title: C-reactive protein predicts mortality in patients referred for coronary angiography and symptoms of heart failure with preserved ejection fraction.
abstract: OBJECTIVE
  Heart failure with preserved ejection fraction (HFpEF) has a different pathophysiological background compared to heart failure with reduced ejection fraction (HFrEF). Tailored risk prediction in this separate heart failure group with a high mortality rate is of major importance. Inflammation may play an important role in the pathogenesis of HFpEF because of its significant contribution to myocardial fibrosis. We therefore aimed to assess the predictive value of C-reactive protein (CRP) in patients with HFpEF.
  
  
  RESULTS
  Plasma levels of CRP were determined in 459 patients with HFpEF in the LUdwigshafen Risk and Cardiovascular Health (LURIC) study using a high-sensitivity assay. During a median follow-up of 9.7 years 40% of these patients died. CRP predicted all-cause mortality with an adjusted hazard ratio (HR) of 1.20 [95% confidence interval (CI) 1.02-1.40, P = 0.018] and cardiovascular mortality with a HR of 1.32 (95% CI 1.08-1.62, P = 0.005) per increase of one standard deviation. CRP was a significantly stronger mortality predictor in HFpEF patients than in a control group of 522 HFrEF patients (for interaction, P = 0.015). Furthermore, CRP added prognostic value to N-terminal pro B-type natriuretic peptide (Nt-proBNP): the lowest 5-year mortality rate of 6.8% was observed for patients in the lowest tertile of Nt-proBNP as well as CRP. The mortality risk peaked in the group combining the highest values of Nt-proBNP and CRP with a 5-year rate of 36.5%.
  
  
  CONCLUSIONS
  It was found that CRP was an independent and strong predictor of mortality in HFpEF. This observation may reflect immunological processes with an adverse impact on the course of HFpEF.
authors.affiliation: Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria.
authors.forename: L
authors.initials: L
authors.lastname: Koller
authors.forename: M
authors.initials: M
authors.lastname: Kleber
authors.forename: G
authors.initials: G
authors.lastname: Goliasch
authors.forename: P
authors.initials: P
authors.lastname: Sulzgruber
authors.forename: H
authors.initials: H
authors.lastname: Scharnagl
authors.forename: G
authors.initials: G
authors.lastname: Silbernagel
authors.forename: T
authors.initials: T
authors.lastname: Grammer
authors.forename: G
authors.initials: G
authors.lastname: Delgado
authors.forename: A
authors.initials: A
authors.lastname: Tomaschitz
authors.forename: S
authors.initials: S
authors.lastname: Pilz
authors.forename: W
authors.initials: W
authors.lastname: März
authors.forename: A
authors.initials: A
authors.lastname: Niessner
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000378:metabolism / Q000401:mortality; D017023:Coronary Angiography; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000401:mortality; D006801:Humans; D007249:Inflammation / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D010446:Peptide Fragments / Q000378:metabolism; D011379:Prognosis; D013318:Stroke Volume
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein
keywords: Biomarker; Heart failure with preserved ejection fraction; High-sensitivity C-reactive protein; Inflammation