Correlation Between Uric Acid and Atrial Electromechanical Coupling Interval in Heart Failure with Reduced Ejection Fraction

Background: Chronic Heart Failure (CHF) can lead to atrial and structural remodeling that result in non-homogenous impulse propagation and inter and intra-atrial conduction delay. Prolongation of interval of Atrial ElectroMechanical Coupling (AEMC) in CHF patient was related to atrial electromechanical remodeling and Atrial Fibrillation (AF) risk. Hyperuricemia found in CHF played a role in the pathophysiology of AF through neuro-hormonal activation, oxidative stress, inflammation and ionic channel dysfunction. This study aimed to investigate the association between uric acid and AEMCinterval in CHF with reduced ejection fraction.Methods: This study was a cross sectional study. Subject were CHF patients with reduced ejection fraction and sinus rhythm who visited cardiology clinic Dr. Hasan Sadikin Bandung between July - September 2018. Blood sampling for uric acid was performed in the morning after fasting 10-12 hours. AEMC interval was measured by echocardiography Tissue Doppler Imaging (TDI) as time interval from onset of P wave in surface electrocardiography to onset of A wave from TDI in lateral atrial wall called lateral PA interval. Statistical analysis was done by linear regression analysis to control confounding variables.Results: This study involved 51 CHF patients with reduced ejection fraction (< 40%) with median age 62 (27 – 81) year, 92% have history of myocardial infarction or coronary revascularization, 16% have diabetes mellitus, 51% have hypertension, and eGFR of 60.9 + 22.1. Mean uric acid was 8.0 + 2.2 mg/dL and mean lateral PA interval was 67.4 + 19.2 ms. Uric acid was significantly associated with lateral PA interval (R : 0.665, adjusted R2 0.407, P < 0.001) after controlling the confounding variables: systolic blood pressure and diastolic function.Conclusion: Uric acid significantly correlated positively with AEMC interval in CHF patients with reduced ejection fraction.