Diagnostic and prognostic value of serum C-reactive protein in heart failure with preserved ejection fraction: a systematic review and meta-analysis

Abstract

Heart failure (HF) is a major epidemic with rising morbidity and mortality rates that encumber global healthcare systems. While some studies have demonstrated the value of CRP in predicting (i) the development of HFpEF and (ii) long-term clinical outcomes in HFpEF patients, others have shown no such correlation. As a result, we conducted the following systematic review and meta-analysis to assess both the diagnostic and prognostic role of CRP in HFpEF. PubMed and Embase were searched for studies that assess the relationship between CRP and HFpEF using the following search terms: (((C-reactive protein) AND ((preserved ejection fraction) OR (diastolic heart failure))). The search period was from the start of database to August 6, 2019, with no language restrictions. A total of 312 and 233 studies were obtained from PubMed and Embase respectively, from which 19 studies were included. Our meta-analysis demonstrated the value of a high CRP in predicting the development of not only new onset HFpEF (HR: 1.08; 95% CI: 1.00-1.16; P = 0.04; I 2 = 22%), but also an increased risk of cardiovascular mortality when used as a categorical (HR: 2.52; 95% CI: 1.61-3.96; P < 0.0001; I 2 = 19%) or a continuous variable (HR: 1.24; 95% CI: 1.04-1.47; P = 0.01; I 2 = 28%), as well as all-cause mortality when used as a categorical (HR: 1.78; 95% CI: 1.53-2.06; P < 0.00001; I 2 = 0%) or a continuous variable: (HR: 1.06; 95% CI: 1.02-1.06; P = 0.003; I 2 = 61%) in HFpEF patients. CRP can be used as a biomarker to predict the development of HFpEF and long-term clinical outcomes in HFpEF patients, in turn justifying its use as a simple, accessible parameter to guide clinical management in this patient population. However, more prospective studies are still required to not only explore the utility and dynamicity of CRP in HFpEF but also to determine whether risk stratification algorithms incorporating CRP actually provide a material benefit in improving patient prognosis.

Heart Failure With Midrange Ejection Fraction: Prior Left Ventricular Ejection Fraction and Prognosis

“…Risk stratification in HF is an important clinical problem ( 24 , 25 ). Previous studies have elucidated that the demographics of patients with HFmrEF lied in between those of HFpEF and HFrEF patients, but in general were more similar to HFpEF patients, with a heavier burden of hypertension and atrial fibrillation/flutter ( 10 , 12 , 13 , 26 ).…”

“…Additionally, the characteristics and clinical outcomes of HFmrEF patients among subgroups defined by the prior directional changes in LVEF are significantly different. Risk stratification in HF is an important clinical problem (24,25). Previous studies have elucidated that the demographics of patients with HFmrEF lied in between those of HFpEF and HFrEF patients, but in general were more similar to HFpEF patients, with a heavier burden of hypertension and atrial fibrillation/flutter (10,12,13,26).…”

Coronary Microvascular Dysfunction

“…It has been observed that CRP, a biomarker of systemic inflammation produced in response to interleukin-6 by inflammatory cells, has both diagnostic and prognostic value in predicting the risk of developing HFpEF and subsequent CV events. However, the results of the studies are conflicting [ 134 ].…”

Leucine Rich Alpha-2-Glycoprotein 1 Is A Novel Predictor Of Diastolic Dysfunction: A Cross-Sectional Study

“…Inclusion of patients with ischemic symptoms at hospital presentation may create a selection bias. The current study did not test for other biomarkers such as brain natriuretic peptides (BNPs) and High Sensitivity C-Reactive Protein (hsCRP) (39). Overall, we consider this research preliminary and encourage replication.…”