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Persistent elevation of C-reactive protein may predict cardiac hypertrophy and dysfunction in patients maintained on
Byung-Soo Kim1, Doo Soo Jeon, Mi Jung Shin
1Division of Nephrology, Department of Internal Medicine, St. Mary's Hospital, The Catholic University of Korea, Yeouido-dong, Yeongdeungpo-gu, Seoul, Korea.
Insights
Persistent high C-reactive protein (CRP) in hemodialysis patients is linked to poorer cardiac function and increased cardiac remodeling. This inflammation marker may predict heart problems in this vulnerable population.
Area of Science:
- Nephrology
- Cardiology
- Clinical Chemistry
Background:
- C-reactive protein (CRP) indicates chronic inflammation and predicts cardiovascular mortality in hemodialysis patients.
- Persistent elevation of CRP may be associated with cardiac function and morphology changes in hemodialysis patients.
Purpose of the Study:
- To investigate the association between persistent elevation of high-sensitivity C-reactive protein (hs-CRP) and cardiac function and morphology in hemodialysis patients.
Main Methods:
- Measured predialysis hs-CRP twice in 52 stable hemodialysis patients.
- Performed echocardiographic studies to assess cardiac function and morphology.
Main Results:
- Patients with persistently high hs-CRP (>3 mg/l) exhibited lower dialysis dose, higher troponin T, and higher fibrinogen.
- High hs-CRP group showed increased left atrial diameter, interventricular septal thickness, left ventricular end-diastolic volume, and left ventricular mass index.
- Ejection fraction was lower in the high hs-CRP group, with a higher prevalence of low ejection fraction (<40%).
- hs-CRP correlated positively with troponin T, fibrinogen, interventricular septal thickness, left ventricular end-diastolic volume, and left ventricular mass index.
- hs-CRP correlated negatively with ejection fraction.
- Multivariate analysis identified high hs-CRP as a significant predictor of reduced ejection fraction, increased left ventricular mass index, and increased interventricular septal thickness.
Conclusions:
- Persistent elevation of CRP is an independent risk factor for cardiac hypertrophy and dysfunction.
- High CRP levels may predict adverse cardiac remodeling and impaired cardiac function in hemodialysis patients.
Background:
C-reactive protein (CRP), which reflects chronic inflammation, is a strong predictor of cardiovascular mortality in hemodialysis patients. We investigated whether persistent elevation of CRP is associated with cardiac function and morphology in patients maintained on hemodialysis.
Methods:
Predialysis high-sensitivity CRP (hs-CRP) was measured twice at an interval of 3 weeks in 52 stable hemodialysis patients, and echocardiographic studies were performed.
Results:
25 patients showed persistent elevation of predialysis hs-CRP (>3 mg/l, high CRP group). Patients in the high CRP group had a lower dialysis dose (p < 0.01), higher troponin T (p < 0.01), and higher fibrinogen (p < 0.01). Echocardiographic studies showed that left atrial diameter (LA, p < 0.05), interventricular septal thickness (IVST, p < 0.05), left ventricular end-diastolic volume (LVEDV, p < 0.05), and left ventricular mass index (LVMI, p < 0.05) were higher in the high CRP group. However the ejection fraction (EF) was lower in the high CRP group (p < 0.05), which also contained more patients with low EF (<40%) (p < 0.01). There was no difference in diabetes mellitus, acute infection and type of vascular access between the groups. hs-CRP level was positively correlated with troponin T (r = 0.416, p < 0.01) and fibrinogen (r = 0.560, p < 0.001), and IVST with hs-CRP level (r = 0.291, p < 0.05), whereas the EF was negatively correlated with hs-CRP (r = -0.301, p < 0.05). In addition, the high CRP group correlated positively with IVST (r = 0.281, p < 0.05), LVEDV (r = 0.322, p < 0.05), and LVMI (r = 0.312, p < 0.05) and negatively with EF (r = -0.311, p < 0.05). On multivariate analysis, the high CRP group (beta = -0.312, beta = 0.238, and beta = 0.318, respectively) was a significant predictor of EF (R = 0.62, p = 0.025), LVMI (R = 0.928, p = 0.02) and IVST (R = 0.64, p = 0.01).
Conclusions:
Persistent elevation of CRP, which is an independent risk factor for EF, LVMI and IVST, may predict cardiac hypertrophy and dysfunction in patients maintained on hemodialysis.
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