Evaluating the role of serum uric acid in the risk stratification and therapeutic response of patients with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD)

Jun Luo; Yuanchang Li; Jingyuan Chen; Haihua Qiu; Wenjie Chen; Xiaoqin Luo; Yusi Chen; Yingjie Tan; Jiang Li

doi:10.3389/fphar.2023.1238581

Evaluating the role of serum uric acid in the risk stratification and therapeutic response of patients with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD)

Front Pharmacol. 2023 Aug 28:14:1238581. doi: 10.3389/fphar.2023.1238581. eCollection 2023.

Authors

Jun Luo¹, Yuanchang Li¹, Jingyuan Chen¹, Haihua Qiu¹, Wenjie Chen¹, Xiaoqin Luo¹, Yusi Chen¹, Yingjie Tan¹, Jiang Li¹

Affiliation

¹ Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.

Abstract

Background: Pulmonary arterial hypertension (PAH) is a malignant pulmonary vascular disease that negatively impacts quality of life, exercise capacity, and mortality. This study sought to investigate the relationship between serum uric acid (UA) level and the disease severity and treatment response of patients with PAH and congenital heart disease (PAH-CHD). Methods: This study included 225 CHD patients and 40 healthy subjects. Serum UA was measured in all patients, and UA levels and haemodynamic parameters were re-evaluated in 20 patients who had received PAH-specific drug treatment for at least 7 ± 1 month. Results: Serum UA levels were significantly higher in PAH-CHD patients than in CHD patients with a normal pulmonary artery pressure and normal subjects (347.7 ± 105.7 μmol/L vs. 278.3 ± 84.6 μmol/L; 347.7 ± 105.7 μmol/L vs. 255.7 ± 44.5 μmol/L, p < 0.05). UA levels in the intermediate and high risk groups were significantly higher than those in the low-risk group (365.6 ± 107.8 μmol/L vs. 311.2 ± 82.8 μmol/L; 451.6 ± 117.6 μmol/L vs. 311.2 ± 82.8 μmol/L, p < 0.05). Serum UA levels positively correlated with mean pulmonary arterial pressure, WHO functional class, pulmonary vascular resistance, and NT-proBNP (r = 0.343, 0.357, 0.406, 0.398; p < 0.001), and negatively with mixed venous oxygen saturation (SvO₂) and arterial oxygen saturation (SaO₂) (r = -0.293, -0.329; p < 0.001). UA significantly decreased from 352.7 ± 97.5 to 294.4 ± 56.8 μmol/L (p = 0.001) after PAH-specific drug treatment for at least 6 months, along with significant decreases in mean pulmonary arterial pressure and pulmonary vascular resistance and increases in cardiac index and mixed SvO₂. Conclusion: Serum UA can be used as a practical and economic biomarker for risk stratification and the evaluation of PAH-specific drug treatment effects for patients with PAH-CHD.

Keywords: congenital heart disease; eisenmenger syndrome; pulmonary arterial hypertension; risk stratification; uric acid.

Grants and funding

This work was supported by National Natural Science Foundation of China (Project 81870233 and 81600249), Natural Science Foundation of Hunan Province (2022JJ30823), Hunan Provincial Health Commission Foundation of China (Project 202103010961), Natural Science Foundation of Changsha city (Project kq2202392) and China International Medical Foundation (2022-N-01-23).