Akpek Mahmut, Sahin Omer, Sarli Bahadir, Arinc Huseyin, Baktir Ahmet O, Akpek Zeynep S, Saglam Hayrettin, Ergin Ali, Kaya Mehmet G
Department of Cardiology, Kayseri Education and Research Hospital, Kayseri, Turkey.
Department of Cardiology, Erciyes University School of Medicine, Kayseri, Turkey.
Echocardiography. 2015 Oct;32(10):1477-82. doi: 10.1111/echo.12897. Epub 2015 Feb 2.
Spontaneous echo contrast (SEC) is the presence of smoke-like echoes with a characteristic swirling motion of the blood in echocardiography. Previous clinical studies have shown that SEC is a risk factor for left atrial thrombus formation and a predictor of potential systemic embolism originating from the heart. There is an association between uric acid and prothrombotic state. Therefore, we aimed to investigate the role of uric acid in SEC in patients with mitral stenosis (MS).
A total of 85 consecutive patients with MS were enrolled in the study. Patients were divided into two groups according to whether SEC was present in the left atrium.
There were 41 patients (mean age 46.4 ± 11.4 and 68% female) in the SEC(-) group and 44 patients (mean age 45.7 ± 7.2 and 64% female) in the SEC(+) group. High sensitive C-reactive protein (hs-CRP) levels were significantly higher in the SEC(+) group than in the SEC(-) group (9.5 ± 4.2 vs. 4.7 ± 2.2 mg/L, P < 0.001). Uric acid was also significantly higher in the SEC (+) group (6.3 ± 1.4 vs. 4.5 ± 1.3 mg/dL, P < 0.001). In receiver operating characteristics curve analysis, uric acid >5.2 mg/dL had a 73% sensitivity and 76% specificity in predicting SEC in patients with MS. At multivariate analysis, uric acid (OR 3.919, 95% CI 1.911-8.035; P < 0.002) was an independent risk factor for SEC in patients with MS.
Uric acid is independently associated with SEC in patients with MS. Our findings suggest that this inexpensive, universally available marker may be a useful biomarker for the stratification of risk in patients with MS.
自发回声增强（SEC）是超声心动图中出现的类似烟雾状回声，伴有血液特征性的漩涡运动。既往临床研究表明，SEC是左心房血栓形成的危险因素，也是源自心脏的潜在系统性栓塞的预测指标。尿酸与血栓前状态之间存在关联。因此，我们旨在研究尿酸在二尖瓣狭窄（MS）患者SEC中的作用。
共纳入85例连续的MS患者。根据左心房是否存在SEC将患者分为两组。
SEC（-）组有41例患者（平均年龄46.4±11.4岁，女性占68%），SEC（+）组有44例患者（平均年龄45.7±7.2岁，女性占64%）。SEC（+）组的高敏C反应蛋白（hs-CRP）水平显著高于SEC（-）组（9.5±4.2 vs. 4.7±2.2 mg/L，P<0.001）。SEC（+）组的尿酸水平也显著更高（6.3±1.4 vs. 4.5±1.3 mg/dL，P<0.001）。在受试者工作特征曲线分析中，尿酸>5.2 mg/dL预测MS患者SEC的敏感性为73%，特异性为76%。多因素分析显示，尿酸（OR 3.919，95%CI 1.911-8.035；P<0.002）是MS患者SEC的独立危险因素。
尿酸与MS患者的SEC独立相关。我们的研究结果表明，这种廉价且普遍可用的标志物可能是MS患者风险分层的有用生物标志物。
