Uric acid in chronic heart failure: A measure of the anaerobic threshold

The anaerobic threshold (AT) is a measure of the balance between aerobic and anaerobic cellular metabolism. Hyperuricemia occurs in conditions that involve an imbalance between cellular oxygen consumption and carbon dioxide production, such as chronic heart failure (CHF). We therefore hypothesized that in CHF, serum uric acid might be related to the AT. Patients with CHF (n = 40, aged 58.7 ± 1.9 years; New York Heart Association Class I-IV; maximal oxygen consumption [MV̇(O₂)], 18.7 ± 01.1 mL/kg/min; left ventricular ejection fraction, 26% ± 2%) and 10 age-matched healthy controls underwent measurement of the serum uric acid level at rest and assessment of the AT. This was derived from MV̇(O₂) and the regression slope relating minute ventilation to carbon dioxide output (VE - V̇(CO₂)) during a maximal treadmill exercise test. Compared with the healthy controls, patients with CHF had a lower AT (11.8 ± 0.7 v 16.9 ± 1.1 mL/kg/min, P<.001) and a higher serum uric acid concentration (493.8 ± 22.4 v 308.7 ± 21.5 μmol/L, P <.001). In univariate analyses of the CHF group, the AT correlated with serum uric acid (r = -.56, P <.001; AT = 19.93- (0.016 · uric acid), R² = .31, P <.001) and plasma creatinine (r = -.43, P <.01), but not with the diuretic dose. In stepwise regression analyses of the CHF group, serum uric acid emerged as a predictor of the AT (standardized coefficient = -.56, P <.001), whereas the diuretic dose and plasma creatinine failed to enter into the final models (multiple R² = .31, P <.001). In conclusion, in CHF there is an inverse relationship between the AT and the resting serum uric acid concentration. This is consistent with the known links between uric acid production and the imbalance in aerobic/anaerobic metabolism that occur in CHF. These findings provide the basis for using the simple measurement of the serum uric acid level as a surrogate measure of the AT.