and Cardiovascular System (Cvs)mentioning

confidence: 85%

Uric acid in the pathogenesis of metabolic, renal, and cardiovascular diseases: A review

Din

Salem

Abdulazim

2017

Journal of Advanced Research

288

165

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“…Conversely, plasma insulin levels were suppressed by about 50% in ZO-Rap compared to ZO-C (Figure 1(a)). At the end of treatment, serum from ZO-C had high levels of uric acid, a marker of chronic inflammation and heart failure [21] compared to ZL-C. Rap treatment suppressed uric acid elevation (Figure 1(d)). Rapamycin treatment did not change these parameters significantly in ZL rats (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

Differential Regulation of Cardiac Function and Intracardiac Cytokines by Rapamycin in Healthy and Diabetic Rats

Lück

DeMarco

Mahmood

et al. 2017

Oxidative Medicine and Cellular Longevity

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Diabetes is comorbid with cardiovascular disease and impaired immunity. Rapamycin improves cardiac functions and extends lifespan by inhibiting the mechanistic target of rapamycin complex 1 (mTORC1). However, in diabetic murine models, Rapamycin elevates hyperglycemia and reduces longevity. Since Rapamycin is an immunosuppressant, we examined whether Rapamycin (750 μg/kg/day) modulates intracardiac cytokines, which affect the cardiac immune response, and cardiac function in male lean (ZL) and diabetic obese Zucker (ZO) rats. Rapamycin suppressed levels of fasting triglycerides, insulin, and uric acid in ZO but increased glucose. Although Rapamycin improved multiple diastolic parameters (E/E′, E′/A′, E/Vp) initially, these improvements were reversed or absent in ZO at the end of treatment, despite suppression of cardiac fibrosis and phosphoSer473Akt. Intracardiac cytokine protein profiling and Ingenuity® Pathway Analysis indicated suppression of intracardiac immune defense in ZO, in response to Rapamycin treatment in both ZO and ZL. Rapamycin increased fibrosis in ZL without increasing phosphoSer473Akt and differentially modulated anti-fibrotic IL-10, IFNγ, and GM-CSF in ZL and ZO. Therefore, fundamental difference in intracardiac host defense between diabetic ZO and healthy ZL, combined with differential regulation of intracardiac cytokines by Rapamycin in ZO and ZL hearts, underlies differential cardiac outcomes of Rapamycin treatment in health and diabetes.

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Determinants and Prognostic Impact of Hyperuricemia in Hospitalization for Acute Heart Failure

Cited by 27 publications

References 28 publications

Performance of AHEAD Score in an Asian Cohort of Acute Heart Failure With Either Preserved or Reduced Left Ventricular Systolic Function

Performance of AHEAD Score in an Asian Cohort of Acute Heart Failure With Either Preserved or Reduced Left Ventricular Systolic Function

Uric acid in the pathogenesis of metabolic, renal, and cardiovascular diseases: A review

Differential Regulation of Cardiac Function and Intracardiac Cytokines by Rapamycin in Healthy and Diabetic Rats

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