Serum Uric Acid is Associated with Right Heart Failure in Patients with Heart Failure with Reduced Ejection Fraction: A Cross-Sectional Study

Objective: Serum uric acid (UA), which is the final product of purine metabolism, is a predictor of left-sided heart failure (HF), as well as being a marker of outcomes and survival in patients with heart failure with reduced ejection fraction (HFrEF). Right-sided HF may or may not accompany HFrEF, but is associated with worse prognosis and increased morbidity and mortality when present. All available data for the association between RHF and UA are derived from patients with pulmonary arterial hypertension, and virtually no data is available for patients with HFrEF. Our aim was to understand the relationships between UA, echocardiographic markers of right ventricular systolic function and RHF in patients with HFrEF. Material and Methods: A total of 45 patients with an ejection fraction <40% and signs of HF were included. Patients were divided into tertiles according to serum UA concentration. RHF was defined according to the modified Interagency Registry for Mechanically Assisted Circulatory Support criteria. Results: Compared to patients within the lowest UA tertile, patients within the 3rd tertile had a significantly higher incidence of RHF (50.0% vs. 0.0%, Bonferroni-corrected p=0.009) and a significantly lower tricuspid annular plane systolic excursion (20.5±4.4 vs. 16.1±4.4, p=0.02). After adjusting for relevant clinical, demographic, laboratory and echocardiographic variables, serum UA remained a significant predictor of RHF [odds ratio: 2.89, 95% confidence interval (CI): 1.21-6.91, p=0.017]. For serum UA, the c-statistic for determination of RHF was 0.83 (95% CI: 0.71-0.96). Conclusion: Serum UA is associated with the occurrence of RHF in patients with HFrEF.