Trial design: congestive heart failure
Independent prognostic value of elevated high-sensitivity C-reactive protein in chronic heart failure

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Abstract

Background

The serum concentration of C-reactive protein (CRP) is mildly elevated in patients with chronic congestive heart failure (CHF), but this level falls well within the range found in healthy subjects. Standard clinical assays for CRP lack sensitivity within the low reference range and thus cannot be used effectively for routine clinical risk prediction. Because assays for high-sensitivity CRP (hsCRP) are now available, we can measure hsCRP to determine its predictive value for the prognosis of patients with CHF.

Methods

Serum levels of hsCRP in 108 patients with CHF and left ventricular ejection fraction (LVEF) <50% were examined. Major adverse cardiac events (death, heart transplantation, or hospitalization with worsening heart failure) during a median follow-up period of 403 days were determined.

Results

The concentrations of hsCRP in this study population were significantly increased with the severity of CHF. In a multivariate analysis, LVEF and serum levels of hsCRP were independent significant predictors for adverse outcomes in these patients (hazard ratio, 3.714, P = .024, and hazard ratio, 2.584, P = .047, respectively). However, hsCRP was minimally correlated with LVEF (r = −0.167, P = .084). Further analysis indicated that hsCRP might identify a different high-risk group and could improve risk stratification beyond that of LVEF.

Conclusions

These findings suggest that an elevated level of hsCRP is an independent predictor of prognosis in CHF and can provide additional prognostic information for the risk stratification and treatment in patients with chronic CHF.

Section snippets

Patient population

A total of 108 patients (71 men, 37 women; age range, 46–78 years; mean age, 62 ± 16 years) were enrolled from outpatient or inpatient cardiology services at Cheng-Hsin General Hospital between October 29, 2000, and March 6, 2002. Men and women at least 18 years old with New York Heart Association (NYHA) functional class II to IV symptoms of heart failure and a left ventricular ejection fraction (LVEF) ≤50% on left ventriculography with radionuclide or contrast medium within 7 days were

Patient characteristics and hemodynamic data

The baseline characteristics of 108 ambulatory patients meeting the study criteria are shown in Table I. There were more men than women in this study population. The causes of heart failure were ischemic heart disease in 34 patients (32%), dilated cardiomyopathy in 39 patients (36%), and valvular heart disease in 35 patients (32%). The mean LVEF was 34% ± 13%; 44 patients (41%) were in NYHA class II, 35 patients (32%) were in class III, and 29 patients (27%) were in class IV. All patients were

Discussion

Recent studies suggest that heart failure may, in part, be an inflammatory disease.1, 2, 3 The inflammatory marker CRP, an acute phase reactive protein that is synthesized in the liver, has been proven to be 1 of the strongest independent predictors of future cardiovascular events in apparently healthy men and women.5, 6, 7 An increased CRP level has also been reported to be an independent predictor of heart failure in study of a community-based elderly population.13 However, although the serum

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