european crystal network workshop

    How the appearance of tophi changes ultrasonographic parameters independently associated with cardiovascular risk.


    R. Gancheva¹, A. Kundurdjiev², M. Ivanova¹, T. Kundurzhiev³, R. Rashkov¹, Z. Kolarov¹

    ¹Clinic of Rheumatology, University Hospital St. Iv. Rilski, ²Clinic of Nephrology, University Hospital Alexandrovska, ³Faculty of Public health, Medical University, Sofia, Bulgaria.


    Introduction: The epidemiological link between gout and cardiovascular (CV) risk has been recognized for many years. It remains unclear whether gout is independent factor of poor CV outcome. Prospective population studies are confounded by coexistent risk factors. Objective: To determine left ventricular mass index (LVMI) and intima-media thickness (IMT) of common carotid arteries, their connection with CV risk factors and to find whether the severity of gout is associated with changes in them.

    Design: We selected patients (pts) hospitalized at the Rheumatology clinic from 2013 till 2015 and healthy controls.

    Setting: Ultrasound examinations were performed once by a single investigator, unaware with the protocol of the study. For abnormal were considered LVMI>125gr/m² and IMT>0.9mm.

    Participants: 169 pts were divided into four groups: Controls-41 in a mean age 55.3±13, 20 males and 21 females, asymptomatic hyperuricemia-41 in a mea n age 54.6±15.6, 23 males and 18 females, gouty arthritis without tophi-49 in a mean age 55.5±11.7, 43 males and 6 females and gouty tophi pts-38 in a mean age 58.3±11, 37 males and 1 female. Interventions: Pts underwent a complex multimodal ultrasonography. Analysis of data was done by x²-test, Kolmogorov- Smirnov, ANOVA, Post-Hoc Tukey and logistic regression.

    Results: Comparing controls with the three pts’ groups there was statistically significant difference in the examined parameters, (p<0.001). Between the pts’ groups gouty tophi had greater IMT (p=0.001) and LVMI (p=0.002) than asymptomatic hyperuricemia. We observed an association between the presence of disease with LVMI (p<0.001) and IMT (p<0.001). As expected, arterial hypertension was associated with LVMI (p<0.001) and IMT (p=0.014). IMT was associated with reduced eGFR (p=0.031). Tophi increased the risk of left ventricular hypertrophy with an OR=31.21 (95% CI 6.50-149.96, p<0.001), while arterial hyperte nsion increased this risk with an OR=9.39 (95% CI 3.39-26.02, p<0.001). Tophi increased the likelihood of having IMT>0.9mm with an OR=21.67 (95% CI 4.57-102.81, p<0.001), while arterial hypertension increased the risk with an OR=3.40 (95% CI 1.18-9.83, p=0.024). Renal failure did not modify the odds of having abnormal value of IMT.

    Conclusions and relevances: Tophi appeared to be independently associated with CV damage. They were more strongly related with left ventricular hypertrophy and abnormal IMT than arterial hypertension, which is a proven CV risk factor.