Gender differences in asymptomatic hyperuricemia’s effects on left ventricular function and remodeling in hypertension: insights from cardiac MRI

Abstract Background This study aimed to explore the association between asymptomatic hyperuricemia (HU) and left ventricular (LV) function and structure in patients with essential hypertension, using cardiac magnetic resonance (CMR). Additionally, it investigated gender differences in the impact of serum uric acid (SUA) on LV myocardial strain and remodeling. Methods A total of 244 essential hypertension patients (137 males and 107 females), comprising 98 with asymptomatic hyperuricemia [hypertension (HU+) group] and 146 without hyperuricemia [hypertension (HU-) group], and 62 controls were included in this study. Conventional LV function parameters and global LV myocardial strain parameters, namely, LV radial peak strain (GRPS), circumferential peak strain (GCPS), longitudinal peak strain (GLPS), were measured using CMR and compared among the three groups. Pearson correlation and regression analyses were conducted to assess the relationship between the physiological-biochemical index and CMR parameters in hypertensive patients of different genders. Results The LV GLPS progressively deteriorated from the control group to the hypertension (HU-) group, and further to the hypertension (HU+) group. LV GCPS and LV GRPS were reduced in the hypertension (HU+) group compared to the control and hypertension (HU-) groups. LV mass index (LVMI) and LV remodeling index increased gradually from the control group to the hypertension (HU-) group and then to the hypertension (HU+) group. SUA was significantly correlated with LV global peak strain. Multiple regression analyses showed SUA was independently associated with LV GLPS in both genders (β = -0.263, P = 0.025 in females and β = -0.328, P = 0.001 in males). After adjusting for clinical factors, SUA was independently associated with LVMI in male hypertensive patients (β = 0.189, P = 0.03), but not in females. Conclusions In hypertensive patients, elevated SUA is associated with impaired LV strain in both sexes; however, only in males is it independently related to greater LV mass index, indicating a gender‑specific influence on ventricular remodeling.