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Published on: August 8, 2013
High-sensitivity C-reactive protein: potential adjunct for risk stratification in patients with stable congestive
Nicolas Lamblin1, Frédéric Mouquet, Bernadette Hennache
1Department of Cardiology, Hôpital Cardiologique, CHRU de Lille, Boul. Prof. Leclercq 59037, Lille Cedex, France.
Insights
High-sensitivity C-reactive protein (hs-CRP) can help stratify risk in congestive heart failure (CHF) patients. Elevated hs-CRP levels (>3 mg/L) independently predict cardiovascular mortality, especially in ischemic cardiomyopathy.
Area of Science:
- Cardiology
- Biomarkers
- Heart Failure Research
Background:
- Congestive heart failure (CHF) management requires accurate risk stratification.
- Identifying novel prognostic markers is crucial for improving patient outcomes.
- High-sensitivity C-reactive protein (hs-CRP) is an inflammatory marker with potential prognostic value.
Purpose of the Study:
- To evaluate the utility of hs-CRP as an adjunct marker for risk stratification in patients with stable CHF.
- To determine if hs-CRP provides independent prognostic information beyond established markers.
- To investigate the differential impact of hs-CRP in ischemic versus non-ischemic CHF.
Main Methods:
- A cohort of 546 clinically stable CHF patients with ejection fraction <45% was studied.
- hs-CRP levels were measured at baseline.
- Patients were followed for a median of 972 days for cardiovascular mortality.
- Multivariable analyses were performed, including clinical, biological (e.g., BNP), and echocardiographic variables (e.g., peak VO2).
Main Results:
- Cardiovascular mortality was significantly higher in patients with hs-CRP >3 mg/L (P=0.001).
- hs-CRP >3 mg/L was an independent predictor of cardiovascular mortality, even after adjusting for BNP and peak VO2.
- The prognostic value of hs-CRP was particularly pronounced in patients with ischemic CHF (P=0.001) but not in non-ischemic CHF (P=0.098).
Conclusions:
- Elevated hs-CRP levels (>3 mg/L) are associated with increased cardiovascular mortality in stable CHF patients.
- hs-CRP offers independent prognostic information, complementing established markers like BNP and peak VO2.
- hs-CRP determination is especially valuable for risk stratification in patients with ischemic cardiomyopathy.
Aims:
To determine the potential adjunct of high-sensitivity (hs) C-reactive protein for risk stratification in patients with stable congestive heart failure (CHF).
Methods And Results:
We studied 546 consecutive patients clinically stable with an ejection fraction <45% who were referred to our centre for evaluation of left ventricular dysfunction. hs C-reactive protein levels were determined on blood samples obtained on entry into the study. Clinical follow-up (median 972 days) was obtained for 545 patients. Cardiovascular mortality was significantly increased (P=0.001) in patients with hs C-reactive protein >3 mg/L. By multivariable analysis, including clinical, biological, and echocardiographic variables, hs C-reactive protein >3 mg/L was an independent predictor of cardiovascular mortality [HR=1.78 (1.17-2.72); P=0.008]; the strongest predictive parameter in this model was B-type natriuretic peptide (BNP) (P=0.005). When peak VO(2) was included into the model, hs C-reactive protein >3 mg/L remained an independent predictor of cardiovascular mortality [HR=1.55 (1.02-2.38); P=0.04]; the strongest predictive parameter in this model was peak VO(2) (P<0.0001). In patients with ischaemic CHF, cardiovascular mortality was significantly increased in patients with hs C-reactive protein >3 mg/L (P=0.001), whereas in patients with non-ischaemic CHF, hs C-reactive protein >3 mg/L was not associated with cardiovascular mortality (P=0.098). By multivariable analysis, hs C-reactive protein >3 mg/L was an independent predictor of cardiovascular mortality in ischaemic patients [HR=2.16 (1.23-3.78)] but not in non-ischaemic patients [HR=1.05 (0.52-2.11)].
Conclusion:
Cardiovascular mortality is increased in CHF patients with hs C-reactive protein >3 mg/L. The impact of hs C-reactive protein is independent of usual prognostic parameters, in particular BNP and peak VO(2). The interest of hs C-reactive protein determination appears to be especially marked in patients with ischaemic cardiomyopathy.
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