Pentraxin‐3 in chronic heart failure: the CORONA and GISSI‐HF trials

Abstract

AimsPentraxin-3 (PTX3) is a component of the humoral arm of innate immunity which can regulate inflammatory processes. Since the role of inflammation in the progression of chronic heart failure (HF) is debated, we investigated the prognostic value of PTX3 and the effect of a statin in two large populations of patients with HF. Methods and resultsPlasma levels of PTX3 were measured at randomization and after 3 months in 1457 patients enrolled in the Controlled Rosuvastatin Multinational Trial in HF (CORONA) and 1233 patients enrolled in the GISSI-Heart Failure trial (GISSI-HF). The relationships between baseline PTX3 levels or their changes over time and mortality were evaluated with multivariable Cox proportional hazard models including clinical factors, high sensitivity C-reactive protein (hsCRP), and N-terminal pro brain natriuretic peptide (NT-proBNP). PTX3 concentration [median (Q1 -Q3) ¼ 5.34 (3.55-7.64) ng/mL, n ¼ 2690] was higher in females, in older patients, and those with lower body mass index. Baseline elevated PTX3 was associated with a higher risk of all-cause mortality [759 events, hazard ratio (HR) for 1 SD increase 1.20, 95% confidence interval (CI) 1.12-1.30, P , 0.0001], cardiovascular mortality (587 events, HR 1.27, 95% CI 1.17-1.38, P , 0.0001), or hospitalization for worsening HF (720 events, HR 1.21, 95% CI 1.12-1.30, P , 0.0001), and marginally improved discrimination. Three-month changes in PTX3 were associated with fatal events after adjustment for hsCRP or NT-proBNP. Rosuvastatin lowered hsCRP levels but significantly raised PTX3. ConclusionIn two independent clinical trials that enrolled patients with chronic HF, PTX3 was consistently associated with outcomes. The opposite effects of a statin on hsCRP and PTX3 call for further investigation. Trial registration NCT00336336

Regular Wine Consumption in Chronic Heart Failure

“…However, the pathophysiologic relevance of an antiinflammatory action of moderate wine consumption should be seen in the light of the fact that in GISSI-HF we found that circulating inflammatory markers had little if any independent prognostic value 23,27 and that rosuvastatin significantly decreased high-sensitivity C-reactive protein levels without affecting outcomes. 18 Finally, although statistically significant, the trend between N-terminal pro B-type natriuretic peptide or high-sensitivity cardiac troponin T and red wine consumption was not clear as for other biomarkers.…”

Pentraxin3 as a new indicator of cardiovascular-related death in patients with advanced chronic kidney disease?

“…These authors also demonstrated that the plasma PTX3 level could be a prognostic risk factor in patients with CHF. Similarly, the Controlled Rosuvastatin Multinational Trial in CHF (CORONA, N = 1457 patients) and GISSI -Heart Failure trials (N = 1233) 19 assessed the correlation between plasma levels of PTX3 and mortality in CHF patients during a 3 -month follow -up. Elevated PTX3 levels were Data are reported as hazard ratio (95% CI) and P value.…”

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

“…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. Other pro‐inflammatory biomarkers that may have prognostic value in HF include galectin‐3 and ST2 27, 28…”