C‐reactive protein, diastolic dysfunction, and risk of heart failure in patients with coronary disease: Heart and Soul Study

Abstract

Background: High-sensitivity C-reactive protein (CRP) is an inflammatory marker that predicts coronary heart disease (CHD) and, in recent studies, incident heart failure (HF). Whether the association of inflammation with incident HF is explained by worse baseline left ventricular dysfunction or by underlying CHD is unknown. Methods and results: Serum CRP was measured in a cohort of 985 outpatients with established CHD from the Heart and Soul Study. During 3 years of follow-up, 15% of the participants with elevated CRP levels (N3 mg/L) were hospitalised for HF, compared with 7% of those with CRP ≤3 mg/L. In multivariate analysis, elevated CRP was associated with HF after adjustment for traditional risk factors, baseline CHD severity and interim MI (adjusted HR 2.1, 95% CI, 1.2-3.6; p = 0.009). However, elevated CRP was no longer associated with HF after further adjustment for the presence of diastolic dysfunction on echocardiography (adjusted HR 1.6, 95% CI, 0.8-3.2; p = 0.1). Conclusions: Among outpatients with stable CHD, elevated CRP levels predict hospitalisation for heart failure, independent of baseline heart failure, medication use, CHD severity, and subsequent MI events. This relationship appears to be at least partly explained by abnormal diastolic function in patients with elevated CRP levels.

Inflammation in HFpEF: Key or circumstantial?

“…In other studies, increased inflammation as evident from increased CRP levels [21], platelet activation measured by soluble P-selectin, and endothelial dysfunction as assessed by plasma van Willebrand factor (vWf) were closely related to diastolic dysfunction in patients with stable coronary artery disease. Increased inflammation measured by circulating IL-6, TNF-α, IL-8, and MCP1 and fibrosis measured by fibrotic signals (PIIINP and CITP) and matrix turnover signals (matrix metalloproteinases; TIMP-1) were also detected in a cross-sectional study of 275 stable hypertensive patients with and without HFpEF, defining varying fibro-inflammatory profiles throughout different stages of hypertensive heart disease (HHD) [22].…”

Effects of Inhaled Tiotropium on Left Ventricular Diastolic Function in Chronic Obstructive Pulmonary Disease Patients after Pulmonary Resection

“…20) These inflammatory factors have been reported to have a pathogenic role in the development of LV diastolic dysfunction. 21) Recent reports have suggested that tiotropium bromide has anti-inflammatory activity via the muscarinic M3 receptor. 22) In this study, WBC counts and CRP levels were relatively lower after than before treatment, but there were no significant differences because their values were within normal ranges even before treatment.…”

Glycemic and Non-Glycemic Effects of Exenatide in Patients With Diabetes Mellitus of Type 2 (Dm2) With Myocardial Infarction

“…В то же время в более ранних исследова-ниях было показано, что уровень СРБ был существенно выше у больных, у которых в дальнейшем развились недо-статочность ЛЖ и разрыв миокарда, по сравнению с паци-ентами, у которых не развилось осложнений [37,38]. Более того, увеличение концентрации СРБ (более 20 мг%) являет-ся независимым фактором риска развития аневризмы ЛЖ, сердечной недостаточности и сердечно-сосудистой смерти в течение 1-го года после перенесенного ИМ [39,40]. Имеются данные о более благоприятном 6-месячном про-гнозе после перенесенного ИМ у больных с исходно более низким уровнем СРБ [39][40].…”

“…Более того, увеличение концентрации СРБ (более 20 мг%) являет-ся независимым фактором риска развития аневризмы ЛЖ, сердечной недостаточности и сердечно-сосудистой смерти в течение 1-го года после перенесенного ИМ [39,40]. Имеются данные о более благоприятном 6-месячном про-гнозе после перенесенного ИМ у больных с исходно более низким уровнем СРБ [39][40]. Cнижение вариабельности гликемии также имеет важное значение для улучшения жизненного прогноза ургентных пациентов [27][28][29].…”