Serum Uric Acid as a Prognostic Predictor in Pulmonary Arterial Hypertension With Connective Tissue Disease

Njaman, Widi; Iesaki, Takafumi; Iwama, Yoshitaka; Takasaki, Yoshinari; Daida, Hiroyuki

doi:10.1536/ihj.48.523

Cited by 20 publications

(14 citation statements)

References 35 publications

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“…Serum urate has not been described previously as being predictive of PAH, but was identified as such in this study where low values were associated with a low PAH risk. There is, however, some support for an association in the literature; in a study of 228 patients, serum urate levels were significantly higher in those with PAH than in age-matched controls,31 findings that have been corroborated elsewhere 32. Interestingly, we have demonstrated the limited utility of the two main components of current guidelines, that is, symptoms and echocardiography: dyspnoea, a prominent symptom of PAH, did not discriminate between PAH and absence of PH (which is consistent with its lack of sensitivity in identifying cardiopulmonary compromise in early disease perhaps due to SSc-associated restricted musculoskeletal mobility), and TR velocity alone would have missed 20% of PAH patients when using a PAH suspicion threshold of ≥2.5 m/s, 36% when using a threshold of >2.8 m/s and 63% when using a threshold of >3.4 m/s.…”

Section: Discussionmentioning

confidence: 92%

Evidence-based detection of pulmonary arterial hypertension in systemic sclerosis: the DETECT study

et al. 2013

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ObjectiveEarlier detection of pulmonary arterial hypertension (PAH), a leading cause of death in systemic sclerosis (SSc), facilitates earlier treatment. The objective of this study was to develop the first evidence-based detection algorithm for PAH in SSc.MethodsIn this cross-sectional, international study conducted in 62 experienced centres from North America, Europe and Asia, adults with SSc at increased risk of PAH (SSc for >3 years and predicted pulmonary diffusing capacity for carbon monoxide <60%) underwent a broad panel of non-invasive assessments followed by diagnostic right heart catheterisation (RHC). Univariable and multivariable analyses selected the best discriminatory variables for identifying PAH. After assessment for clinical plausibility and feasibility, these were incorporated into a two-step, internally validated detection algorithm. Nomograms for clinical practice use were developed.ResultsOf 466 SSc patients at increased risk of PAH, 87 (19%) had RHC-confirmed PAH. PAH was mild (64% in WHO functional class I/II). Six simple assessments in Step 1 of the algorithm determined referral to echocardiography. In Step 2, the Step 1 prediction score and two echocardiographic variables determined referral to RHC. The DETECT algorithm recommended RHC in 62% of patients (referral rate) and missed 4% of PAH patients (false negatives). By comparison, applying European Society of Cardiology/European Respiratory Society guidelines to these patients, 29% of diagnoses were missed while requiring an RHC referral rate of 40%.ConclusionsThe novel, evidence-based DETECT algorithm for PAH detection in SSc is a sensitive, non-invasive tool which minimises missed diagnoses, identifies milder disease and addresses resource usage.

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Section: Discussionmentioning

confidence: 92%

Evidence-based detection of pulmonary arterial hypertension in systemic sclerosis: the DETECT study

et al. 2013

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“…The other studies have shown that an elevated serum UA level was an independent predictor for the survival of patients with pulmonary arterial hypertension [19,20]. In our study the CKD patients had normal tricuspid regurgitation pressure gradient in echocardiographic DD (+) -group with diastolic dysfunction, DD (-) -group without diastolic dysfunction, eGFR -estimated glomerular filtration rate, P -serum levels of phosphorus, Ca -serum levels of calcium, PLT -platelets, Hb -haemoglobin, PTH -parathormone, NT-proBNP -N-terminal pro brain natriuretic peptide, LVEDD -left ventricular end-diastolic dimension, RVEDD -right ventricular end-diastolic dimension, LAD -left atrial diastolic dimension, IVSd -interventricular septal diastolic diameter, LVPWd -left ventricular left ventricular posterior wall dimension at diastole, LVEF -left ventricular ejection fraction, LVMI -left ventricular mass index, E -early transmitral peak velocity, A -late transmitral peak velocity, DT -deceleration time, E/A ratio -ratio of early transmitral peak velocity to late transmitral peak velocity, SmLV -peak mitral annular systolic velocity, EmLV -peak mitral annular early diastolic velocity, AmLV -peak mitral annular late diastolic velocity, Em/AmLV -ratio of peak mitral annular early diastolic velocity to peak mitral annular late diastolic velocity, E/Em ratio -ratio of early transmitral peak velocity to peak mitral annular early diastolic velocity.…”

Section: Discussionmentioning

confidence: 94%

Hyperuricemia is an Independent Predictive Factor for Left Ventricular Diastolic Dysfunction in Patients with Chronic Kidney Disease

Gromadziński¹,

Januszko‐Giergielewicz

Pruszczyk

2015

Adv Clin Exp Med

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Background. It has been reported that elevated serum uric acid (UA) levels is an independent factor of poor prognosis in patients with chronic heart failure and chronic kidney disease (CKD). Objectives. In our study, we assessed the potential impact of hyperuricemia on left ventricular (LV) diastolic dysfunction (DD) in patient with CKD. Material and Methods. The study group consisted of 50 patients with CKD, stages 2-5. Standard echocardiography and tissue Doppler imaging (TDI) were performed. The levels of UA and N-terminal prohormone brain natriuretic peptide (NT-proBNP) were determined. Patients were divided into two groups according to the results of peak mitral annular early diastolic velocity (EmLV): group with LV diastolic dysfunction (EmLV < 8 cm/s) DD (+) and group with normal LV diastolic function DD (-), when EmLV ≥ 8 cm/s. Results. Patients DD (+) group, as compared to DD (-) patients were characterized by significantly higher serum UA levels [6.7 (4.4-14.3) mg/dL vs 5.8 (1.9-8.9) mg/dL, p = 0.004] respectively. The area under the receiver operating characteristic (ROC) curve was of serum UA levels for the detection of LV diastolic dysfunction was 0.734, 95% confidence interval (CI) 0.590-0.849, p = 0.001, whereas ROC derived UA value of > 6.0 mg/dL was characterized by a sensitivity of 76.9% and specificity of 62.5% for diagnosing LV diastolic dysfunction. The independent variable predicting LV diastolic dysfunction as measured by a multivariate logistic regression analysis was UA level > 6.0 mg/dL with odds ratio (OR) = 14.3 (95% CI 2.0-103.2), p = 0.006. Conclusions. Hyperuricemia is an independent predictive factor for LV diastolic dysfunction in patients with CKD (Adv Clin Exp Med 2015, 24, 1, 47-54).

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“…The mean PVR in this group was 2.3 Wood units and the highest PVR was 5.1 Wood units. In the High levels of uric acid have been observed in patients with other forms of PH and were assigned to the depletion of adenosine triphosphate in the tissues and worsening of oxidative metabolism [27]. Hyperuricaemia also occurs in haemolytic disease as a consequence of the increased production of uric acid after the recycling of purines.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary hypertension diagnosed by right heart catheterisation in sickle cell disease

Fonseca

Souza²,

Salemi³

et al. 2011

Eur Respir J

236

224

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Recent studies have recognised the importance of pulmonary hypertension (PH) in sickle cell disease (SCD). The aim of this study was to determine the prevalence and prognostic impact of PH and its features in patients with SCD.80 patients with SCD underwent baseline clinical evaluation, laboratory testing, 6-min walk tests (6MWTs) and echocardiography. Patients with a peak tricuspid regurgitant jet velocity (TRV) of o2.5 m?s -1 were further evaluated through right heart catheterisation (RHC) to assure the diagnosis of PH. Our study evidenced a 40% prevalence of patients with elevated TRV at echocardiography. RHC (performed in 25 out of 32 patients) confirmed PH in 10% (95% CI 3.4-16.5%) of all patients, with a prevalence of post-capillary PH of 6.25% (95% CI 0.95-11.55%) and pre-capillary PH of 3.75% (95% CI -0.4-7.9%). Patients with PH were older, had worse performance in 6MWTs, and more pronounced anaemia, haemolysis and renal dysfunction. Survival was shorter in patients with PH.Our study reinforced the use of echocardiography as a screening tool for PH in SCD and the mandatory role of RHC for proper diagnosis. Our findings confirmed the prognostic significance of PH in SCD as its association to pronounced haemolytic profile.

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Serum Uric Acid as a Prognostic Predictor in Pulmonary Arterial Hypertension With Connective Tissue Disease

Cited by 20 publications

References 35 publications

Evidence-based detection of pulmonary arterial hypertension in systemic sclerosis: the DETECT study

Evidence-based detection of pulmonary arterial hypertension in systemic sclerosis: the DETECT study

Hyperuricemia is an Independent Predictive Factor for Left Ventricular Diastolic Dysfunction in Patients with Chronic Kidney Disease

Pulmonary hypertension diagnosed by right heart catheterisation in sickle cell disease

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