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European Heart Journal Advance Access published online on September 23, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi501
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received February 20, 2005
Revised August 25, 2005
Accepted September 2, 2005

Clinical research

High-sensitivity C-reactive protein: potential adjunct for risk stratification in patients with stable congestive heart failure

Nicolas Lamblin 1, Frédéric Mouquet 2, Bernadette Hennache 3, Joël Dagorn 2, Sophie Susen 4, Christophe Bauters 1*, and Pascal de Groote 2

1 Department of Cardiology, Hôpital Cardiologique, CHRU de Lille, Boul. Prof. Leclercq, 59037, Lille Cedex, France; INSERM U508, Institut Pasteur, Lille, France
2 Department of Cardiology, Hôpital Cardiologique, CHRU de Lille, Boul. Prof. Leclercq, 59037, Lille Cedex, France
3 Department of Biochemistry, CHRU de Lille, Lille, France
4 Department of Hematology, CHRU de Lille, Lille, France

* To whom correspondence should be addressed.
Christophe Bauters, E-mail: cbauters{at}chru-lille.fr


  Abstract

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.

Keywords: Congestive heart failure; Ischaemic cardiomyopathy; Prognosis; Inflammation; C-reactive protein.
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