Background Gout connects to cardiovascular (CV) morbidity and higher risk of death due to CV events. A few ultrasound studies assess the way in which heart and vessels change over time in gout patients (pts). It is still unclear whether treatment with allopurinol or febuxostat reduces to some extent target organ damage.
Objectives We aimed to establish heart and vessels alterations developing over time in gout pts and to find out whether treatment with allopurinol or febuxostat is associated with a change in these structures.
Methods A total of 53 gout pts were examined and divided into two groups: 31 gouty arthritis without tophi, 24 males and 7 females aged 55.8±12.3 years and 22 gouty tophi, 20 males and 2 females aged 59±9 years. Pts underwent multimodal ultrasound examination at study entry and one year and six months thereafter. Aortic root diameter (Ao), left atrium (LA) size, thickness of the interventricular septum (IVS) and of posterior wall (PW) of the left ventricle, end-diastolic volume index (EDVi), end-systolic volume index (ESVi), stroke volume index (SVi), fractional shortening (FS), and ejection fraction (EF) were recorded with 2.5 MHz transducer. Intima-media thickness (IMT) and rigidity of the common carotid arteries, judged by the values of the common carotid artery resistive index (CCARI), were examined with 10 MHz transducer. Statistical analyzes were done by chi-square or Fisher's exact test, One-Sample Kolmogorov-Smirnov, Shapiro-Wilk and Paired-Samples T-test. Within-subjects effects and between-subjects effects were assessed by the Repeated Measures ANOVA.
Results At the two time points of pts' examination there was no deviation in Hb (p=0.412), Ht (p=0.866), serum uric acid (p=0.877), serum albumin (p=0.515), eGFR (p=0.793), EDVi (p=0.248), ESVi (p=0.345), SVi (p=0.357), FS (p=0.516) and CCARI (p=0.244), but PW tended to be thicker (p=0.067). Ao (p=0.008), LA (p=0.001), IVS (p=0.007) increased, and EF (p=0.026) decreased between the two examinations. In gouty arthritis without tophi and in gouty tophi Ao (mean±SD; 39.42±5.00 vs 39.14±3.77, p=0.471), LA (mean±SD; 39.10±5.11 vs 43.86±5.95, p=0.088), IVS (mean±SD; 12.77±1.58 vs 13.47±1.54, p=0.910) and IMT (mean±SD; 0.93±0.17 vs 1.05±0.17, p=0.237) changed similarly over time, but the reduction in EF was more pronounced in gouty tophi (p=0.031). In pts not taking allopurinol an increase in LA (p=0.012), IVS (p=0.006) and IMT (p<0.001) was registered. In those treated with allopurinol Ao (p=0.011), LA (p=0.022) increased, EF (p=0.016) decreased and no change in IVS (p=0.523) and IMT (p=0.165) was found. Pts who had not received febuxostat tended to have greater Ao (p=0.063), larger LA (p=0.003), thicker IVS (p=0.046), thicker IMT (p<0.001) and lower EF (p=0.034). In contrast, no change was registered in Ao (p=0.559), LA (p=0.332), IVS (p=0.125), EF (p=0.689) and IMT (p=0.163) in treated with febuxostat.
Conclusions Over time in gouty arthritis without tophi and gouty tophi similar changes in the heart and carotids develop, but heart pumping function is more affected in the later stage of the disease. Heart and carotids morphology and function are preserved in pts treated with febuxostat. In the allopurinol group cardiac morphological and functional alterations occur with no change in IMT.
Disclosure of Interest None declared