Abstract 11572: Hyperuricemia Reflects Heart Failure Severity and Predicts Morbidity and Mortality in Patients After the Fontan Operation

Abstract

Background: Serum uric acid level (UA, mg/dl) not only associates with pathophysiology in adult patients with chronic heart failure but also predicts the cardiac events. However, the clinical significance of UA remains unclear in patients after the Fontan operation. Purpose: To clarify clinical significance of hyperuricemia (HUA, UA≥7.0) in Fontan patients. Methods and Results: We prospectively measured UA in consecutive 306 Fontan patients (16±8 years) and compared the results with the clinical variables, including hemodynamics, exercise capacity, plasma levels of norepinephrine (NE), brain natriuretic peptide (BNP), and unscheduled hospitalization (USH), including all-cause mortality. The UA was 5.8±1.7 and 70 (23%) patients showed HUA. On multivariate model, high levels of plasma creatinine and NE, use of diuretics, low cardiac index, hypoxia, and hyponatrenia independently associated with HUA (p<0.05-0.001), however BNP level did not correlate with UA (p=0.35). During a follow-up of 49±27 months, 69 USH, including 16 deaths, occurred. In addition to BNP levels, HUA independently predicted USH (hazard ratio [HR]: 2.9, 95% confidence interval [CI]: 1.8-4.6, p<0.0001) and mortality (HR: 3.8, 95%CI: 1.4-10, p<0.01). When compared with Fontan patients with normal UA with low BNP, those with HUA and high BNP (≥18.4 pg/ml) had a high HR of 7.0 (CI:3.5-14.1, p<0.0001) and 11.7 (CI:2.9-78.1, p<0.001) for USH and all-cause mortality, respectively. Conclusions: UA is a simple and clinically useful marker for stratifying heart failure severity of Fontan patients and HUA predicts the morbidity and mortality.