Lacaita Pietro G, Schoegl Susanne, Barbieri Fabian, Widmann Gerlig, Held Julia, Haschka David, Weiss Guenter, Klauser Andrea, Feuchtner Gudrun M
Department of Radiology, Innsbruck Medical University, Innsbruck, Austria.
Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, 12203, Berlin, Germany.
Nutr Metab Cardiovasc Dis. 2025 Apr;35(4):103828. doi: 10.1016/j.numecd.2024.103828. Epub 2024 Dec 10.
The interaction of serum uric acid (SUA) with atherogenesis is incompletely understood. Aim of our study was to investigate the association of SUA levels with coronary plaque composition including high-risk-plaque (HRP) features by coronary computed tomography angiography (CTA) and for the prediction of major adverse cardiac events (MACE).
1242 patients (age 66.17 ± 11.03; 56 % males) referred to coronary CTA were included. SUA>6.5 mg/dl was defined as hyperuricemia. CTA-image analysis included: Coronary stenosis severity (CADRADS), plaque burden (SIS/G-score weighted for non-calcifying plaque), plaques types (1 = calcifying; 2 = mixed (predominantly calcifying); 3 = mixed (predominantly noncalcifying), 4 = noncalcifying."High-risk-plaque"(HRP)-features were quantified: Low-attenuation plaque (LAP) density, Spotty calcification, Napkin-Ring Sign (NRS), Remodeling Index. Coronary Artery Calcium Score (CAC) was measured. Primary outcome was MACE. HRP-features were more prevalent in patients with hyperuricemia (p = 0.005, p = 0.0002, p = 0.0004). SUA level was associated with LAP<30HU (HR:1.23; p = 0.04). Plaque burden and CAC-score were higher in the hyperuricemia group (G-score:p = 0.022 and CAC:p = 0.027). After a mean follow-up of mean 8,32 years, MACE rate was 2.9 %. There was no difference in the MACE rate between subjects with elevated SUA and normals (HR 1.221:95%CI:0.817-2.563; p = 0.597). Low-attenuation-plaque density/LAP<30HU was the strongest prognosticator for MACE (p = 0.033 and p = 0.013); stenosis severity, plaque types and G-score were also predictive, but not SUA, CAC and the other conventional cardiovascular risk factors (except smoking).
SUA is associated with HRP-features and coronary plaque burden. Low attenuation plaque is the strongest predictor of MACE, but not SUA level and other major CVRF. CTA imaging biomarkers may improve CV-risk stratification in patients with hyperuricemia.
血清尿酸（SUA）与动脉粥样硬化形成之间的相互作用尚未完全明确。我们研究的目的是通过冠状动脉计算机断层扫描血管造影（CTA）研究SUA水平与冠状动脉斑块成分（包括高危斑块（HRP）特征）之间的关联，并预测主要不良心脏事件（MACE）。
纳入1242例接受冠状动脉CTA检查的患者（年龄66.17±11.03岁；56%为男性）。SUA>6.5mg/dl被定义为高尿酸血症。CTA图像分析包括：冠状动脉狭窄严重程度（CADRADS）、斑块负荷（SIS/G评分，针对非钙化斑块加权）、斑块类型（1=钙化；2=混合（主要为钙化）；3=混合（主要为非钙化），4=非钙化）。对“高危斑块”（HRP）特征进行量化：低衰减斑块（LAP）密度、斑点状钙化、餐巾环征（NRS）、重塑指数。测量冠状动脉钙化积分（CAC）。主要结局为MACE。HRP特征在高尿酸血症患者中更为普遍（p=0.005，p=0.0002，p=0.0004）。SUA水平与LAP<30HU相关（HR：1.23；p=0.04）。高尿酸血症组的斑块负荷和CAC评分更高（G评分：p=0.022，CAC：p=0.027）。平均随访8.32年后，MACE发生率为2.9%。SUA升高的受试者与正常受试者之间的MACE发生率无差异（HR 1.221：95%CI：0.817-2.563；p=0.597）。低衰减斑块密度/LAP<30HU是MACE最强的预后指标（p=0.033和p=0.013）；狭窄严重程度、斑块类型和G评分也具有预测性，但SUA、CAC和其他传统心血管危险因素（吸烟除外）则不然。
SUA与HRP特征和冠状动脉斑块负荷相关。低衰减斑块是MACE最强的预测指标，但不是SUA水平和其他主要心血管危险因素。CTA成像生物标志物可能改善高尿酸血症患者的心血管风险分层。
