Key result
Serum uric acid was significantly associated with reduced ejection fraction in patients with atrial fibrillation and preserved kidney function (AUC 0.607; 95% CI 0.554-0.660; p=0.001).
Why the study?
Coexisting chronic kidney disease and cardiovascular drugs make it difficult to determine whether hyperuricemia is a risk factor or merely a marker of pathology in atrial fibrillation and heart failure.
Is hyperuricemia associated with impaired left ventricular systolic function in patients with atrial fibrillation and preserved kidney function?
Cohort (n=829)
Yes
Is hyperuricemia associated with impaired left ventricular systolic function in patients with atrial fibrillation and preserved kidney function?
Effect estimate: AUC 0.607 (95% CI 0.554-0.660)
p-value: p=0.001
In patients with atrial fibrillation and preserved renal function, higher serum uric acid levels are independently associated with reduced left ventricular ejection fraction.
Hyperuricemia association with AF in registry data warrants interpretive caution; leaves open independent prognostic role amid CKD and drug confounders.
Hyperuricemia is associated with the risk of developing atrial fibrillation (AF) and heart failure. However, coexisting chronic kidney disease and certain cardiovascular drugs make it difficult to determine whether hyperuricemia is a risk factor or merely a marker of pathology. We retrieved data from the Polish Atrial Fibrillation (POL-AF) registry, which included consecutive patients hospitalized with AF from January to December, 2019. We included 829 patients (mean age: 72.7 ± 11.1 years) with data on serum uric acid (UA, mean: 6.56 ± 1.78 mg/dL) and estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2. We found that UA and ejection fraction (EF) were significantly correlated (r = −0.15, p < 0.05), but not EF and eGFR or eGFR and UA. A multiple regression analysis adjusted for age, body mass index, eGFR, and UA, showed that UA was significantly associated with a reduced EF (R2: 0.021; p < 0.001). The UA cut-off indicative of an EF < 40% was 6.69 mg/dL (AUC, area under the curve: 0.607; 95% CI: 0.554−0.660; p = 0.001). Among drugs known to effect UA concentrations, we found that only diuretics were used more frequently in patients with high UA (above the median) than in patients with low UA (77.5% vs. 67%, p < 0.001). Among patients that used diuretics, UA remained significantly correlated with EF. Thus, we showed that reduced EF was associated with UA in patients with AF and normal renal function, independent of eGFR and diuretic use.
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Wełnicki et al. (2022) conducted a cohort in Atrial fibrillation and preserved kidney function (n=829). Serum uric acid was evaluated on Ejection fraction (EF) < 40% (AUC 0.607, 95% CI 0.554-0.660, p=0.001). Serum uric acid was significantly associated with reduced ejection fraction in patients with atrial fibrillation and preserved kidney function (AUC 0.607; 95% CI 0.554-0.660; p=0.001).
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