Norvik Jon V, Schirmer Henrik, Ytrehus Kirsti, Storhaug Hilde M, Jenssen Trond G, Eriksen Bjørn O, Mathiesen Ellisiv B, Løchen Maja-Lisa, Wilsgaard Tom, Solbu Marit D
Metabolic and Renal Research GroupUiT The Arctic University of NorwayN-9037TromsøNorway.
Cardiovascular Research Group IMBUiT The Arctic University of NorwayN-9037TromsøNorway.
ESC Heart Fail. 2017 May;4(2):154-161. doi: 10.1002/ehf2.12134. Epub 2017 Jan 31.
To investigate whether serum uric acid predicts adverse outcomes in persons with indices of diastolic dysfunction in a general population.
We performed a prospective cohort study among 1460 women and 1480 men from 1994 to 2013. Endpoints were all-cause mortality, incident myocardial infarction, and incident ischaemic stroke. We stratified the analyses by echocardiographic markers of diastolic dysfunction, and uric acid was the independent variable of interest. Hazard ratios (HR) were estimated per 59 μmol/L increase in baseline uric acid. Multivariable adjusted Cox proportional hazards models showed that uric acid predicted all-cause mortality in subjects with E/A ratio <0.75 (HR 1.12, 95% confidence interval [CI] 1.00-1.25) or E/A ratio >1.5 (HR 1.51, 95% CI 1.09-2.09, for interaction between E/A ratio category and uric acid = 0.02). Elevated uric acid increased mortality risk in persons with E-wave deceleration time <140 ms or >220 ms (HR 1.46, 95% CI 1.01-2.12 and HR 1.13, 95% CI 1.02-1.26, respectively; for interaction = 0.04). Furthermore, in participants with isovolumetric relaxation time ≤60 ms, mortality risk was higher with increasing uric acid (HR 4.98, 95% CI 2.02-12.26, for interaction = 0.004). Finally, elevated uric acid predicted ischaemic stroke in subjects with severely enlarged left atria (HR 1.62, 95% CI 1.03-2.53, for interaction = 0.047).
Increased uric acid was associated with higher all-cause mortality risk in subjects with echocardiographic indices of diastolic dysfunction, and with higher ischaemic stroke risk in persons with severely enlarged left atria.
研究在普通人群中，血清尿酸是否可预测舒张功能障碍指标异常者的不良结局。
1994年至2013年，我们对1460名女性和1480名男性进行了一项前瞻性队列研究。终点指标为全因死亡率、首次发生心肌梗死和首次发生缺血性卒中。我们根据舒张功能障碍的超声心动图指标进行分层分析，尿酸是感兴趣的自变量。每增加59 μmol/L基线尿酸，估计风险比（HR）。多变量校正Cox比例风险模型显示，尿酸可预测E/A比值<0.75的受试者的全因死亡率（HR 1.12，95%置信区间[CI] 1.00 - 1.25）或E/A比值>1.5的受试者的全因死亡率（HR 1.51，95% CI 1.09 - 2.09，E/A比值类别与尿酸之间的交互作用P = 0.02）。尿酸升高会增加E波减速时间<140 ms或>220 ms者的死亡风险（HR分别为1.46，95% CI 1.01 - 2.12和HR 1.13，95% CI 1.02 - 1.26；交互作用P = 0.04）。此外，在等容舒张时间≤60 ms的参与者中，随着尿酸升高，死亡风险更高（HR 4.98，95% CI 2.02 - 12.26，交互作用P = 0.004）。最后，尿酸升高可预测左心房严重扩大的受试者发生缺血性卒中（HR 1.62，95% CI 1.03 - 2.53，交互作用P = 0.047）。
尿酸升高与舒张功能障碍超声心动图指标异常的受试者全因死亡风险较高相关，且与左心房严重扩大者缺血性卒中风险较高相关。
