Uric Acid and P-Wave Dispersion in Subjects with Heart Failure
DOI:
https://doi.org/10.31964/mltj.v7i1.259Keywords:
P-wave dispersion, uric acid, heart failureAbstract
Uric acid used as a marker of cardiovascular risk, which is associated with oxidative stress and inflammation. P-wave dispersion (PWD) is an electrocardiographic measure, which shows heterogeneity of atrial depolarization. It has demonstrated that there is an association of increased PWD with atrial fibrillation. This article aimed to investigate the relationship between PWD and uric acid in subjects with heart failure (HF). This descriptive method, cross-sectional study included a total of 315 stable HF outpatients. The subjects were classified into two groups by their PWD: the normal PWD group consisted of subjects with a PWD lower than 40 ms (n = 201), and the increased PWD group consisted of subjects with a PWD higher than or equal to 40 ms (n = 114). Significantly, the results showed higher uric acid levels determined in the increased PWD group, in comparison with the normal PWD group (7.4 ± 1.6 mg/dL, vs. 6.5 ± 1.6 mg/dL p < 0.001). Univariate analyses revealed an association between uric acid, blood urea nitrogen, systolic pulmonary artery pressure, left atrial diameter, and increased PWD. In multivariate logistic regression analysis, there was an association of uric acid level (OR: 1.293; 95% CI: 1.106-1.511, p: 0.001), systolic pulmonary artery pressure (OR: 1.027; 95% CI: 1.011-1.044, p: 0.001), and left atrial diameter (OR: 1.754; 95% CI: 1.028-2.992, p: 0.039) with PWD. The receiver operating characteristics (ROC) curve analysis demonstrated that the optimal cut-off level of uric acid for predicting increased PWD was ≥ 7.1 mg/dL with a specificity of 77 percent and a sensitivity of 81 percent. Conclusion of our study results suggested that serum uric acid levels independently correlated with PWD in subjects with HF.References
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Akutsu, Y., Kaneko, K., Kodama, Y., Miyoshi, F., Li, H. L., Watanabe, N., ... & Kobayashi, Y. (2013). A combination of P wave electrocardiography and plasma brain natriuretic peptide level for predicting the progression to persistent atrial fibrillation: comparisons of sympathetic activity and left atrial size. Journal of Interventional Cardiac Electrophysiology, 38(2), 79-84.
Bergamini, C., Cicoira, M., Rossi, A., & Vassanelli, C. (2009). Oxidative stress and hyperuricaemia: pathophysiology, clinical relevance, and therapeutic implications in chronic heart failure. European journal of heart failure, 11(5), 444-452.
Borghi, C., Palazzuoli, A., Landolfo, M., & Cosentino, E. (2020). Hyperuricemia: a novel old disorder—relationship and potential mechanisms in heart failure. Heart failure reviews, 25(1), 43-51.
Borghi, C., Tykarski, A., Widecka, K., Filipiak, K. J., Domienik-Karłowicz, J., Kostka-Jeziorny, K., ... & Mancia, G. (2018). Expert consensus for the diagnosis and treatment of patient with hyperuricemia and high cardiovascular risk. Cardiology journal, 25(5), 545-564.
Bui, A. L., Horwich, T. B., & Fonarow, G. C. (2011). Epidemiology and risk profile of heart failure. Nature Reviews Cardiology, 8(1), 30.
Carlisle, M. A., Fudim, M., DeVore, A. D., & Piccini, J. P. (2019). Heart failure and atrial fibrillation, like fire and fury. JACC: Heart Failure, 7(6), 447-456.
Çakar, M., Metin, S., Balta, S., Öztürk, C., Demirkol, S., Çakmak, T., ... & Sen, A. (2016). Military jet pilots have higher p-wave dispersions compared to the transport aircraft aircrew. International journal of occupational medicine and environmental health, 29(4), 563.
Dilaveris, P. E., Gialafos, E. J., Chrissos, D., Andrikopoulos, G. K., Richter, D. J., Lazaki, E., & Gialafos, J. E. (1999). Detection of hypertensive patients at risk for paroxysmal atrial fibrillation during sinus rhythm by computer-assisted P wave analysis. Journal of hypertension, 17(10), 1463-1470.
Dilaveris, P. E., Gialafos, E. J., Sideris, S. K., Theopistou, A. M., Andrikopoulos, G. K., Kyriakidis, M., ... & Toutouzas, P. K. (1998). Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. American heart journal, 135(5), 733-738.
Dogan, U., Dogan, E. A., Tekinalp, M., Tokgoz, O. S., Aribas, A., Akilli, H., ... & Yuruten, B. (2012). P-wave dispersion for predicting paroxysmal atrial fibrillation in acute ischemic stroke. International Journal of Medical Sciences, 9(1), 108.
Gazi, E., Gencer, M., Hanci, V., Temiz, A., Altun, B., Barutcu, A., ... & Colkesen, Y. (2015). Atrial conduction time, and left atrial mechanical and electromechanical functions in patients with polycystic ovary syndrome: interatrial conduction delay: cardiovascular topics. Cardiovascular journal of Africa, 26(6), 217-221.
George, J., Carr, E., Davies, J., Belch, J. J. F., & Struthers, A. (2006). Clinical perspective. Circulation, 114(23), 2508-2516.
Gudul, N. E., Karabag, T., Sayin, M. R., Bayraktaroglu, T., & Aydin, M. (2017). Atrial conduction times and left atrial mechanical functions and their relation with diastolic function in prediabetic patients. The Korean journal of internal medicine, 32(2), 286.
Guntekin, U., Gunes, Y., Tuncer, M., Gunes, A., Sahin, M., & Simsek, H. (2008). Long‐term follow‐up of P‐wave duration and dispersion in patients with mitral stenosis. Pacing and clinical electrophysiology, 31(12), 1620-1624.
Hatam, N., Aljalloud, A., Mischke, K., Karfis, E. A., Autschbach, R., Hoffmann, R., & Goetzenich, A. (2014). Interatrial conduction disturbance in postoperative atrial fibrillation: a comparative study of P-wave dispersion and Doppler myocardial imaging in cardiac surgery. Journal of cardiothoracic surgery, 9(1), 1-9.
Huang, G., Qin, J., Deng, X., Luo, G., Yu, D., Zhang, M., ... & Wang, L. (2019). Prognostic value of serum uric acid in patients with acute heart failure: A meta-analysis. Medicine, 98(8).
Johnson, R. J., Rodriguez-Iturbe, B., Kang, D. H., Feig, D. I., & Herrera-Acosta, J. (2005). A unifying pathway for essential hypertension. American journal of hypertension, 18(3), 431-440.
Kocaoglu C, Sert A, Aypar E, Oran B, Odabas D, Arslan D, Akin F. (2012). P-wave dispersion in children with acute rheumatic fever. Pediatr Cardiol, 33(1), 90-4.
Koide, Y., Yotsukura, M., Sakata, K., Yoshino, H., & Ishikawa, K. (2002). Investigation of the predictors of transition to persistent atrial fibrillation in patients with paroxysmal atrial fibrillation. Clinical Cardiology: An International Indexed and Peer‐Reviewed Journal for Advances in the Treatment of Cardiovascular Disease, 25(2), 69-75.
Kotecha, D., & Piccini, J. P. (2015). Atrial fibrillation in heart failure: what should we do?. European heart journal, 36(46), 3250-3257.
Lancellotti, P., Moura, L., Pierard, L. A., Agricola, E., Popescu, B. A., Tribouilloy, C., ... & Roelandt, J. R. (2010). European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). European Journal of Echocardiography, 11(4), 307-332.
Lang RM, Bierig M, Devereux RB et al. (2005). Chamber Quantification Writing Group; American Society of Echocardiography's Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr, 18, 1440-63.
Nyrnes, A., Toft, I., Njølstad, I., Mathiesen, E. B., Wilsgaard, T., Hansen, J. B., & Løchen, M. L. (2014). Uric acid is associated with future atrial fibrillation: an 11-year follow-up of 6308 men and women—the Tromsø Study. Europace, 16(3), 320-326.
Ogino, K., Kato, M., Furuse, Y., Kinugasa, Y., Ishida, K., Osaki, S., ... & Doehner, W. (2010). Uric acid-lowering treatment with benzbromarone in patients with heart failure: a double-blind placebo-controlled crossover preliminary study. Circulation: Heart Failure, 3(1), 73-81.
Oikonomou, E., Zografos, T., Papamikroulis, G. A., Siasos, G., Vogiatzi, G., Theofilis, P., ... & Tousoulis, D. (2019). Biomarkers in atrial fibrillation and heart failure. Current medicinal chemistry, 26(5), 873-887.
Ozyigit, T., Kocas, O., Karadag, B., & Ozben, B. (2016). Three dimensional left atrial volume index is correlated with P wave dispersion in elderly patients with sinus rhythm. Wiener klinische Wochenschrift, 128(5-6), 182-186.
Pérez-Riera, A. R., de Abreu, L. C., Barbosa-Barros, R., Grindler, J., Fernandes-Cardoso, A., & Baranchuk, A. (2016). P-wave dispersion: an update. Indian Pacing and Electrophysiology Journal, 16(4), 126-133.
Sarvari, S. I., Haugaa, K. H., Stokke, T. M., Ansari, H. Z., Leren, I. S., Hegbom, F., ... & Edvardsen, T. (2016). Strain echocardiographic assessment of left atrial function predicts recurrence of atrial fibrillation. European Heart Journal–Cardiovascular Imaging, 17(6), 660-667.
Shao, Y., Shao, H., Sawhney, M. S., & Shi, L. (2019). Serum uric acid as a risk factor of all-cause mortality and cardiovascular events among type 2 diabetes population: Meta-analysis of correlational evidence. Journal of Diabetes and its Complications, 33(10), 107409.
Su, H. M., Tsai, W. C., Lin, T. H., Hsu, P. C., Lee, W. H., Lin, M. Y., ... & Sheu, S. H. (2012). P wave dispersion and maximum P wave duration are independently associated with rapid renal function decline. PloS one, 7(8), e42815.
Tamariz, L., Agarwal, S., Soliman, E. Z., Chamberlain, A. M., Prineas, R., Folsom, A. R., ... & Alonso, A. (2011). Association of serum uric acid with incident atrial fibrillation (from the Atherosclerosis Risk in Communities [ARIC] study). The American journal of cardiology, 108(9), 1272-1276.
Tsioufis, C., Konstantinidis, D., Nikolakopoulos, I., Vemmou, E., Kalos, T., Georgiopoulos, G., ... & Tousoulis, D. (2019). Biomarkers of atrial fibrillation in hypertension. Current medicinal chemistry, 26(5), 888-897.
Tüukek, T., Akkaya, V., Atilgan, D., Demirel, Ş., Özcan, M., Güuven, Ö., & Korkut, F. (2001). Effect of left atrial size and function on P‐wave dispersion: A study in patients with paroxysmal atrial fibrillation. Clinical cardiology, 24(10), 676-680.
Tükek, T., Akkaya, V., Demirel, Ş., Sözen, A. B., Kudat, H., Atılgan, D., ... & Korkut, F. (2000). Effect of Valsalva maneuver on surface electrocardiographic P-wave dispersion in paroxysmal atrial fibrillation. American Journal of Cardiology, 85(7), 896-899.
Turhan, H., Yetkin, E., Senen, K., Yilmaz, M. B., Ileri, M., Atak, R., ... & Kutuk, E. (2002). Effects of percutaneous mitral balloon valvuloplasty on P-wave dispersion in patients with mitral stenosis. American Journal of Cardiology, 89(5), 607-609.
Zacharia, E., Papageorgiou, N., Ioannou, A., Siasos, G., Papaioannou, S., Vavuranakis, M., ... & Tousoulis, D. (2019). Inflammatory biomarkers in atrial fibrillation. Current medicinal chemistry, 26(5), 837-854.
Zhao, Q. Y., Yu, S. B., Huang, H., Cui, H. Y., Mu, Q. I. N., Huang, T., & Huang, C. X. (2012). Serum uric acid levels correlate with atrial fibrillation in patients with chronic systolic heart failure. Chinese medical journal, 125(10), 1708-1712.
Akutsu, Y., Kaneko, K., Kodama, Y., Miyoshi, F., Li, H. L., Watanabe, N., ... & Kobayashi, Y. (2013). A combination of P wave electrocardiography and plasma brain natriuretic peptide level for predicting the progression to persistent atrial fibrillation: comparisons of sympathetic activity and left atrial size. Journal of Interventional Cardiac Electrophysiology, 38(2), 79-84.
Bergamini, C., Cicoira, M., Rossi, A., & Vassanelli, C. (2009). Oxidative stress and hyperuricaemia: pathophysiology, clinical relevance, and therapeutic implications in chronic heart failure. European journal of heart failure, 11(5), 444-452.
Borghi, C., Palazzuoli, A., Landolfo, M., & Cosentino, E. (2020). Hyperuricemia: a novel old disorder—relationship and potential mechanisms in heart failure. Heart failure reviews, 25(1), 43-51.
Borghi, C., Tykarski, A., Widecka, K., Filipiak, K. J., Domienik-Karłowicz, J., Kostka-Jeziorny, K., ... & Mancia, G. (2018). Expert consensus for the diagnosis and treatment of patient with hyperuricemia and high cardiovascular risk. Cardiology journal, 25(5), 545-564.
Bui, A. L., Horwich, T. B., & Fonarow, G. C. (2011). Epidemiology and risk profile of heart failure. Nature Reviews Cardiology, 8(1), 30.
Carlisle, M. A., Fudim, M., DeVore, A. D., & Piccini, J. P. (2019). Heart failure and atrial fibrillation, like fire and fury. JACC: Heart Failure, 7(6), 447-456.
Çakar, M., Metin, S., Balta, S., Öztürk, C., Demirkol, S., Çakmak, T., ... & Sen, A. (2016). Military jet pilots have higher p-wave dispersions compared to the transport aircraft aircrew. International journal of occupational medicine and environmental health, 29(4), 563.
Dilaveris, P. E., Gialafos, E. J., Chrissos, D., Andrikopoulos, G. K., Richter, D. J., Lazaki, E., & Gialafos, J. E. (1999). Detection of hypertensive patients at risk for paroxysmal atrial fibrillation during sinus rhythm by computer-assisted P wave analysis. Journal of hypertension, 17(10), 1463-1470.
Dilaveris, P. E., Gialafos, E. J., Sideris, S. K., Theopistou, A. M., Andrikopoulos, G. K., Kyriakidis, M., ... & Toutouzas, P. K. (1998). Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. American heart journal, 135(5), 733-738.
Dogan, U., Dogan, E. A., Tekinalp, M., Tokgoz, O. S., Aribas, A., Akilli, H., ... & Yuruten, B. (2012). P-wave dispersion for predicting paroxysmal atrial fibrillation in acute ischemic stroke. International Journal of Medical Sciences, 9(1), 108.
Gazi, E., Gencer, M., Hanci, V., Temiz, A., Altun, B., Barutcu, A., ... & Colkesen, Y. (2015). Atrial conduction time, and left atrial mechanical and electromechanical functions in patients with polycystic ovary syndrome: interatrial conduction delay: cardiovascular topics. Cardiovascular journal of Africa, 26(6), 217-221.
George, J., Carr, E., Davies, J., Belch, J. J. F., & Struthers, A. (2006). Clinical perspective. Circulation, 114(23), 2508-2516.
Gudul, N. E., Karabag, T., Sayin, M. R., Bayraktaroglu, T., & Aydin, M. (2017). Atrial conduction times and left atrial mechanical functions and their relation with diastolic function in prediabetic patients. The Korean journal of internal medicine, 32(2), 286.
Guntekin, U., Gunes, Y., Tuncer, M., Gunes, A., Sahin, M., & Simsek, H. (2008). Long‐term follow‐up of P‐wave duration and dispersion in patients with mitral stenosis. Pacing and clinical electrophysiology, 31(12), 1620-1624.
Hatam, N., Aljalloud, A., Mischke, K., Karfis, E. A., Autschbach, R., Hoffmann, R., & Goetzenich, A. (2014). Interatrial conduction disturbance in postoperative atrial fibrillation: a comparative study of P-wave dispersion and Doppler myocardial imaging in cardiac surgery. Journal of cardiothoracic surgery, 9(1), 1-9.
Huang, G., Qin, J., Deng, X., Luo, G., Yu, D., Zhang, M., ... & Wang, L. (2019). Prognostic value of serum uric acid in patients with acute heart failure: A meta-analysis. Medicine, 98(8).
Johnson, R. J., Rodriguez-Iturbe, B., Kang, D. H., Feig, D. I., & Herrera-Acosta, J. (2005). A unifying pathway for essential hypertension. American journal of hypertension, 18(3), 431-440.
Kocaoglu C, Sert A, Aypar E, Oran B, Odabas D, Arslan D, Akin F. (2012). P-wave dispersion in children with acute rheumatic fever. Pediatr Cardiol, 33(1), 90-4.
Koide, Y., Yotsukura, M., Sakata, K., Yoshino, H., & Ishikawa, K. (2002). Investigation of the predictors of transition to persistent atrial fibrillation in patients with paroxysmal atrial fibrillation. Clinical Cardiology: An International Indexed and Peer‐Reviewed Journal for Advances in the Treatment of Cardiovascular Disease, 25(2), 69-75.
Kotecha, D., & Piccini, J. P. (2015). Atrial fibrillation in heart failure: what should we do?. European heart journal, 36(46), 3250-3257.
Lancellotti, P., Moura, L., Pierard, L. A., Agricola, E., Popescu, B. A., Tribouilloy, C., ... & Roelandt, J. R. (2010). European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). European Journal of Echocardiography, 11(4), 307-332.
Lang RM, Bierig M, Devereux RB et al. (2005). Chamber Quantification Writing Group; American Society of Echocardiography's Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr, 18, 1440-63.
Nyrnes, A., Toft, I., Njølstad, I., Mathiesen, E. B., Wilsgaard, T., Hansen, J. B., & Løchen, M. L. (2014). Uric acid is associated with future atrial fibrillation: an 11-year follow-up of 6308 men and women—the Tromsø Study. Europace, 16(3), 320-326.
Ogino, K., Kato, M., Furuse, Y., Kinugasa, Y., Ishida, K., Osaki, S., ... & Doehner, W. (2010). Uric acid-lowering treatment with benzbromarone in patients with heart failure: a double-blind placebo-controlled crossover preliminary study. Circulation: Heart Failure, 3(1), 73-81.
Oikonomou, E., Zografos, T., Papamikroulis, G. A., Siasos, G., Vogiatzi, G., Theofilis, P., ... & Tousoulis, D. (2019). Biomarkers in atrial fibrillation and heart failure. Current medicinal chemistry, 26(5), 873-887.
Ozyigit, T., Kocas, O., Karadag, B., & Ozben, B. (2016). Three dimensional left atrial volume index is correlated with P wave dispersion in elderly patients with sinus rhythm. Wiener klinische Wochenschrift, 128(5-6), 182-186.
Pérez-Riera, A. R., de Abreu, L. C., Barbosa-Barros, R., Grindler, J., Fernandes-Cardoso, A., & Baranchuk, A. (2016). P-wave dispersion: an update. Indian Pacing and Electrophysiology Journal, 16(4), 126-133.
Sarvari, S. I., Haugaa, K. H., Stokke, T. M., Ansari, H. Z., Leren, I. S., Hegbom, F., ... & Edvardsen, T. (2016). Strain echocardiographic assessment of left atrial function predicts recurrence of atrial fibrillation. European Heart Journal–Cardiovascular Imaging, 17(6), 660-667.
Shao, Y., Shao, H., Sawhney, M. S., & Shi, L. (2019). Serum uric acid as a risk factor of all-cause mortality and cardiovascular events among type 2 diabetes population: Meta-analysis of correlational evidence. Journal of Diabetes and its Complications, 33(10), 107409.
Su, H. M., Tsai, W. C., Lin, T. H., Hsu, P. C., Lee, W. H., Lin, M. Y., ... & Sheu, S. H. (2012). P wave dispersion and maximum P wave duration are independently associated with rapid renal function decline. PloS one, 7(8), e42815.
Tamariz, L., Agarwal, S., Soliman, E. Z., Chamberlain, A. M., Prineas, R., Folsom, A. R., ... & Alonso, A. (2011). Association of serum uric acid with incident atrial fibrillation (from the Atherosclerosis Risk in Communities [ARIC] study). The American journal of cardiology, 108(9), 1272-1276.
Tsioufis, C., Konstantinidis, D., Nikolakopoulos, I., Vemmou, E., Kalos, T., Georgiopoulos, G., ... & Tousoulis, D. (2019). Biomarkers of atrial fibrillation in hypertension. Current medicinal chemistry, 26(5), 888-897.
Tüukek, T., Akkaya, V., Atilgan, D., Demirel, Ş., Özcan, M., Güuven, Ö., & Korkut, F. (2001). Effect of left atrial size and function on P‐wave dispersion: A study in patients with paroxysmal atrial fibrillation. Clinical cardiology, 24(10), 676-680.
Tükek, T., Akkaya, V., Demirel, Ş., Sözen, A. B., Kudat, H., Atılgan, D., ... & Korkut, F. (2000). Effect of Valsalva maneuver on surface electrocardiographic P-wave dispersion in paroxysmal atrial fibrillation. American Journal of Cardiology, 85(7), 896-899.
Turhan, H., Yetkin, E., Senen, K., Yilmaz, M. B., Ileri, M., Atak, R., ... & Kutuk, E. (2002). Effects of percutaneous mitral balloon valvuloplasty on P-wave dispersion in patients with mitral stenosis. American Journal of Cardiology, 89(5), 607-609.
Zacharia, E., Papageorgiou, N., Ioannou, A., Siasos, G., Papaioannou, S., Vavuranakis, M., ... & Tousoulis, D. (2019). Inflammatory biomarkers in atrial fibrillation. Current medicinal chemistry, 26(5), 837-854.
Zhao, Q. Y., Yu, S. B., Huang, H., Cui, H. Y., Mu, Q. I. N., Huang, T., & Huang, C. X. (2012). Serum uric acid levels correlate with atrial fibrillation in patients with chronic systolic heart failure. Chinese medical journal, 125(10), 1708-1712.
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2021-06-18
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Kurt, R., & Şahin, A. (2021). Uric Acid and P-Wave Dispersion in Subjects with Heart Failure. Medical Laboratory Technology Journal, 7(1), 26–35. https://doi.org/10.31964/mltj.v7i1.259
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