High-sensitivity C-reactive protein in heart failure with preserved ejection fraction.

Pubmed ID: 30114262

Pubmed Central ID: PMC6095520

Journal: PloS one

Publication Date: Aug. 16, 2018

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6095520/pdf/pone.0201836.pdf?link_time=2024-07-29_00:31:00.155872

MeSH Terms: Humans, Male, Female, Aged, Middle Aged, Heart Failure, Severity of Illness Index, Comorbidity, Motor Activity, Stroke Volume, C-Reactive Protein, Biomarkers, Phosphodiesterase 5 Inhibitors, Sildenafil Citrate

Authors: AbouEzzeddine OF, DuBrock HM, Redfield MM

Cite As: DuBrock HM, AbouEzzeddine OF, Redfield MM. High-sensitivity C-reactive protein in heart failure with preserved ejection fraction. PLoS One 2018 Aug 16;13(8):e0201836. doi: 10.1371/journal.pone.0201836. eCollection 2018.

Studies:

Abstract

BACKGROUND: Microvascular inflammation may contribute to the pathogenesis of both heart failure with preserved ejection fraction (HFpEF) and pulmonary hypertension (PH). We investigated whether the inflammation biomarker C-reactive protein (CRP) was associated with clinical characteristics, disease severity or PH in HFpEF. METHODS: Patients in the Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in Diastolic Heart failure (RELAX) trial had baseline high-sensitivity CRP levels measured (n = 214). Clinical characteristics, exercise performance, echocardiographic variables and biomarkers of neurohumoral activation, fibrosis and myocardial necrosis were assessed. Patients with normal (≤3mg/L) versus high (>3mg/L) CRP levels were compared. RESULTS: The median CRP level was 3.69mg/L. CRP was elevated in 57% of patients. High CRP levels were associated with younger age, higher body mass index (BMI), chronic obstructive pulmonary disease (COPD), lower peak oxygen consumption and higher endothelin-1 and aldosterone levels. CRP increased progressively with the number of comorbidities (0.7mg/L per increment in comorbidity number, P = 0.02). Adjusting for age, BMI and statin use, high CRP levels were additionally associated with atrial fibrillation, right ventricular dysfunction, and higher N-terminal pro-B-type natriuretic peptide levels (P<0.05 for all). CRP was not associated with PH or left ventricular function. CRP did not identify responders to sildenafil(P-value for interaction 0.13). CONCLUSIONS: In HFpEF, high CRP is associated with greater comorbidity burden and some markers of disease severity but CRP was normal in 40% of patients. These findings support the presence of comorbidity-driven systemic inflammation in HFpEF but also the need to study other biomarkers which may better reflect the presence of systemic inflammation.