C-Reactive Protein in Heart Failure

Anand, Inder; Latini, Roberto; Florea, Viorel G.; Kuskowski, Michael A.; Rector, Thomas S.; Masson, Serge; Signorini, Stefano; Mocarelli, Paolo; Hester, Allen; Glazer, Robert; Cohn, Jay N.

doi:10.1161/circulationaha.104.508465

Cited by 398 publications

(154 citation statements)

References 30 publications

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“…RELAX included S‐HFpEF patients while DOSE and ROSE included acutely decompensated HF (ADHF) patients with both HFrEF and HFpEF. IL‐6, TNF‐α, and hs‐CRP were selected because of the long‐standing experience with their use in HF10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 and PTX3 because of its association with vascular inflammation21 and ability to risk‐stratify HF patients. Each trial was approved by the Institutional Review Board at each participating site, and all patients provided written informed consent.…”

Section: Methodsmentioning

confidence: 99%

“…A number of studies have revealed a significant correlation between elevations in blood levels of pro‐inflammatory biomarkers such as tumor necrosis factor alpha (TNF‐α), C‐reactive protein (CRP),interleukin 6 (IL‐6), and HF severity and prognosis 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20. Recently, pentraxin 3 (PTX3), an acute‐phase reactant member of the CRP super family expressed by a variety of cell types in response to various inflammatory stimuli21 and thought to be a marker of vascular inflammation, was found to facilitate risk stratification of HF patients 22, 23, 24, 25, 26.…”

Section: Introductionmentioning

confidence: 99%

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Pro‐Inflammatory Biomarkers in Stable Versus Acutely Decompensated Heart Failure With Preserved Ejection Fraction

Abernethy

Raza

Sun

et al. 2018

JAHA

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BackgroundUnderlying inflammation has been increasingly recognized in heart failure with a preserved ejection fraction (HFpEF). In this study we tested the hypothesis that pro‐inflammatory biomarkers are elevated in patients with acutely decompensated HFpEF (AD‐HFpEF) compared with patients with stable HFpEF (S‐HFpEF).Methods and ResultsUsing a post hoc analysis the serum biomarkers tumor necrosis factor‐alpha, high‐sensitivity C‐reactive protein interleukin 6 and pentraxin 3 (PTX3) and clinical, demographic, echocardiographic‐Doppler and clinical outcomes data were analyzed in HFpEF patients enrolled in NHLBI Heart Failure Research Network clinical trials which enrolled patients with either AD‐HFpEF or S‐HFpEF. Compared to S‐HFpEF, AD‐HFpEF patients had higher levels of PTX3 (3.08 ng/mL versus 1.27 ng/mL, P<0.0001), interleukin‐6 (4.14 pg/mL versus 1.71 pg/mL, P<0.0001), tumor necrosis factor‐alpha (11.54 pg/mL versus 8.62 pg/mL, P=0.0015), and high‐sensitivity C‐reactive protein (11.90 mg/dL versus 3.42 mg/dL, P<0.0001). Moreover, high‐sensitivity C‐reactive protein, interleukin‐6 and PTX3 levels were significantly higher in AD‐HFpEF compared with S‐HFpEF patients admitted for decompensated HF within the previous year. PTX3 was positively correlated with left atrial volume index (r=0.41, P=0.0017) and left ventricular mass (r=0.26, P=0.0415), while tumor necrosis factor‐alpha was inversely correlated with E/A ratio (r=−0.31, P=0.0395).ConclusionsLevels of pro‐inflammatory biomarkers are strikingly higher in AD‐HFpEF compared with S‐HFpEF patients. PTX3 and tumor necrosis factor‐alpha are correlated with echocardiographic‐Doppler evidence of diastolic dysfunction. Taken together these data support the concept that a heightened pro‐inflammatory state has a pathophysiologic role in the development of AD‐HFpEF.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pro‐Inflammatory Biomarkers in Stable Versus Acutely Decompensated Heart Failure With Preserved Ejection Fraction

Abernethy

Raza

Sun

et al. 2018

JAHA

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“…1 Several new biomarkers have emerged as strong predictors of risk among patients presenting with cardiovascular disease, including CHF. Among them, cardiac troponin I (cTnI) and T, 2 B-type natriuretic peptide (BNP), 3 N-terminal pro-B-type natriuretic peptide (NT-proBNP) 4 and high-sensitivity C-reactive protein (hsCRP) 5,6 are easy to measure and such measurement is now routinely available to clinicians. Sabatine et al have demonstrated that simultaneous assessment of cTnI, CRP, and BNP could enable clinicians to stratify risk more effectively among patients with acute coronary syndrome.…”

Section: Introductionmentioning

confidence: 99%

Multimarker Approach to Risk Stratification Among Patients with Advanced Chronic Heart Failure

Yin

Chen

Feng

et al. 2007

Clinical Cardiology

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SummaryBackground: Cardiac troponin I (cTnI), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and highsensitivity C-reactive protein (hsCRP) each predict adverse cardiac events in chronic heart failure (CHF). However, little is known about the utility of these novel biomarkers of CHF in combination.Hypothesis: We hypothesized that simultaneous assessment of the three biomarkers would enable clinicians to stratify risk more effectively among patients with advanced CHF.Methods: Measurements of the biomarkers were performed on 152 patients with symptomatic advanced CHF. Major adverse cardiac events during a median follow-up period of 186 days were determined.Results: Univariate and multivariate analysis revealed that elevations of each biomarker were significant predictors of clinical outcome independently of clinical variables. When patients were categorized on the basis of the number of elevated biomarkers, patients with one, two and three elevated biomarkers respectively had a 2.7-(p = 0.125), 8.6-(p < 0.0001) and 23.4-(p < 0.0001) fold increase in the risk of adverse events.

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“…Attenuating inflammatory responses associated with HF may potentially represent another drug target (e.g. by use of angiotensin II receptor blocker, ω‐3 polyunsaturated acids) 32, 33. The randomized PICNIC study is currently evaluating the impact of nutritional intervention on morbidity and mortality in malnourished hospitalized HF patients with and without hypoalbuminemia 34.…”

Section: Discussionmentioning

confidence: 99%

Serum albumin level and hospital mortality in acute non‐ischemic heart failure

et al. 2017

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AimsHypoalbuminemia is common in heart failure (HF), especially in elderly patients. It is associated with an increased risk of death. The present study sought to examine the prognostic significance of serum albumin level in the prediction of hospital mortality in patients admitted for acute non‐ischemic HF.Methods and resultsWe examined the association between albumin and hospital mortality in a cohort of 546 patients admitted for acute non‐ischemic HF. None of the patients had infectious disease, severe arrhythmias (atrial fibrillation, ventricular tachycardia, ventricular fibrillation), required invasive ventilation, or presented with acute coronary syndrome or primary valvular disease. Thirty‐six patients (7%) died during the hospital stay. These patients were significantly older (78 ± 9 vs. 72 ± 12 years; P = 0.006), had higher heart rate (P < 0.0001), increased creatinine level (P = 0.01), lower systolic and diastolic blood pressures (P < 0.05), elevated leucocyte count (P = 0.001), and lower albumin levels (31.3 ± 5.6 g/L vs. 36.9 ± 4.1 g/L; P < 0.001). With multivariable analysis, age (P = 0.01), heart rate (P < 0.0003), diastolic blood pressure (P < 0.01), leukocyte count (P = 0.009), and serum albumin level (P < 0.0001) emerged as independent predictors of hospital mortality. Hypoalbuminemia (<34 g/L) yielded the best sensitivity (78.8%) and specificity (75%) for predicting hospital death.ConclusionsSerum albumin level measured at admission can serve as a simple prognostic factor in acute non‐ischemic HF. Hypoalbuminemia is associated with increased risk of hospital mortality, especially in elderly patients.

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C-Reactive Protein in Heart Failure

Abstract: CRP is increased in heart failure. Higher levels are associated with features of more severe heart failure and are independently associated with mortality and morbidity. The ability of treatments to reduce CRP levels and the prognostic importance of reducing CRP require further study.

Cited by 398 publications

References 30 publications

Pro‐Inflammatory Biomarkers in Stable Versus Acutely Decompensated Heart Failure With Preserved Ejection Fraction

Pro‐Inflammatory Biomarkers in Stable Versus Acutely Decompensated Heart Failure With Preserved Ejection Fraction

Multimarker Approach to Risk Stratification Among Patients with Advanced Chronic Heart Failure

Serum albumin level and hospital mortality in acute non‐ischemic heart failure

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