European Heart Journal Advance Access originally published online on September 23, 2005
European Heart Journal 2005 26(21):2245-2250; doi:10.1093/eurheartj/ehi501
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High-sensitivity C-reactive protein: potential adjunct for risk stratification in patients with stable congestive heart failure
1Department of Cardiology, Hôpital Cardiologique, CHRU de Lille, Boul. Prof. Leclercq, 59037, Lille Cedex, France
2Department of Biochemistry, CHRU de Lille, Lille, France
3Department of Hematology, CHRU de Lille, Lille, France
4INSERM U508, Institut Pasteur, Lille, France
Received 20 February 2005; revised 25 August 2005; accepted 2 September 2005; online publish-ahead-of-print 23 September 2005.
* Corresponding author. Tel: +33 320445045; fax: +33 320444881. E-mail address: cbauters{at}chru-lille.fr
See page 2218 for the editorial comment on this article (doi:10.1093/eurheartj/ehi464)
Aims To determine the potential adjunct of high-sensitivity (hs) C-reactive protein for risk stratification in patients with stable congestive heart failure (CHF).
Methods and results We studied 546 consecutive patients clinically stable with an ejection fraction <45% who were referred to our centre for evaluation of left ventricular dysfunction. hs C-reactive protein levels were determined on blood samples obtained on entry into the study. Clinical follow-up (median 972 days) was obtained for 545 patients.
Cardiovascular mortality was significantly increased (P=0.001) in patients with hs C-reactive protein >3 mg/L. By multivariable analysis, including clinical, biological, and echocardiographic variables, hs C-reactive protein >3 mg/L was an independent predictor of cardiovascular mortality [HR=1.78 (1.17–2.72); P=0.008]; the strongest predictive parameter in this model was B-type natriuretic peptide (BNP) (P=0.005). When peak VO2 was included into the model, hs C-reactive protein >3 mg/L remained an independent predictor of cardiovascular mortality [HR=1.55 (1.02–2.38); P=0.04]; the strongest predictive parameter in this model was peak VO2 (P<0.0001). In patients with ischaemic CHF, cardiovascular mortality was significantly increased in patients with hs C-reactive protein >3 mg/L (P=0.001), whereas in patients with non-ischaemic CHF, hs C-reactive protein >3 mg/L was not associated with cardiovascular mortality (P=0.098). By multivariable analysis, hs C-reactive protein >3 mg/L was an independent predictor of cardiovascular mortality in ischaemic patients [HR=2.16 (1.23–3.78)] but not in non-ischaemic patients [HR=1.05 (0.52–2.11)].
Conclusion Cardiovascular mortality is increased in CHF patients with hs C-reactive protein >3 mg/L. The impact of hs C-reactive protein is independent of usual prognostic parameters, in particular BNP and peak VO2. The interest of hs C-reactive protein determination appears to be especially marked in patients with ischaemic cardiomyopathy.
Key Words: Congestive heart failure • Ischaemic cardiomyopathy • Prognosis • Inflammation • C-reactive protein
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