Association of Hyperuricemia with Impaired Left Ventricular Systolic Function in Patients with Atrial Fibrillation and Preserved Kidney Function: Analysis of the POL-AF Registry Cohort

Abstract

Hyperuricemia is associated with the risk of developing atrial fibrillation (AF) and heart failure. However, coexisting chronic kidney disease and certain cardiovascular drugs make it difficult to determine whether hyperuricemia is a risk factor or merely a marker of pathology. We retrieved data from the Polish Atrial Fibrillation (POL-AF) registry, which included consecutive patients hospitalized with AF from January to December, 2019. We included 829 patients (mean age: 72.7 ± 11.1 years) with data on serum uric acid (UA, mean: 6.56 ± 1.78 mg/dL) and estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2. We found that UA and ejection fraction (EF) were significantly correlated (r = −0.15, p < 0.05), but not EF and eGFR or eGFR and UA. A multiple regression analysis adjusted for age, body mass index, eGFR, and UA, showed that UA was significantly associated with a reduced EF (R2: 0.021; p < 0.001). The UA cut-off indicative of an EF < 40% was 6.69 mg/dL (AUC, area under the curve: 0.607; 95% CI: 0.554–0.660; p = 0.001). Among drugs known to effect UA concentrations, we found that only diuretics were used more frequently in patients with high UA (above the median) than in patients with low UA (77.5% vs. 67%, p < 0.001). Among patients that used diuretics, UA remained significantly correlated with EF. Thus, we showed that reduced EF was associated with UA in patients with AF and normal renal function, independent of eGFR and diuretic use.

Uric acid is a biomarker for heart failure, but not therapeutic target: result from a comprehensive meta‐analysis

“…Follow‐up time ranged from 1 to 29 years. These studies were conducted in China, 24 , 25 , 26 Poland, 27 Italy, 28 Japan, 29 USA, 30 , 31 , 32 Turkey, 33 and Korea. 34 Heart failure was diagnosed according to ESC guidelines or based on symptoms, physical signs, and treatment response.…”

Worsening Renal Function and Adverse Outcomes in Patients with HFpEF with or without Atrial Fibrillation

“…Finally, the TOPCAT trial included a few patients with non-vitamin K antagonist oral anticoagulants, and further study could examine the impact of non-vitamin K antagonist oral anticoagulants on our results [ 28 ]. In addition, although some studies suggested hyperuricemia as a marker of HFrEF [ 29 ], whether similar results were observed in the HFpEF population needs further examination.…”

Role of hyperuricemia in cardiovascular disease and its treatment options: A review article

“…The connection between UA and EF is unaffected by renal function or the use of common HF medicines like diuretics. To predict an EF of less than 40%, 6.69 mg/dL of UA concentration was the cut-off point for higher UA concentrations (17).…”