Features of Left Ventricle Remodeling in Patients with Hypertension on the Primary Gout Background depending on Functional State of Kidneys

Gout is the most common cause of inflammatory arthritis in men elder 30, whose share accounts are from 0,1 % to 1,7 % of the total morbidity. An increase of the incidence of gout and its frequent association with hypertension require a detailed study of the features of heart and kidneys damage as the main target organs. The purpose of the study was to investigate the correlation between functional state of the kidneys and features of the left ventricle (LV) remodeling in patients with hypertension combined with primary gout. Material and methods. 50 men with primary gout with hypertension and 20 healthy men were investigated. We used ultrasound to detect the main morphological and functional parameters of LV. Concentration of serum uric acid, creatinine, cystatin C and the level of albuminuria were also determined. Results and discussion. In the course of study we found the significant increase of volumetric parameters of LV and significant decrease of ejection fraction on 8,3 % in patients with gout. The prevalent type of LV geometry was concentric hypertrophy (44 %). Albuminuria level significantly correlated with age of patients (R = +0,35, p < 0,05), duration of gout (R = +0,5, p < 0,05) and concentration of uric acid in serum (R = + 0,3, p < 0,05). We detected the connection between albuminuria level increasing and increasing of LV volumetric parameters, LV mass (r = +0,4, p < 0,05) and reduction of ejection fraction (r= -0,3, p < 0,05). Patients with albuminuria (n = 19) in comparison to patients without albuminuria (n = 31) were characterized by decrease of ejection fraction on 9,3 %. Moreover, there was a significant increase of LV mass on 16,3 % and index of LV mass on 20,3 % in comparison to patients without albuminuria. In patients with hypertension of the first degree the concentration of serum creatinine and level of albuminuria were not significantly different from the same parameters of the control group but cystatin C concentration was on 68,5 % higher (p < 0,001). Serum level of cystatin C correlated with ejection fraction (r= -0,3, p < 0,05) and LV mass (r = +0,4, p < 0,05). Conclusions. Patients with hypertension combined with primary gout are characterized by significant deteriorations of systolic and diastolic function of LV and prevalence of concentric hypertrophy in the remodeling structure. There is the significant correlation between albuminuria increasing and worsening of morphological and functional parameters of LV which indicate dependence of cardiovascular system from renal function. The increase in the serum level of cystatin C significantly correlates with the deterioration of the LV systolic function and begins to increase in the period of subclinical reduction of GFR and normal level of albuminuria.