الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Heart failure is a leading cause of mortality in Egypt, 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, uric acid may also have prognostic value (Stöhr et al., 2020).Increases in BNP results primarily from increasing cardiac filling pressures, whereas increases in uric acid are associated with increased vascular tone and depressed myocardial contractility via increased xanthine oxidase activity (Tedeschi et al., 2020). Thus, uric acid, like BNP, could be associated with haemodynamic compromise in heart failure. Increased uric acid levels can be associated with worsening haemodynamic compromise in patients with heart failure independent of BNP (Palazzuoli et al., 2017). High serum uric acid (UA) has recently been discussed not only as a gout culprit but also as a cause of cardiovascular disorders. According to previous studies, serum UA levels predict the progression of chronic kidney disease and the development of stroke. Additionally, high serum UA is associated with the presence of hypertension, diabetes, and metabolic syndrome (Borghi et al., 2020). High serum UA levels also predict an increase in morbidity and mortality in patients with heart failure. That high UA is causally associated with left ventricular (LV) systolic dysfunction and a reduced LV ejection fraction (LVEF) in patients with ischemic heart disease (Tanaka et al., 2017). Importantly, the effect of high UA on LV dysfunction is exerted not only through an atherosclerotic process in the coronary arteries (cardiac ischemia) but also directly, as represented by a possible cause-and-effect relationship. (Kato et al., 2020). B-type natriuretic peptide (BNP) is a natriuretic peptide that is widely used for diagnosis and predicting prognosis in heart failure. Measurement of plasma BNP is recommended as a reliable diagnostic method of heart failure in general practice and emergency medical care. It is thus conceivable that plasma BNP should be potentially linked to high serum UA and associated LV dysfunction. There have been few reports of a close linkage between serum UA and plasma BNP in heart failure (Yoshitsugu et al., 2019). Instead, there has been a negative report in which UA did not significantly add to the prognostic utility of BNP. Although a high serum UA level is associated with heart failure, more studies are required to confirm the role of high serum UA in heart failure in consideration of the observed LV dysfunction and plasma BNP (Natali et al., 2017). Plasma BNP levels are associated with many confounding factors, including ageing, gender distinction, body mass index (BMI), LV dysfunction, and renal dysfunction. Additionally, serum UA is associated with the same factors (Kumagai et al., 2020). Elevated serum UA is known to be associated with aggravated insulin resistance, obesity, hypertension, renal dysfunction, and hypothyroidism, which may explain enhanced cardiovascular risk and advanced left ventricular hypertrophy (LVH) among hyperuricemic individuals. On the other hand, however, uric acid plays a causal role in cardiovascular morbidity (Ma et al., 2020).