Division of Cardiology, Department of Medicine, Duke University Hospital, Durham, NC; Duke Clinical Research Institute, Durham, NC.
Duke Clinical Research Institute, Durham, NC.
Am J Med. 2020 Dec;133(12):e716-e721. doi: 10.1016/j.amjmed.2020.03.054. Epub 2020 May 13.
We aimed to 1) describe characteristics of patients with heart failure with preserved ejection fraction (HFpEF) enrolled in RELAX stratified by normal or elevated baseline serum uric acid (sUA) level; 2) evaluate the association between sUA level and surrogate clinical measures; and 3) assess associations between changes in sUA level over time and changes in surrogate clinical measures.
We analyzed 212 patients with HFpEF and normal or elevated (>6 mg/dL) baseline sUA measurements from the RELAX trial. Variables examined included clinical characteristics, cardiopulmonary exercise testing, 6-minute walk testing, quality of life, echocardiography, and serum biomarker testing. Baseline characteristics between groups were compared and scatter plots with quadratic regression lines and linear regression modeling were used to assess the relationship between baseline sUA and clinical measures. Kaplan-Meier curves were used to describe composite death or cardiovascular/renal hospitalization.
The prevalence of elevated baseline sUA was 68.9%. Patients with elevated sUA had more baseline comorbidities and poorer functional status on cardiopulmonary exercise testing than those without. After adjustment, significant associations between baseline sUA levels and cystatin C, N-terminal pro B-type natriuretic peptide, high-sensitivity troponin I, and high-sensitivity C-reactive protein were identified. Higher baseline sUA was also associated with worsening peak VO, 6-minute walk testing, and left ventricular mass. No significant association was found between baseline sUA levels and the composite of death or cardiovascular/renal hospitalization at 24 weeks.
sUA is an important marker of comorbidities and functional status in patients with HFpEF. Clinical trials of sUA-lowering therapies in patients with HFpEF are promising.
我们旨在 1）描述射血分数保留的心力衰竭（HFpEF）患者的特征，这些患者根据正常或升高的基线血清尿酸（sUA）水平进行分层；2）评估 sUA 水平与替代临床指标之间的关系；3）评估随时间推移 sUA 水平变化与替代临床指标变化之间的关系。
我们分析了 RELAX 试验中 212 例 HFpEF 患者的正常或升高（>6mg/dL）基线 sUA 测量值。检查的变量包括临床特征、心肺运动试验、6 分钟步行测试、生活质量、超声心动图和血清生物标志物检测。比较组间的基线特征，并使用散点图和二次回归线以及线性回归模型评估基线 sUA 与临床指标之间的关系。使用 Kaplan-Meier 曲线描述复合死亡或心血管/肾脏住院。
升高的基线 sUA 的患病率为 68.9%。与没有升高 sUA 的患者相比，sUA 升高的患者基线合并症更多，心肺运动试验的功能状态更差。调整后，基线 sUA 水平与胱抑素 C、N 末端 B 型利钠肽前体、高敏肌钙蛋白 I 和高敏 C 反应蛋白之间存在显著相关性。基线 sUA 较高也与峰值 VO、6 分钟步行测试和左心室质量恶化相关。在 24 周时，基线 sUA 水平与死亡或心血管/肾脏住院的复合终点之间未发现显著相关性。
sUA 是 HFpEF 患者合并症和功能状态的重要标志物。HFpEF 患者降低 sUA 治疗的临床试验很有前景。
