Hyperuricemia as a Marker of Reduced Left Ventricular Ejection Fraction in Patients with Atrial Fibrillation: Results of the POL-AF Registry Study

Abstract

Background: Hyperuricemia is an established risk factor for cardiovascular disease, including atrial fibrillation (AF). The prevalence of hyperuricemia and its clinical significance in patients with already diagnosed AF remain unexplored. Methods: The Polish Atrial Fibrillation (POL-AF) registry includes consecutive patients with AF hospitalized in 10 Polish cardiology centers from January to December 2019. This analysis included patients in whom serum uric acid (SUA) was measured. Results: From 3999 POL-AF patients, 1613 were included in the analysis. The mean age of the subjects was 72 ± 11.6 years, and the mean SUA was 6.88 ± 1.93 mg/dL. Hyperuricemia was found in 43% of respondents. Eighty-four percent of the respondents were assigned to the high cardiovascular risk group, and 45% of these had SUA >7 mg/dL. Comparison of the extreme SUA groups (<5 mg/dL vs. >7 mg/dL) showed significant differences in renal parameters, total cholesterol concentration, and left ventricular ejection fraction (EF). Multivariate regression analysis showed that SUA >7 mg/dL (OR 1.74, 95% CI 1.32–2.30) and GFR <60 mL/min/1.73 m2 (OR 1.94, 95% CI 1.46–2.48) are significant markers of EF <40% in the study population. Female sex was a protective factor (OR 0.74, 95% CI 0.56–0.97). The cut-off point for SUA with 60% sensitivity and specificity indicative of an EF <40% was 6.9 mg/dL. Conclusions: Although rarely assessed, hyperuricemia appears to be common in patients with AF. High SUA levels may be a significant biomarker of reduced left ventricular EF in AF patients.

Uricase deficiency causes mild and multiple organ injuries in rats

“…It is also regarded as a risk factor closely correlated with hypertension, type 2 diabetes mellitus, and hyperlipidemia [ 2 , 3 ]. Previous reports have suggested that hyperuricemia is tangled with the injuries to the intestinal tract [ 4 ], liver [ 5 ] and heart failure [ 6 ]. Hyperuricemia and associated disorders cause a significant economic burden on modern society.…”

Effect of febuxostat on left ventricular diastolic function in patients with asymptomatic hyperuricemia: a sub analysis of the PRIZE Study

“…Elevated SUA has been shown to inhibit nitric oxide production by vascular endothelial cells and also to inhibit their proliferation and migration [ 15 ]. In the clinical trial, there are several observational studies and meta-analyses that described elevations of SUA as an independent marker of poor cardiac function, mortality, and poor exercise capacity [ 16 – 18 ]. Increased SUA levels might lead to the echocardiographic abnormalities through impacts on endothelial function and inflammation.…”

Czy wynik CHA2DS2-VASc determinuje leczenie przeciwzakrzepowe u pacjentów z migotaniem przedsionków? Dane z POLish Atrial Fibrillation (POL-AF) Registry?

“…Interestingly, in the presented study, AF type or impaired kidney function were not shown to be the predictors of OAC use in patients at low thromboembolic risk. It has been reported that the aforementioned factors increase the risk of thromboembolic complications in patients with AF or predispose them to thrombus formation in the left atrial appendage [8][9][10][11][12][13][14][15][16][17][18][19][20]. Study results connected with anticoagulant overtreatment of patients with AF prove that it is common and most likely stems from using OACs due to temporary indications to anticoagulant therapy and from the presence of thromboembolic risk factors not included in the CHA 2 DS 2 -VASc score.…”

“…The POL-AF Registry (NCT04419012) was a prospective, observational study enrolling AF patients hospitalized in 10 cardiology departments in Poland (eight of them were academic and two regional). Details on the study design have been reported elsewhere [9][10][11]. In brief, consecutive hospitalized patients were included in the study on the condition that they were at least 18 years of age and had AF history reported by electrocardiography or in their case record.…”