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

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 VO 2. The interest of hs C-reactive protein determination appears to be especially marked in patients with ischaemic cardiomyopathy. © The European Society of Cardiology 2005. All rights reserved.