Serum Level of Uric Acid, Partly Secreted From the Failing Heart, is a Prognostic Marker in Patients With Congestive Heart Failure

Abstract

Methods PatientsStudy 1 Fifty consecutive patients with mild to severe CHF (left ventricular ejection fraction (LVEF) <45%, New York Heart Association (NYHA) functional classes II-IV) underwent diagnostic cardiac catheterization. Patients taking allopurinol, with renal failure, malignancy or congenital malformations of the heart or vessels were excluded. Renal failure was defined as an estimated glomerular filtration rate (eGFR) <30 ml · min -1 · (1.73 m 2 ) -1 according to the MDRD equation. 20 Informed consent was given by all patients before participating in the study, and the protocol Background A recent study suggested that xanthine oxidase is activated in congestive heart failure (CHF). However, whether uric acid (UA) is secreted from the failing heart remains unknown, so it is currently unclear whether serum UA can provide prognostic information independent of brain natriuretic peptide (BNP). Methods and ResultsSerum UA was measured in the aortic root (AO) and the coronary sinus (CS) of 74 patients with CHF. The serum UA level was significantly higher in the CS than in the AO. The transcardiac gradient of UA (CS -AO) increased with the severity of CHF, inversely correlated with left ventricular ejection fraction (LVEF) and positively correlated with left ventricular end-diastolic volume index. The plasma levels of norepinephrine, BNP, UA, and LVEF were monitored prospectively in 150 CHF patients for a mean follow-up of 3 years. High plasma levels of UA (p<0.001) and BNP (p<0.001) were shown by multivariate stepwise analysis to be independent predictors of mortality. Conclusions High plasma UA level, partly secreted from the failing heart, is a prognostic predictor independent of BNP in patients with CHF. Monitoring a combination of BNP and UA may be useful for the management of patients with CHF. (Circ J 2006; 70: 1006 -1011

Is Serum Uric Acid Independently Associated With Left Ventricular Mass Index, Ejection Fraction, and B-Type Natriuretic Peptide Among Female and Male Cardiac Patients?

“…Considering that low LVEF was not associated with SUA in the full-adjusted model, association between SUA and elevated BNP may be, in part, attributed to the cardiac hypertrophy. 34) Another possibility is that uric acid secreted from failing heart may in part contribute to the increased SUA, 35) which might explain the observed association between SUA and BNP. On the other hand, however, the highest SUA was associated with elevated BNP, but not with LVH among female patients.…”

Comparison of Active Renin Concentration and Plasma Renin Activity as a Prognostic Predictor in Patients With Heart Failure

“…[25][26][27][28][29][30] However, the prognostic role of the parameters of RAS such as renin, AngII and ALD remain controversial because many factors, including therapy for HF, influence the plasma levels of these markers. Plasma AngII concentrations have been reported as useful for predicting prognosis, despite ACEI therapy, 5,6 but in the present study it was not a prognostic predictor probably because of increased AngII after ARB therapy.…”

Recent Improvements in Survival in Primary Systemic Amyloidosis and the Importance of an Early Mortality Risk Score

“…[34][35][36][37][38] Several studies have suggested that uric acid is a powerful prognostic factor in patients with cardiac failure and that uric acid may play a direct role in inducing myocardial damage. In the setting of AL, it is possible that uric acid is a surrogate marker for damage to additional organs, such as the kidney, potentially conferring additional prognostic value for this variable.…”