title: Effect of serum uric acid on the positive predictive value of dobutamine stress echocardiography.
abstract: There is controversial data regarding the relationship between uric acid (UA) and coronary artery disease and cardiovascular events. Despite the deleterious effects of hyperuricemia on endothelial function, the effect of UA on myocardial ischemia has not been previously studied. We aimed to investigate the relationship between UA and myocardial ischemia that was identified using dobutamine stress echocardiography (DSE). In this retrospective study, the laboratory and DSE reports of 548 patients were reviewed. The patients were divided into two groups based on the presence of ischemia and further subdivided into three groups according to the extent of ischemia (none, ischemia in 1-3 segments, ischemia in >3 segments). Serum UA levels were compared. Determinants of ischemia were assessed using a regression model. UA was increased in patients with ischemia and was correlated with the number of ischemic segments (p < 0.001). A cutoff value of UA > 5 mg/dl had 63.9 % sensitivity, 62.0 % specificity, 42.5 % positive predictive value (PPV), and 79.6 % negative predictive value for ischemia. When the positive DSE exams were further sorted according to the UA cutoff, the PPV of DSE increased from 80.2 to 94.0 %. Uric acid (odds ratio 1.51; 95 % CI 1.14-1.99), diabetes mellitus, HDL and glomerular filtration rate were found to be independent determinants of myocardial ischemia in DSE. Increased UA is associated with both the presence and extent of DSE-identified myocardial ischemia. A UA cutoff may be a good method to improve the PPV of DSE.
authors.affiliation: Department of Cardiology, Necmettin Erbakan University Meram School of Medicine, Meram, Konya, Turkey. draribas@hotmail.com.
authors.forename: Alpay
authors.initials: A
authors.lastname: Aribas
authors.affiliation: Department of Cardiology, Necmettin Erbakan University Meram School of Medicine, Meram, Konya, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Akilli
authors.affiliation: Department of Cardiology, Necmettin Erbakan University Meram School of Medicine, Meram, Konya, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kayrak
authors.affiliation: Department of Cardiology, Lokman Hekim Van Hospital, Van, Turkey.
authors.forename: Hayrudin
authors.initials: H
authors.lastname: Alibasic
authors.affiliation: Tokat State Hospital, Cardiology Clinic, Tokat, Turkey.
authors.forename: Oguzhan
authors.initials: O
authors.lastname: Yildirim
authors.affiliation: Department of Cardiology, Necmettin Erbakan University Meram School of Medicine, Meram, Konya, Turkey.
authors.forename: Ahmet Lutfi
authors.initials: AL
authors.lastname: Sertdemir
authors.affiliation: Department of Cardiology, Necmettin Erbakan University Meram School of Medicine, Meram, Konya, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Karanfil
authors.affiliation: Department of Cardiology, Necmettin Erbakan University Meram School of Medicine, Meram, Konya, Turkey.
authors.forename: Kurtulus
authors.initials: K
authors.lastname: Ozdemir
mesh_terms: D058665:Adrenergic beta-1 Receptor Agonists / Q000008:administration & dosage*; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D004280:Dobutamine / Q000008:administration & dosage*; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D006801:Humans; D033461:Hyperuricemia / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015854:Up-Regulation; D014527:Uric Acid / Q000097:blood*
chemical_list: D058665:Adrenergic beta-1 Receptor Agonists; D015415:Biomarkers; D014527:Uric Acid; D004280:Dobutamine
keywords: Coronary artery disease; Dobutamine stress echocardiography; Hyperuricemia; Myocardial ischemia; Uric acid