Eser AÇIKGÖZ, Sadık Kadri AÇIKGÖZ, Mustafa CANDEMİR, Burak SEZENÖZ, Salih TOPAL, Nuri Bülent BOYACI

An old friend: uric acid and its association with fractional flow reserve

Background/aim: The aim of this study was to investigate the importance of preprocedural uric acid (UA) level in predicting fractionalflow reserve (FFR) results of intermediate coronary lesions in patients with stable coronary artery disease undergoing coronaryangiography.Materials and methods: We retrospectively analyzed 293 patients who underwent FFR measurement to determine the significance ofintermediate coronary stenosis detected by conventional coronary angiography. Patients were divided into 2 groups: Group 1 (n = 127)included patients with FFR of 0.80 (hemodynamically nonsignificant lesions). Uric acid levels were assessed in both groups with the enzymatic colorimetric methodby clinical chemistry autoanalyzer.Results: The mean UA level was significantly higher in patients whose FFR indicated hemodynamically significant coronary lesions(UA: 5.43 ± 1.29 mg/dL in Group 1 vs. 4.51 ± 1.34 mg/dL in Group 2, P < 0.001).Conclusion: Elevated UA levels are associated with hemodynamically significant coronary lesions measured with FFR. Uric acid maybe used as a predictor of hemodynamically compromised coronary lesions before FFR procedures.

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1. Topol EJ, Nissen SE. Our preoccupation with coronary luminology. The dissociation between clinical and angiographic findings in ischemic heart disease. Circulation 1995; 92 (8): 2333-2342. doi: 10.1161/01.cir.92.8.2333
2. Pijls NH, Kern MJ, Yock PG, De Bruyne B. Practice and potential pitfalls of coronary pressure measurement. Catheter Cardiovascular Intervention 2000; 49 (1): 1-16. doi: 10.1002/ (SICI)1522-726X(200001)49:1<1::AID-CCD1>3.0.CO;2-5
3. Culleton BF, Larson MG, Kannel WB, Levy D. Serum uric acid and risk for cardiovascular disease and death: the Framingham Heart Study. Annals Internal Medicine 1999; 131 (1): 7-13. doi: 10.7326/0003-4819-131-1-199907060-00003
4. Doehner W, Schoene N, Rauchhaus M, Leyva-Leon F, Pavitt DV et al. Effects of xanthine oxidase inhibition with allopurinol on endothelial function and peripheral blood flow in hyperuricemic patients with chronic heart failure: results from 2 placebo-controlled studies. Circulation 2002; 105 (22): 2619-2624. doi: 10.1161/01.cir.0000017502.58595.ed
5. Yu MA, Sanchez-Lozada LG, Johnson RJ, Kang DH. Oxidative stress with an activation of the renin-angiotensin system in human vascular endothelial cells as a novel mechanism of uric acid-induced endothelial dysfunction. Journal of Hypertension 2010; 28 (6): 1234-1242. doi: 10.1016/S1520-765X(03)90057-5
6. Yu J, Han J, Mao J, Guo L, Gao W. Association between serum uric acid level and the severity of coronary artery disease in patients with obstructive coronary artery disease. Chinese Medical Journal 2014; 127 (6): 1039-1045. doi: 10.3760/ cma.j.issn.0366-6999.20133024
7. Ndrepepa G, Braun S, King L, Hadamitzky M, Haase HU et al. Association of uric acid with mortality in patients with stable coronary artery disease. Metabolism 2012; 61 (12): 1780-1786. doi: 10.1016/j.metabol.2012.05.014
8. Matsuo H, Kawase Y. FFR and iFR guided percutaneous coronary intervention. Cardiovascular Intervention and Therapeutics 2016; 31 (3): 183-195. doi: 10.1007/s12928-016-0404-2
9. Kanbay M, Segal M, Afsar B, Kang DH, Rodriguez-Iturbe B et al. The role of uric acid in the pathogenesis of human cardiovascular disease. Heart 2013; 99 (11): 759-766. doi: 10.1136/heartjnl-2012-302535
10. Jun JE, Lee YB, Lee SE, Ahn JY, Kim G et al. Elevated serum uric acid predicts the development of moderate coronary artery calcification independent of conventional cardiovascular risk factors. Atherosclerosis 2018; 272: 233-239. doi: 10.1016/j. atherosclerosis.2018.02.014
11. Ndrepepa G, Braun S, King L, Fusaro M, Tada T et al. Uric acid and prognosis in angiography-proven coronary artery disease. European Journal of Clinical Investigation 2013; 43 (3): 256- 266. doi: 10.1111/eci.12039
12. Sanchez-Lozada LG, Soto V, Tapia E, Avila-Casado C, Sautin YY et al. Role of oxidative stress in the renal abnormalities induced by experimental hyperuricemia. American Journal of Physiology-Renal Physiology 2008; 295 (4): F1134-1141. doi: 10.1152/ajprenal.00104.2008
13. Chao HH, Liu JC, Lin JW, Chen CH, Wu CH et al. Uric acid stimulates endothelin-1 gene expression associated with NADPH oxidase in human aortic smooth muscle cells. Acta Pharmacologica Sinica 2008; 29 (11): 1301-1312. doi: 10.1111/j.1745-7254.2008.00877.x
14. Kanellis J, Watanabe S, Li JH, Kang DH, Li P et al. Uric acid stimulates monocyte chemoattractant protein-1 production in vascular smooth muscle cells via mitogen-activated protein kinase and cyclooxygenase-2. Hypertension 2003; 41 (6): 1287- 1293. doi: 10.1161/01.HYP.0000072820.07472.3B
15. Gur M, Yilmaz R, Demirbag R, Aksoy N. Relation of serum uric acid levels with the presence and severity of angiographic coronary artery disease. Angiology 2008; 59 (2): 166-171. doi: 10.1177/0003319706292010
16. Kim SC, Shah NR, Rogers JR, Bibbo CF, Di Carli MF et al. Assessment of coronary vascular function with cardiac PET in relation to serum uric acid. PLoS One 2018; 13 (2): e0192788. doi: 10.1371/journal.pone.0192788
17. Greene HL, Wilson FA, Hefferan P, Terry AB, Moran JR et al. ATP depletion, a possible role in the pathogenesis of hyperuricemia in glycogen storage disease type I. Journal of Clinical Investigation 1978; 62 (2): 321-328. doi: 10.1172/JCI109132
18. Yang Y, Zhou Y, Cheng S, Sun JL, Yao H et al. Effect of uric acid on mitochondrial function and oxidative stress in hepatocytes. Genetics and Molecular Research 2016; 15 (2): gmr8644. doi: 10.4238/gmr.15028644.
19. Kocaman SA, Sahinarslan A, Arslan U, Timurkaynak T. The delta fractional flow reserve can predict lesion severity and long-term prognosis. Atherosclerosis 2009; 203 (1): 178-184. doi: 10.1016/j.atherosclerosis.2008.06.009