Abstract 2914: Serum Uric Acid is a Powerful Predictor of Survival in Patients With Stable Chronic Heart Failure Receiving Beta-Blocker Therapy
Background: Previous studies have demonstrated that uric acid was a powerful predictor of survival in pts with chronic heart failure (CHF), but these studies were performed before the beta-blocker (BB) era.
Aim of the study: to define independent biological prognostic parameters of survival in stable CHF pts receiving BB.
Results: We studied 437 consecutive pts (mean age: 56±12 years, ischemic cardiomyopathy: 183 pts (42%), 365 pts (83%) in NYHA class I/II, LVEF of 35±12%). Most of the pts (99%) received renin system blockers, 20% received carvedilol [mean dose: 52±25 mg/d], 75% bisoprolol [mean dose: 8.7±2.8 mg/d] and 23 pts other beta-1 selective blockers. During a median follow-up period of 1113 days, there were 81 cardiac deaths, 11 non-urgent transplantations and 16 non-cardiac deaths. Independent predictors of cardiac survival were BNP (RR:1.48 [1.28 –1.72], p<0.0001), uric acid (1.02 [1.004 –1.03], p=0.015), albumin (0.88 [0.79 – 0.98], p=0.015), NYHA class III (2.15 [1.1– 4.2], p=0.025) and diabetes (2.01 [1.03–3.9], p=0.04). With cut-off values (ROC method), independent predictors of cardiac survival were BNP≥200 pg/ml (RR:4.85 [2.21–10.6], p<0.0001), NYHA class III (2.37 [1.29 – 4.36], p=0.005) and uric acid≥80 mg/l (2 [1.16 –3.48], p=0.013). Other biological parameters, such as sodium, creatinine (or creatinine clearance (Cockroft or MDRD methods)), haemoglobin and cholesterol were not associated with cardiac survival. Uric acid was particularly useful for risk stratification in patients with high levels of BNP (Figure⇓).
Conclusion: Uric acid and BNP were the most useful biological parameters for risk stratification of stable pts with CHF receiving BB.