High sensitivity C-reactive protein (hsCRP) assay has been found to be a useful biomarker for cardiovascular risk stratification. Little information exists regarding its prognostic impact in outpatients with heart failure (HF) as well as its correlation to other biomarkers or outcomes.
Serum levels of hsCRP were obtained in 89 patients with stage C HF. All patients were followed in a specialized HF management center for 2-24 months (average 13.5±6.06). The primary end point was major adverse cardiovascular events defined as cardiac hospitalization or cardiac death.
The average age of the subjects was 62.8±14.2 years (range19-88). The etiology of HF was ischemic in 36 patients (40.45%) and non-ischemic in 53 patients (59.55%). There were 46 men and 43 women, 72 patients with systolic dysfunction and 17 patients with diastolic dysfunction defined as LVEF > 50%. The baseline hsCRP ranged from 0.03 to 8.4 mg/dl and averaged 0.86±1.39 mg/dl. HsCRP levels were < 0.1 mg/dl in 14 patients (15.8 %), 0.1-0.3 mg/dl in 25 patients (28%), and > 0.3 mg/dl in 50 patients (56.2%) (p<0.0001). Adverse cardiovascular events were significantly higher in patients with increased hsCRP (88.23% vs. 19%, p = 0.006, using hsCRP level of 0.2 mg/dl as a cutoff). Patients with systolic dysfunction had higher levels of hsCRP compared to patients with diastolic dysfunction (0.95 mg/dl vs. 0.46 mg/dl, respectively, p = 0.030). There was no significant difference in hsCRP levels in ischemic HF compared to non- ischemic HF (0.92 mg/dl vs. 0.81 mg/dl, respectively, p = 0.72). There was no significant correlation between baseline hsCRP levels and baseline BNP levels.
Our findings establish that hsCRP is elevated in patients with stable Stage C HF independent of the etiology. Increased hsCRP levels were associated with significantly higher adverse cardiovascular events. The elevations in hsCRP and the cardiovascular outcomes are independent of other important biomarkers.
In conclusion, our data suggests that elevated hsCRP is an independent prognostic marker for risk stratification in patients with chronic HF.
Marc Silver, None.