High-sensitivity C-reactive protein: potential adjunct for risk stratification in patients with stable congestive heart failure

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Abstract
Aims To determine the potential adjunct of high-sensitivity (hs) C-reactive protein for risk stratification in patients with stable congestive heart failure (CHF). Methods and results We studied 546 consecutive patients clinically stable with an ejection fraction 3 mg/L. By multivariable analysis, including clinical, biological, and echocardiographic variables, hs C-reactive protein >3 mg/L was an independent predictor of cardiovascular mortality [HR=1.78 (1.17–2.72); P=0.008]; the strongest predictive parameter in this model was B-type natriuretic peptide (BNP) (P=0.005). When peak VO2 was included into the model, hs C-reactive protein >3 mg/L remained an independent predictor of cardiovascular mortality [HR=1.55 (1.02–2.38); P=0.04]; the strongest predictive parameter in this model was peak VO2 (P3 mg/L (P=0.001), whereas in patients with non-ischaemic CHF, hs C-reactive protein >3 mg/L was not associated with cardiovascular mortality (P=0.098). By multivariable analysis, hs C-reactive protein >3 mg/L was an independent predictor of cardiovascular mortality in ischaemic patients [HR=2.16 (1.23–3.78)] but not in non-ischaemic patients [HR=1.05 (0.52–2.11)]. Conclusion Cardiovascular mortality is increased in CHF patients with hs C-reactive protein >3 mg/L. The impact of hs C-reactive protein is independent of usual prognostic parameters, in particular BNP and peak VO2. The interest of hs C-reactive protein determination appears to be especially marked in patients with ischaemic cardiomyopathy.

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