Abstract
Background
Uric acid (UA) has been shown to be an independent risk factor for various cardiovascular
diseases. However, its significance in hypertrophic cardiomyopathy (HCM) has not yet
been evaluated. The objective of the present study was to evaluate clinical implications
of plasma UA levels on the prognosis of patients with HCM.
Methods
A total of 588 adult patients with HCM were enrolled at FuWai Hospital from 1999-2011
and followed until 2014. The plasma levels of UA were measured at enrollment.
Results
During the follow-up of 5.2 ± 2.4 years, 44 (7.5%) patients had cardiovascular-related
deaths, and 100 (17.0%) patients had cardiac events. Compared with the first tertile
of UA concentration (< 284.6 μmol/L), patients in the highest tertile (> 358.7 μmol/L)
had a higher risk for the development of adverse events: cardiovascular death (adjusted
hazard ratio [HR], 3.10; 95% confidence interval [CI], 1.37-7.04; P = 0.007), all-cause mortality (adjusted HR, 2.33; 95% CI, 1.11-4.89; P = 0.025), cardiac events (adjusted HR, 4.20, 95% CI, 2.38-7.42; P < 0.001), heart failure events (adjusted HR, 3.46; 95% CI, 1.86-6.45; P < 0.001), and arrhythmic events (adjusted HR, 9.19; 95% CI, 2.40-35.25; P = 0.001). Similarly, the continuous variable of UA (for every 1 mg/dL higher concentration)
was also an independent predictor for adverse outcomes: cardiovascular death (adjusted
HR, 1.29; 95% CI, 1.11-1.49; P = 0.001), all-cause mortality (adjusted HR, 1.23; 95% CI, 1.07-1.41; P = 0.004), cardiac events (adjusted HR, 1.27; 95% CI, 1.15-1.41; P < 0.001), heart failure events (adjusted HR, 1.19; 95% CI, 1.06-1.33; P = 0.003), and arrhythmic events (adjusted HR, 1.60; 95% CI, 1.30-1.98; P < 0.001).
Conclusions
Our results indicate that UA is an independent predictor of adverse outcomes in patients
with HCM.
Résumé
Introduction
Il a été démontré que l’acide urique (AU) est un facteur de risque indépendant de
plusieurs maladies cardiovasculaires. Cependant, son importance dans la cardiomyopathie
hypertrophique (CMH) n’a pas encore été évaluée. L’objectif de la présente étude était
d’évaluer les implications cliniques des concentrations plasmatiques de l’AU sur le
pronostic des patients souffrant de CMH.
Méthodes
Un total de 588 patients adultes souffrant de CMH ont été inscrits à l’hôpital FuWai
de 1999 à 2011 et suivis jusqu’en 2014. Les concentrations plasmatiques de l’AU ont
été mesurées à l’inscription.
Résultats
Durant le suivi de 5,2 ± 2,4 ans, 44 (7,5 %) patients ont connu une mort d’origine
cardiovasculaire et 100 (17,0 %) patients ont subi des événements cardiaques. Comparativement
au premier tertile de la concentration en AU (< 284,6 μmol/l), les patients dans le
tertile le plus élevé (> 358,7 μmol/l) étaient exposés à un risque plus élevé de développer
des événements indésirables : la mort d’origine cardiovasculaire (rapport de risque
[RR] ajusté, 3,10; intervalle de confiance [IC] à 95 %, 1,37-7,04; P = 0,007), la mortalité toutes causes confondues (RR ajusté, 2,33; IC à 95 %, 1,11-4,89;
P = 0,025), les événements cardiaques (RR ajusté, 4,20, IC à 95 %, 2,38-7,42; P < 0,001), les événements liés à l’insuffisance cardiaque (RR ajusté, 3,46; IC à 95
%, 1,86-6,45; P < 0,001) et les événements arythmiques (RR ajusté, 9,19; IC à 95 %, 2,40-35,25; P = 0,001). De la même façon, la variable continue de l’AU (pour chaque concentration
supérieure à 1 mg/dl) était également un prédicteur indépendant des résultats cliniques
défavorables : la mort cardiovasculaire (RR ajusté, 1,29; IC à 95 %, 1,11-1,49; P = 0,001), la mortalité toutes causes confondues (RR ajusté, 1,23; IC à 95 %, 1,07-1,41;
P = 0,004), les événements cardiaques (RR ajusté, 1,27; IC à 95 %, 1,15-1,41; P < 0,001), les événements liés à l’insuffisance cardiaque (RR ajusté, 1,19; IC à 95
%, 1,06-1,33; P = 0,003) et les événements arythmiques (RR ajusté, 1,60; IC à 95 %, 1,30-1,98; P < 0,001).
Conclusions
Nos résultats indiquent que l’AU est un prédicteur indépendant des résultats cliniques
défavorables chez les patients souffrant de CMH.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Canadian Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.J Am Coll Cardiol. 2011; 58: e212-e260
- Hypertrophic cardiomyopathy in a large community-based population: clinical outcome and identification of risk factors for sudden cardiac death and clinical deterioration.J Am Coll Cardiol. 2003; 41: 987-993
- Clinical profile of stroke in 900 patients with hypertrophic cardiomyopathy.J Am Coll Cardiol. 2002; 39: 301-307
- The role of uric acid in the pathogenesis of human cardiovascular disease.Heart. 2013; 99: 759-766
- Serum uric acid and cardiovascular mortality the NHANES I epidemiologic follow-up study, 1971-1992. National health and nutrition examination survey.JAMA. 2000; 283: 2404-2410
- Uric acid levels are associated with all-cause and cardiovascular disease mortality independent of systemic inflammation in men from the general population: The MONICA/KORA cohort study.Arterioscler Thromb Vasc Biol. 2008; 28: 1186-1192
- Serum uric acid level as an independent risk factor for all-cause, cardiovascular, and ischemic stroke mortality: A Chinese cohort study.Arthritis Rheum. 2009; 61: 225-232
- Uric acid and survival in chronic heart failure: validation and application in metabolic, functional, and hemodynamic staging.Circulation. 2003; 107: 1991-1997
- Uric acid level and allopurinol use as risk markers of mortality and morbidity in systolic heart failure.Am Heart J. 2010; 160: 928-933
- Uric acid and risk of myocardial infarction, stroke and congestive heart failure in 417,734 men and women in the apolipoprotein MORtality RISk study (AMORIS).J Intern Med. 2009; 266: 558-570
- Uric acid is a risk factor for myocardial infarction and stroke: the Rotterdam study.Stroke. 2006; 37: 1503-1507
- Serum uric acid and target organ damage in primary hypertension.Hypertension. 2005; 45: 99196
- Plasma uric acid and hypertension in a Chinese community: prospective study and metaanalysis.Clin Chem. 2009; 55: 2026-2034
- Serum uric acid and risk of left atrial thrombus in patients with nonvalvular atrial fibrillation.Can J Cardiol. 2014; 30: 1415-1421
- American College of Cardiology/European Society of Cardiology clinical expert consensus document on hypertrophic cardiomyopathy. A report of The American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines.J Am Coll Cardiol. 2003; 42: 1687-1713
- Determination of uric acid: an automated analysis based on a carbonate method.Clin Chem. 1964; 10: 838-844
- ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM).Eur J Heart Fail. 2008; 10: 933-989
- Uric acid and cardiovascular risk.N Engl J Med. 2008; 359: 1811-1821
- Clinical characteristics and outcomes of dilated phase of hypertrophic cardiomyopathy: report from the registry data in Japan.J Cardiol. 2013; 61: 65-70
- Uric acid, left ventricular mass index, and risk of cardiovascular disease in essential hypertension.Hypertension. 2006; 47: 195-202
- Allopurinol improves myocardial efficiency in patients with idiopathic dilated cardiomyopathy.Circulation. 2001; 104: 2407-2411
- Uric acid predicts clinical outcomes in heart failure: insights regarding the role of xanthine oxidase and uric acid in disease pathophysiology.Circulation. 2003; 107: 1951-1953
- Hypertrophic cardiomyopathy due to sarcomeric gene mutations is characterized by impaired energy metabolism irrespective of the degree of hypertrophy.J Am Coll Cardiol. 2003; 41: 1776-1782
- Diastolic dysfunction and altered energetics in the alphaMHC403/+ mouse model of familial hypertrophic cardiomyopathy.J Clin Invest. 1998; 101: 1775-1783
- Elevated serum uric acid levels impair coronary microvascular function in patients with idiopathic dilated cardiomyopathy.Eur J Heart Fail. 2007; 9: 466-468
- Serum uric acid is associated with microvascular function in hypertensive individuals.J Hum Hypertens. 2007; 21: 610-615
- Is there a pathogenetic role for uric acid in hypertension and cardiovascular and renal disease?.Hypertension. 2003; 41: 1183-1190
- Serum uric acid as an index of impaired oxidative metabolism in chronic heart failure.Eur Heart J. 1997; 18: 858-865
- Differences in coronary flow and myocardial metabolism at rest and during pacing between patients with obstructive and patients with nonobstructive hypertrophic cardiomyopathy.J Am Coll Cardiol. 1987; 10: 53-62
- Hypertrophic cardiomyopathy and sudden death in the young: pathologic evidence of myocardial ischemia.Hum Pathol. 2000; 31: 988-998
- Coronary microvascular dysfunction.N Engl J Med. 2007; 356: 830-840
- Coronary vasodilator reserve is impaired in patients with hypertrophic cardiomyopathy and left ventricular dysfunction.Am Heart J. 1998; 136: 972-981
- Transmural myocardial blood flow distribution in hypertrophic cardiomyopathy and effect of treatment.Basic Res Cardiol. 1999; 94: 49-59
- Decreased coronary flow reserve in hypertrophic cardiomyopathy is related to remodeling of the coronary microcirculation.Circulation. 1998; 97: 230-233
- Hypertrophic cardiomyopathy and transmural myocardial infarction without significant atherosclerosis of the extramural coronary arteries.Am J Cardiol. 1979; 43: 1086-1102
- Coronary microvascular dysfunction and prognosis in hypertrophic cardiomyopathy.N Engl J Med. 2003; 349: 1027-1035
- Relevance of coronary microvascular flow impairment to long-term remodeling and systolic dysfunction in hypertrophic cardiomyopathy.J Am Coll Cardiol. 2006; 47: 1043-1048
Article info
Publication history
Published online: February 20, 2015
Accepted:
February 16,
2015
Received:
October 19,
2014
Footnotes
See page 1257 for disclosure information.
Identification
Copyright
© 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
