Usefulness of C-Reactive Protein and Left Ventricular Diastolic Performance for Prognosis in Patients With Left Ventricular Systolic Heart Failure

High-sensitivity C-reactive protein (hs-CRP) is a hepatocyte-derived inflammatory cytokine shown to be increased in the setting of acute heart failure (HF), particularly with increased intracardiac filling pressures. In the chronic HF setting, the relation between hs-CRP and echocardiographic indexes of left ventricular (LV) diastolic performance has not been examined. We measured plasma hs-CRP levels using a particle-enhanced immunonephelometry assay (Dade Behring, Inc., Deerfield, Illinois) in 136 subjects with chronic HF (LV ejection fraction [EF] ≤35%, New York Heart Association functional classes II to IV). We performed echocardiography, including color M-mode and tissue Doppler methods. We prospectively examined subjects’ death, cardiac transplantation, and HF hospitalization status over 33 ± 17 months. In our study cohort (mean LVEF 26 ± 6%, median plasma hs-CRP 3.19 mg/L), plasma hs-CRP levels progressively increased with worsening LV diastolic dysfunction. In particular, plasma hs-CRP levels correlated with mitral E/A wave ratio (Spearman r = 0.25, p = 0.004), mitral deceleration time (r = −0.28, p = 0.002), pulmonary vein systolic wave/diastolic wave ratio (r = −0.32, p <0.001), mitral E wave/color M-mode velocity of propagation ratio (r = 0.28, p = 0.001), and mitral E wave/tissue Doppler septal E′ wave ratio (r = 0.28, p = 0.001). Plasma hs-CRP levels independently predicted adverse clinical events even after adjustment for LVEF and mitral E wave/tissue Doppler septal E′ wave ratio (hazard ratio 2.28, 95% confidence interval 1.18 to 4.39). In conclusion, in patients with chronic systolic HF, expression of circulating CRP was associated with increasing echocardiographic indexes of diastolic dysfunction. High plasma hs-CRP levels portend poor long-term outcomes, particularly in those with severe concomitant systolic and diastolic dysfunctions.


W.H. Wilson Tang, MDa, Kevin Shrestha, ABa, Frederick Van Lente, PhDb, Richard W. Troughton, MBBSc, Maureen G. Martin, RDCSa, Allen G. Borowski, RDCSa, Sue Jasper, RN, BSNa, Allan L. Klein, MDa