Pierpaolo Pellicori1,2, Jufen Zhang1,3, Joe Cuthbert1, Alessia Urbinati1, Parin Shah1, Syed Kazmi1, Andrew L Clark1, John G F Cleland4,2. 1. Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, UK. 2. Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, University Avenue, Glasgow. 3. Faculty of Medical Science, Anglia Ruskin University, Chelmsford, UK. 4. National Heart & Lung Institute and National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield Hospitals, Imperial College, London.
Abstract
AIMS: Plasma concentrations of high sensitivity C-reactive protein (hsCRP) are often raised in chronic heart failure (CHF) and might indicate inflammatory processes that could be a therapeutic target. We aimed to study the associations between hsCRP, mode and cause of death in patients with CHF. METHODS AND RESULTS: We enrolled 4,423 patients referred to a heart failure clinic serving a local population. CHF was defined as relevant symptoms or signs with either a reduced left ventricular ejection fraction (LVEF) <40% or raised plasma concentrations of amino-terminal pro-B type natriuretic peptide (NT-proBNP >125 pg/ml).The median (IQR) plasma hsCRP for patients diagnosed with CHF (n = 3,756) was 3.9 (1.6-8.5) mg/L and 2.7 (1.3-5.1) mg/L for those who were not (n = 667; p < 0.001). Patients with hsCRP ≥10 mg/L (N = 809; 22%) were older and more congested than those with hsCRP <2 mg/L (N = 1,117, 30%).During a median follow up of 53 (IQR: 28-93) months, 1,784 (48%) patients with CHF died. Higher plasma hsCRP was associated with greater mortality, independent of age, symptom severity, creatinine and NT-proBNP. Comparing a hsCRP ≥10mg/L to < 2mg/L, the hazard ratio for all-cause mortality was 2.49 (95% confidence interval: 2.19-2.84); P < 0.001), for cardiovascular (CV) mortality was 2.26 (1.91-2.68; p < 0.001) and for non-CV mortality was 2.96 (2.40-3.65; p < 0.001). . CONCLUSIONS: In patients with CHF, a raised plasma hsCRP is associated with more congestion and a worse prognosis. The proportion of deaths that are non-CV also increases with higher hsCRP. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Plasma concentrations of high sensitivity C-reactive protein (hsCRP) are often raised in chronic heart failure (CHF) and might indicate inflammatory processes that could be a therapeutic target. We aimed to study the associations between hsCRP, mode and cause of death in patients with CHF. METHODS AND RESULTS: We enrolled 4,423 patients referred to a heart failure clinic serving a local population. CHF was defined as relevant symptoms or signs with either a reduced left ventricular ejection fraction (LVEF) <40% or raised plasma concentrations of amino-terminal pro-B type natriuretic peptide (NT-proBNP >125 pg/ml).The median (IQR) plasma hsCRP for patients diagnosed with CHF (n = 3,756) was 3.9 (1.6-8.5) mg/L and 2.7 (1.3-5.1) mg/L for those who were not (n = 667; p < 0.001). Patients with hsCRP ≥10 mg/L (N = 809; 22%) were older and more congested than those with hsCRP <2 mg/L (N = 1,117, 30%).During a median follow up of 53 (IQR: 28-93) months, 1,784 (48%) patients with CHF died. Higher plasma hsCRP was associated with greater mortality, independent of age, symptom severity, creatinine and NT-proBNP. Comparing a hsCRP ≥10mg/L to < 2mg/L, the hazard ratio for all-cause mortality was 2.49 (95% confidence interval: 2.19-2.84); P < 0.001), for cardiovascular (CV) mortality was 2.26 (1.91-2.68; p < 0.001) and for non-CV mortality was 2.96 (2.40-3.65; p < 0.001). . CONCLUSIONS: In patients with CHF, a raised plasma hsCRP is associated with more congestion and a worse prognosis. The proportion of deaths that are non-CV also increases with higher hsCRP. Published on behalf of the European Society of Cardiology. All rights reserved.
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