Elsevier

American Heart Journal

Volume 153, Issue 6, June 2007, Pages 1048-1055
American Heart Journal

Clinical Investigation
Congestive Heart Disease
Relationship of high-sensitivity C-reactive protein to prognosis and other prognostic markers in outpatients with heart failure

https://doi.org/10.1016/j.ahj.2007.03.044Get rights and content

Background

Inflammatory markers are increased in chronic heart failure (CHF), including high-sensitivity C-reactive protein (hsCRP), but there is little information on its relationship to prognosis or other prognostic markers. We aimed to investigate the relationship between hsCRP and prognosis in patients with CHF and left ventricular systolic dysfunction (LVSD).

Methods

Patients with CHF and LVSD (n = 957), but without infection or inflammatory disease, were identified. Patients had their medical history taken, underwent physical examination, had electrocardiographic and echocardiographic assessment, and had a 6-minute corridor walk test (6MWT) and blood tests, including hsCRP and N-terminal pro-B natriuretic peptide (NT-pro-BNP).

Results

Patients with worse New York Heart Association class (P = .02), shorter 6-minute corridor walk test distance (P < .001), higher NT-pro-BNP levels (P < .001), anemia (P < .001), and renal dysfunction (P < .001), but not lower LV ejection fraction, had higher plasma concentrations of hsCRP. Patients with a CRP of >11.0 pg/mL had a hazard ratio for death of 3.0 compared with those with a CRP of <2.8 pg/mL (P < .001). Of 402 patients who had a second sample taken for hsCRP at 1 year, 46% showed a substantial change from baseline levels. Marked increases in hsCRP were associated with a fall in hemoglobin level. NT-pro-BNP was noted to be a more accurate prognostic marker than hsCRP (area under the curve of 0.74 compared with 0.67 for hsCRP, P < .05).

Conclusion

Patients with CHF and LVSD have increased serum concentrations of hsCRP that are related to functional limitation and prognosis but not to the severity of LV ejection fraction.

Section snippets

Methods

All patients referred to the heart failure clinic for the investigation of the presence and/or cause of heart failure had hsCRP routinely measured. Patients were referred directly to the clinic by physicians working in the community or from our hospital colleagues. All signed a standard informed consent form that was approved by our local ethics committee.

The principal population of interest was patients with a diagnosis of heart failure secondary to LVSD who were free of infection, other

Results

Of 1941 patients referred to our clinic with a diagnosis of possible heart failure between September 11, 2001, and February 25, 2005, for whom hsCRP was available, the diagnosis of heart failure due to LVSD was made in 1178 patients. Heart failure was considered secondary to valve disease in 40 patients, but heart failure in the absence of LVSD or valve disease was diagnosed in only 77 patients, perhaps because the clinic policy discouraged such a diagnosis without definitive evidence of

Discussion

This study demonstrates that in patients with LVSD, an increased hsCRP is associated with poorer functional capacity and an adverse outcome independent of other prognostic markers. It also describes changes in hsCRP over the following year and their relationship to other measures of disease progression. These data suggest that hsCRP, a simple and widely available test, might be useful in clinical practice either to identify patients with an adverse outcome or, potentially, as a new target for

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