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Increased levels of uric acid predict haemodynamic compromise in patients with heart failure independently of B-type natriuretic peptide levels
  1. Michelle M Kittleson1,
  2. Marcus E St John3,
  3. Valeriani Bead2,
  4. Hunter C Champion2,
  5. Edward K Kasper2,
  6. Stuart D Russell2,
  7. Ilan S Wittstein2,
  8. Joshua M Hare4
  1. 1Division of Cardiology, The David Geffen School of Medicine at UCLA, Los Angeles California, USA
  2. 2Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
  3. 3Division of Cardiology, Department of Medicine, Baptist Hospital, Miami, Florida, USA
  4. 4Division of Cardiology, Miller School of Medicine, University of Miami, Miami, Florida, USA
  1. Correspondence to:
    Dr J M Hare
    Clinical Research Building, 1120 NW 14th Street, 8th floor, Miami, FL 33136, USA; jhare{at}

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Heart failure is a leading cause of mortality in the USA and Europe, and the ability to predict prognosis is essential for optimal allocation of treatments. Biomarkers offering prognostic information in patients with heart failure have recently entered practice. Although B-type natriuretic peptide (BNP) is an established biomarker,1 uric acid may also have prognostic value.2,3

Increases in BNP results primarily from increasing cardiac filling pressures, whereas increases in uric acid are associated with increased vascular tone4 and depressed myocardial contractility via increased xanthine oxidase activity.5 Thus, uric acid, like BNP, could be associated with haemodynamic compromise in heart failure. We tested the hypothesis that increased uric acid levels are associated with worsening haemodynamic compromise in patients with heart failure independent of BNP.


Study patients were referred for right heart catheterisation between 1 January 2003 and 1 July 2004. Right atrial, pulmonary arterial and pulmonary capillary wedge (PCW) pressures were measured using a balloon-tipped, flow-directed catheter. Cardiac output was determined by thermodilution. Heart transplant recipients or patients currently receiving synthetic human BNP were excluded. Uric acid and N-terminal proBNP (NT-proBNP) levels were drawn during the right heart catheterisation. The study was approved by the Johns Hopkins Institutional Review Board.

Patients were divided into groups on the basis of the median serum uric acid and NT-proBNP levels: low uric acid and low NT-proBNP (n = 27), high uric acid and low NT-proBNP (n = 24), low uric acid and high NT-proBNP (n = 22), and high uric acid and high NT-proBNP (n = 33). We compared haemodynamic parameters between groups using linear …

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  • Competing interests: JMH is a paid consultant at Cardiome Pharma Corporation, a manufacturer of oxypurinol. The terms of this arrangement are being managed by the Johns Hopkins University in accordance with its conflict of interest policies. Cardiome Pharma Corporation had no involvement in the study design, data collection or analysis, writing of the report, or in the decision to submit the paper for publication.