title: Usefulness of C-Reactive Protein Plasma Levels to Predict Exercise Intolerance in Patients With Chronic Systolic Heart Failure.
abstract: Patients with heart failure (HF) have evidence of chronic systemic inflammation. Whether inflammation contributes to the exercise intolerance in patients with HF is, however, not well established. We hypothesized that the levels of C-reactive protein (CRP), an established inflammatory biomarker, predict impaired cardiopulmonary exercise performance, in patients with chronic systolic HF. We measured CRP using high-sensitivity particle-enhanced immunonephelometry in 16 patients with ischemic heart disease (previous myocardial infarction) and chronic systolic HF, defined as a left ventricular ejection fraction ≤ 50% and New York Heart Association class II-III symptoms. All subjects with CRP >2 mg/L, reflecting systemic inflammation, underwent cardiopulmonary exercise testing using a symptom-limited ramp protocol. CRP levels predicted shorter exercise times (R = -0.65, p = 0.006), lower oxygen consumption (VO2) at the anaerobic threshold (R = -0.66, p = 0.005), and lower peak VO2 (R = -0.70, p = 0.002), reflecting worse cardiovascular performance. CRP levels also significantly correlated with an elevated ventilation/carbon dioxide production slope (R = +0.64, p = 0.008), a reduced oxygen uptake efficiency slope (R = -0.55, p = 0.026), and reduced end-tidal CO2 level at rest and with exercise (R = -0.759, p = 0.001 and R = -0.739, p = 0.001, respectively), reflecting impaired gas exchange. In conclusion, the intensity of systemic inflammation, measured as CRP plasma levels, is associated with cardiopulmonary exercise performance, in patients with ischemic heart disease and chronic systolic HF. These data provide the rationale for targeted anti-inflammatory treatments in HF.
authors.affiliation: VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Justin McNair
authors.initials: JM
authors.lastname: Canada
authors.affiliation: VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Daniel Taylor
authors.initials: DT
authors.lastname: Fronk
authors.affiliation: VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Laura Freeman
authors.initials: LF
authors.lastname: Cei
authors.affiliation: VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Carbone
authors.affiliation: VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Claudia Oddi
authors.initials: CO
authors.lastname: Erdle
authors.affiliation: VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Nayef Antar
authors.initials: NA
authors.lastname: Abouzaki
authors.affiliation: VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Ryan David
authors.initials: RD
authors.lastname: Melchior
authors.affiliation: VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Christopher Scott
authors.initials: CS
authors.lastname: Thomas
authors.affiliation: VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Sanah
authors.initials: S
authors.lastname: Christopher
authors.affiliation: VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Jeremy Shane
authors.initials: JS
authors.lastname: Turlington
authors.affiliation: VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Cory Ross
authors.initials: CR
authors.lastname: Trankle
authors.affiliation: VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Clinton Joseph
authors.initials: CJ
authors.lastname: Thurber
authors.affiliation: Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Ronald Kenneth
authors.initials: RK
authors.lastname: Evans
authors.affiliation: School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Dave L
authors.initials: DL
authors.lastname: Dixon
authors.affiliation: School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Benjamin Wallace
authors.initials: BW
authors.lastname: Van Tassell
authors.affiliation: Department of Physical Therapy and Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Ross
authors.initials: R
authors.lastname: Arena
authors.affiliation: VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia. Electronic address: antonio.abbate@vcuhealth.org.
authors.forename: Antonio
authors.initials: A
authors.lastname: Abbate
mesh_terms: D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism*; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D054143:Heart Failure, Systolic / Q000097:blood* / Q000503:physiopathology / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D002097:C-Reactive Protein