title: High-sensitivity C-reactive protein: potential adjunct for risk stratification in patients with stable congestive heart failure.
abstract: OBJECTIVE
  To determine the potential adjunct of high-sensitivity (hs) C-reactive protein for risk stratification in patients with stable congestive heart failure (CHF).
  
  
  RESULTS
  We studied 546 consecutive patients clinically stable with an ejection fraction <45% who were referred to our centre for evaluation of left ventricular dysfunction. hs C-reactive protein levels were determined on blood samples obtained on entry into the study. Clinical follow-up (median 972 days) was obtained for 545 patients. Cardiovascular mortality was significantly increased (P=0.001) in patients with hs C-reactive protein >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 VO(2) 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 VO(2) (P<0.0001). In patients with ischaemic CHF, cardiovascular mortality was significantly increased in patients with hs C-reactive protein >3 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)].
  
  
  CONCLUSIONS
  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 VO(2). The interest of hs C-reactive protein determination appears to be especially marked in patients with ischaemic cardiomyopathy.
authors.affiliation: Department of Cardiology, Hôpital Cardiologique, CHRU de Lille, Boul. Prof. Leclercq 59037, Lille Cedex, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lamblin
authors.forename: Frédéric
authors.initials: F
authors.lastname: Mouquet
authors.forename: Bernadette
authors.initials: B
authors.lastname: Hennache
authors.forename: Joël
authors.initials: J
authors.lastname: Dagorn
authors.forename: Sophie
authors.initials: S
authors.lastname: Susen
authors.forename: Christophe
authors.initials: C
authors.lastname: Bauters
authors.forename: Pascal
authors.initials: P
authors.lastname: de Groote
mesh_terms: D002097:C-Reactive Protein / Q000032:analysis*; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality; D011379:Prognosis; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000209:etiology* / Q000401:mortality
chemical_list: D002097:C-Reactive Protein