High density lipoprotein cholesterol / C reactive protein ratio in heart failure with preserved ejection fraction

Abstract

AimsThe impacts of high density lipoprotein cholesterol (HDL-C) as an anti-inflammatory and C reactive protein (CRP) as inflammatory properties on the pathogenesis of heart failure were reported. At present, the clinical significance of the HDL-C/CRP ratio in heart failure with preserved ejection fraction (HFpEF) patients remains unknown. Methods and resultsWe examined the data on 796 consecutive HFpEF (left ventricular ejection fraction ≥50%) patients hospitalized due to acute decompensated heart failure from the PURSUIT-HFpEF registry, a prospective, multicentre observational study. We calculated the HDL/CRP ratios and evaluated the relationship between the values and clinical outcomes, including degree of cardiac function. The mean follow-up duration was 420 ± 346 days. All-cause death occurred in 118 patients, of which 51 were cardiac deaths. HDL/CRP ≤ 4.05 was independently and significantly associated with all-cause death (odds ratio = 1.84, 95% CI: 1.06-3.20, P = 0.023), and HDL/CRP ≤ 3.14 was associated with cardiac death by multivariate Cox proportional hazard analysis (odds ratio = 2.86, 95% CI: 1.36-6.01, P = 0.003). HDL-C/CRP ratio significantly correlated with the product of the left atrial volume and left ventricular mass index as well as the tricuspid annular plane systolic excursion by multiple regression analysis (standardized beta-coefficient = À0.085, P = 0.034 and standardized beta-coefficient = 0.081, P = 0.044, respectively). Conclusions HDL-C/CRP ratio was a useful marker for predicting all-cause death and cardiac death and correlated with left ventricular diastolic function and right ventricular systolic function in HFpEF patients.

Inflammation in Human Heart Failure: Major Mediators and Therapeutic Targets

“…For example, higher IL-6 levels were demonstrated to be associated with an increased risk of developing HFpEF (Chia et al, 2021) and circulating levels of TNF-α receptor 2 were shown to be increased in association with the degree of diastolic dysfunction in patients with HFpEF but not HFrEF (Putko et al, 2014). Also, (anti-inflammatory) high density lipoprotein cholesterol/(inflammatory) CRP ratio was shown to be a useful marker for prognostication and correlated with echocardiographic parameters in HFpEF patients (Yano et al, 2021). Moreover, a recent report suggested that the deletion of resolution sensor ALX/FPR2 is associated with the development of diastolic dysfunction related with obesity in mice with HFpEF (Tourki et al, 2020), supporting the concept of nonresolving inflammation in HFpEF (Tourki and Halade, 2021).…”

Predictors and Outcomes of Heart Failure With Preserved Ejection Fraction in Patients With a Left Ventricular Ejection Fraction Above or Below 60%

“… 32 From the PURSUIT‐HFpEF registry, Yano et al evaluated the HDL/CRP ratio as an anti‐inflammatory marker and showed that the ratio on admission was an independent predictor for all‐cause mortality and cardiac death in patients with HFpEF. 8 We found that the ratio at discharge, in a more stable status, was a distinctive prognostic factor among lower LVEF patients with HFpEF. Empagliflozin potentially restores cardiac microvascular endothelial function via the modulation of inflammatory mediators.…”

“…Cox proportional hazards regression models were used to calculate hazard ratios (HRs) and 95% CIs for associations between clinical factors of interest and outcome. These factors comprised fundamental background (age and sex); well‐established prognostic factors for patients with HFpEF 20 (HF history, AF, diabetes, estimated glomerular filtration rate [eGFR], NT‐proBNP, and the diastolic function markers 21 of LAVI, LVMI, and E/e′), including prognostic factors reported from our previous investigations in this registry (systolic blood pressure, 7 HDL/CRP, 8 and TAPSE/PASP ratios 12 , 13 ), and background factors that significantly differed between the 2 groups (heart rate, hematocrit, and LVEDVI). We used multivariable Cox proportional hazards regression analysis with statistical interaction terms to test for effect modification (described as P for interaction) in each LVEF‐categorized group.…”

“…As shown between patients with HFrEF and HFpEF, prognostic factors also likely differ between populations that pathophysiologically differ with regard to LVEF. 5 We previously reported several prognostic factors among hospitalized East Asian patients with HFpEF based on a prospective multicenter observational cohort, including sex, 6 blood pressure, 7 high‐density lipoprotein (HDL) to CRP (C‐reactive protein) ratio, 8 diastolic dysfunction, 9 LV filling pressure, 10 , 11 and right ventricular to pulmonary circulation coupling evaluated with tricuspid annular plane systolic excursion (TAPSE) to pulmonary arterial systolic pressure (PASP) ratio. 12 , 13 …”

Application Value of Systemic Inflammatory Indexes in the Clinical Evaluation of Patients with Heart Failure with Preserved Ejection Fraction (HFpEF)

“…The clinical value of systemic inflammatory indexes (SII) such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), fibrinogen-to-albumin ratio (FAR), albumin-to-gamma-glutamyl-transferase ratio (AGR), monocyte/high-density-lipoprotein-cholesterol-C (HDL-c) ratio (MHR), white-blood-cell-count-to-mean-platelet-volume ratio (WMR) and high-density-lipoprotein-cholesterol-to-C-reactive protein (CRP) ratio (HCR) in patients with HFpEF were discussed, because they are easy to obtain and have certain clinical value in the diagnosis, therapy and prognosis of cardiovascular diseases [ 1 , 4 , 5 , 6 , 7 ].…”