Hyperuricemia Reflects Cardiometabolic Burden Rather than Left Ventricular Systolic Dysfunction Across Heart Failure Phenotypes: Insights from a Real-World Acute Heart Failure Cohort

Figure 1. Raincloud plot illustrating the distribution of left ventricular ejection fraction (EF) at admission (EF_A), stratified by biological sex. Each panel combines a half-violin density plot (top), a boxplot displaying median and interquartile range (middle), and individual data points (bottom). Female patients (F, grey) demonstrate a more compact distribution with higher median ejection fraction values, while male patients (M, teal) exhibit a broader, right-skewed distribution extending toward higher ejection fraction values. These patterns are consistent with the known epidemiological predilection of older women toward heart failure with preserved ejection fraction (HFpEF). One observation was excluded due to missing data.

Figure 2. Raincloud plot illustrating the distribution of serum uric acid at admission (Uric Acid_A), stratified by hyperuricemia status. Each panel combines a half-violin density plot (top), a boxplot displaying median and interquartile range (middle), and individual data points (bottom). Patients classified as hyperuricemic demonstrate markedly elevated and more dispersed uric acid values compared to normouricemic patients, reflecting the high prevalence of hyperuricemia (64.6%) observed in this acute heart failure cohort. Fifteen observations were excluded due to missing data.

Figure 3. Scatter plot illustrating the relationship between serum uric acid at admission (Uric Acid_A) and left ventricular ejection fraction at admission (EF_A). Spearman’s rank-order correlation revealed a non-significant inverse association (rho = −0.107, p = 0.069), indicating the absence of a meaningful linear relationship between serum uric acid and systolic function in this cohort.

Figure 4. Scatter plot illustrating the relationship between NT-proBNP at admission (NT-PROBNP_A) and left ventricular ejection fraction at admission (EF_A). Spearman’s rank-order correlation demonstrated a statistically significant inverse association (rho = −0.282, p < 0.001), confirming that natriuretic peptide burden—rather than serum uric acid—serves as the clinically meaningful correlate of impaired systolic function in this acute heart failure cohort.

Figure 5. The ROC curve illustrates the diagnostic performance of the multivariable model in predicting the non-HFrEF status, achieving an area under the curve (AUC) of 0.804.