| Background & Objective:Many patients with heart failure have hyperuricemia,their clinical prognosis is poor,and the fatality rate is high.The influence of xanthine oxidase-related oxidative stress on the occurrence and development of heart failure has also been continuously concerned by researchers.With the gradual increase of heart failure,the activity and quantity of xanthine oxidase also increase.This study aimed to evaluate the effect of the xanthine oxidase inhibitor-febuxostat on the prognosis of patients with heart failure with preserved ejection fraction through a cohort study.Methods: A cohort study method was used to continuously collect heart failure patients with hyperuricemia who were hospitalized in the Affiliated Hospital of Qingdao University from2014 to 2017.The 276 patients who were followed up for 1 year were divided into the conventional treatment group and Febuxostat group.The conventional treatment group received standard anti-heart failure treatment.Febuxostat group was treated with febuxostat uric acid on the basis of standard heart failure treatment.Blood pressure,blood uric acid,and atrial natriuretic peptide(BNP B-type natriuretic peptide)were collected before and after 1year of follow-up treatment.LVEF left ventricular ejection fractions,LAD left atrial dimension,LVMI left ventricular mass index and E/E ’ratio were measured by echocardiography to record the incidence of cardiovascular events in febuxostat group and conventional treatment group for 1 year.Results:1.Changes of post-treatment echocardiography and clinical baseline: Compared with before treatment,serum uric acid levels,E/E ’and LVMI decreased significantly in febuxustat group,which were significantly different from those in conventional treatment group(P<0.01).BNP and blood pressure also decreased in both groups compared with before treatment,but there was no significant difference between the two groups.EGFR in febuxostat group did not change significantly during treatment.2.Analysis of follow-up cardiovascular events: During the 1-year follow-up,23 patients(14.8%)in the conventional treatment group and 8 patients(6.6%)in the febuxastat group were readmission to the hospital for cardiac insufficiency.Kaplan-Meier statistical analysis showed that febuxastat could effectively reduce ejection fraction and preserve the re-hospitalization rate of patients with heart failure,and the difference was statistically significant(P=0.034).3.Multivariate Cox regression analysis of cardiovascular events in patients with hyperuricemia and heart failure: Log-rank test results showed that age,LVMI,E/E ’,ACEI/ARB medication,serum uric acid,and febuxostat treatment were all associated with readmissions(P<0.10).The analysis showed that ACEI/ARB treatment(HR0.247,95%CI0.062-0.984,P<0.05)reduced the risk of readmission in patients with hyperuricemia with retained ejection fraction,while age,LVMI,and E/E ’may be influencing factors for readmission in patients with heart failure.Conclusion:As a xanthine oxidase inhibitor,febuxostat can significantly reduce the ejection fraction and preserve the blood uric acid level,E/e’,LVMI of patients with heart failure,and effectively reduce the readmission rate of such patients.Because of its high efficiency and low cost,febuxostat is expected to be used in patients with heart failure with preserved ejection fraction.It can effectively reduce uric acid and improve the prognosis of such patients. |
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