High-sensitivity C-reactive protein in heart failure with preserved ejection fraction

Area of Science:

• Cardiology
• Inflammation Research
• Biomarker Discovery

Background:

• Microvascular inflammation is implicated in heart failure with preserved ejection fraction (HFpEF) and pulmonary hypertension (PH).
• C-reactive protein (CRP) is a key inflammation biomarker.
• The association of CRP with HFpEF characteristics and PH requires further investigation.

Purpose of the Study:

• To investigate the association of C-reactive protein (CRP) with clinical characteristics, disease severity, and pulmonary hypertension (PH) in patients with HFpEF.
• To determine if CRP levels correlate with comorbidities and specific disease markers in HFpEF.

Main Methods:

• Analysis of baseline high-sensitivity CRP levels in 214 patients from the RELAX trial.
• Comparison of clinical characteristics, exercise capacity, echocardiographic data, and biomarkers between patients with normal (≤3mg/L) and high (>3mg/L) CRP levels.
• Statistical adjustments for age, body mass index (BMI), and statin use.

Main Results:

• Median CRP was 3.69mg/L, with 57% of patients having elevated levels.
• High CRP was linked to younger age, higher BMI, COPD, lower peak oxygen consumption, and elevated endothelin-1 and aldosterone.
• CRP levels increased with comorbidity burden and were associated with atrial fibrillation, right ventricular dysfunction, and higher NT-proBNP, but not PH or left ventricular function.

Conclusions:

• Elevated CRP in HFpEF is associated with a higher comorbidity burden and certain markers of disease severity.
• The finding that 40% of patients had normal CRP levels highlights the need for alternative biomarkers to fully capture systemic inflammation in HFpEF.
• These results support the role of comorbidity-driven inflammation in HFpEF pathogenesis.