Fatih DEDE, Çiğdem YÜCEL, Sevilay SEZER, Turan TURHAN, Canan TOPÇUOĞLU, Mustafa ÇETİN

Serum Ürik Asit Düzeyinin Kardiyak Disfonksiyonda Prognostik bir Önemi Var mıdır?

Amaç: Ürik asit, pürin metabolizmasının son ürünü ve gut için iyi bilinen bir risk faktörüdür. Bununla birlikte, yüksek serum ürik asit düzeyleri insülin rezistansı, obezite, hipertansiyon, renal disfonksiyon, hipotiroidi gibi birçok hastalıkla ilişkili bulunmuştur. Öte yandan, ürik asidin kardiyovasküler morbiditede nedensel bir rol oynayıp oynamadığı tartışılmaktadır. Çalışmamızda serum ürik asit (ÜA) ve kalp yetmezliği prognostik belirteci olan N terminal pro B‐tipi Natriüretik Peptit (NT‐proBNP) düzeyleri ile sol ventrikül fonksiyon bozukluğu arasında ilişki olup olmadığını araştırmayı amaçladık. Materyal ve Metot: Çalışma retrospektif olarak planlandı. Mart 2016 ile Şubat 2017 tarihleri arasında Ankara Numune Eğitim ve Araştırma Hastanesi Kardiyoloji Servisi ve Koroner Yoğun Bakımda yatan 326 hasta çalışmaya dahil edildi. Bu hastaların serum ÜA, NT‐proBNP düzeyleri ile ejeksiyon fraksiyonu (EF) bulguları hastane enformasyon sisteminden alındı. Hastalar serum ÜA düzeylerine göre 4 gruba ayrıldı (1. grup ÜA; 2,7‐4,9 mg/dL, 2. grup ÜA; 5‐6 mg/dL, 3. grup ÜA; 6,1‐7,4 mg/dL, 4. grup ÜA; 7,5‐15,6 mg/dL). Gruplar arasında parametreler ANOVA testi kullanılarak karşılaştırıldı. Ayrıca, sol ventrikül disfonksiyon bulgularında ürat düzeylerine göre değişimler incelenirken, cinsiyet, yaş ve eGFR ‘nin bu parametreler üzerindeki etkileri değerlendirildi. Değişkenler arasında ilişki için Pearson korelasyon testi kullanıldı. Bulgular: 4. grup; yaş, NT‐proBNP, eGFR diğer gruplardan anlamlı düzeyde farklıydı (p

Is There a Prognostic Significance of Serum Uric Acid Level in Cardiac Dysfunction?

Objectives: Uric acid (UA) is the end‐product of purine metabolism and is a well‐known risk factor forgout disease. In addition to that, elevated serum UA levels have been associated with many disordersincluding insulin resistance, obesity, hypertension, renal dysfunction and hypothyroidism. On the otherhand, whether uric acid has any causal relationship with cardiovascular morbidity is a debated issue.Materials and Methods: This retrospective study included totally 326 patients who were inpatients atthe Cardiology Ward or Coronary Intensive Care Unit of Ankara Numune Training and ResearchHospital between March 2016 and February 2017. Data regarding serum UA and N‐terminal pro B‐typeNatriuretic Peptide (NT‐proBNP) levels and left ventricular ejection fraction %) LVEF) were retrievedfrom the hospital information system. Patients were categorized into four groups based on their UAlevels (Group 1 UA: 2.7‐4.9 mg/dL, Group 2 UA: 5‐6 mg/dL, Group 3 UA: 6.1‐7.4 mg/dL, Group 4 UA: 7.5‐15.6 mg/dL). Other parameters were compared between the groups using ANOVA test. Additionally, theeffects of gender, age and eGFR were also examined when evaluating the changes in left ventricularfunction according to UA levels. Correlation between the variables was analyzed with Pearson’scorrelation test.Results: Group 4 was significantly different than the rest of the groups in terms of age, NT‐proBNP andeGFR (p

PDF

___

1. El Ridi R, Tallima H. Physiological functions and pathogenic potential of uric acid: A review. J Adv Res 2017;8:487‐93.
2. Martínez‐Quintana E, Tugores A, Rodríguez‐González F. Serum uric acid levels and cardiovascular disease: the Gordian knot. J Thorac Dis 2016;8(11):E1462‐E1466.
3. Ames BN, Cathcart R, Schwiers E, Hochstein P. Uric acid provides an antioxidant defense in humans against oxidant‐ and radical‐caused aging and cancer: a hypothesis. Proc Natl Acad Sci USA 1981;78(11):6858–62.
4. Nery RA, Kahlow BS, Skare TL, Tabushi FI, do Amaral e Castro A. Uric acid and tissue repair. Arq Bras Cir Dig 2015;28(4):290–2.
5. Sharaf El Din UAA, Salem MM, Abdulazim DO. Uric acid in pathogenesis of metabolic, renal and cardiovascular diseases. A review. J Adv Res 2017;8:537‐48.
6. Choi HK, Ford ES. Prevalence of the metabolic syndrome in individuals with hyperuricemia. Am J Med 2007;120(5):442–7.
7. Krishnan E, Pandya BJ, Chung L, Hariri A, Dabbous O. Hyperuricemia in young adults and risk of insulin resistance, prediabetes, and diabetes: a 15‐year follow‐up study. Am J Epidemiol. 2012;176(2):108–16.
8. Shani M, Vinker S, Dinour D, et al. High normal uric acid levels are associated with an increased risk of diabetes in lean, normoglycemic healthy women. J Clin Endocrinol Metab 2016;101(10):3772–8.
9. Cicerchi C, Li N, Kratzer J, Garcia G, et al. Uric acid‐dependent inhibition of AMP kinase induces hepatic glucose production in diabetes and starvation: evolutionary implications of the uricase loss in hominids..FASEB J 2014;8:3339–50.
10. Roy D, Perreault M, Marette A. Insulin stimulation of glucose uptake in skeletal muscles and adipose tissues in vivo is NO dependent. Am J Physiol 1998;274(4 Pt 1):E692‐9.
11. Leiba A, Vinker S, Dinour D, Holtzman EJ, Shani M. Uric acid levels within the normal range predict increased risk of hypertension: a cohort study. J Am Soc Hypertens 2015;9(8):600–9.
12. Yamauchi Y, Fujita Shu, Shibata K, et al. Is Serum Uric Acid Independently Associated With Left Ventricular Mass Index, Ejection Fraction, and B‐Type Natriuretic Peptide Among Female and Male Cardiac Patients? Int Heart Jm. 2017;58(4):562‐9.
13. Borghi C, Cosentino ER, Rinaldi ER, Cicero AF. Uricaemia and ejection fraction in elderly heart failure outpatients. Eur J Clin Invest 2014;44(6):573‐8.
14. Amin A, Vakilian F, Maleki M. Serum uric acid levels correlate with filling pressures in systolic heart failure. Congest Heart Fail 2011;17:80–4.
15. Duan X, Ling F. Is uric acid itself a player or a bystander in the pathophysiology of chronic heart failure? Med Hypotheses 2008;70 (3):578–81.
16. Kırça M, Oğuz N, Çetin A, Uzuner F, Yeşilkaya A. Uric acid stimulates proliferative pathways in vascular smooth muscle cells through the activation of p38 MAPK, p44/42 MAPK and PDGFRb. J Recept Signal Transduct Res 2017;37(2):167‐73.
17. Culleton BF, Larson MG, Kannel WB, Levy D. Serum uric acid and risk for cardiovascular disease and death: the Framingham Heart Study. Ann Intern Med 1999;131(1):7–13.
18. Jayashankar CA, Andrews HP, Vijayasarathi Pinnelli VB, et al. Serum uric acid and low‐density lipoprotein cholesterol levels are independent predictors of coronary artery disease in Asian Indian patients with type 2 diabetes mellitus. J Nat Sci Biol Med 2016;7(2):161–5.
19. Ekici B, Kütük U, Alhan A, Töre HF. The relationship between serum uric acid levels and angiographic severity of coronary heart disease. Kardiol Pol 2015;73(7):533–8.
20. Holme I, Aastveit AH, Hammar N, Jungner I, Walldius G. 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(6):558–70.
21. Khan A, Shah MH, Khan S, Shamim U, Arshad S. Serum Uric Acid level in the severity of Congestive Heart Failure (CHF). Pak J Med Sci 2017;33(2):330‐4.
22. Zeng C, Cheng D, Sheng X, et al. Increased Serum Uric Acid Level Is a Risk Factor for Left Ventricular Hypertrophy but Not Independent of eGFR inbPatients with Type 2 Diabetic Kidney Disease. J Diabetes Res 2017 (doi: 10.1155/2017/5016093).