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High-sensitivity C-reactive protein in heart failure with preserved ejection fraction: Findings from TOPCAT
João Pedro Ferreira1, Brian L Claggett2, Jiankang Liu2
1Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Centre - UnIC@RISE, Faculty of Medicine of the University of Porto, Porto, Portugal; Université de Lorraine, Inserm, Centre d'Investigation Clinique Plurithématique 1433, U1116, CHRU de Nancy, F-CRIN INI-CRCT, Nancy, France.
Insights
High-sensitivity C-reactive protein (hsCRP) ≥2 mg/L identifies heart failure with preserved ejection fraction (HFpEF) patients at high risk for cardiovascular death and HF hospitalizations. Spironolactone did not affect hsCRP levels.
Area of Science:
- Cardiology
- Inflammation Research
- Biomarker Discovery
Background:
- Inflammation is key in heart failure with preserved ejection fraction (HFpEF) development and progression.
- High-sensitivity C-reactive protein (hsCRP) is a marker for systemic inflammation and HF prognosis.
- Further study is needed on inflammation markers in HFpEF outpatients.
Purpose of the Study:
- To characterize HFpEF patients using hsCRP levels.
- To investigate the prognostic associations of hsCRP in HFpEF.
- To analyze hsCRP in a biomarker subset of the TOPCAT-Americas trial.
Main Methods:
- hsCRP levels were measured in 232 HFpEF participants.
- Patients were categorized into hsCRP <2 mg/L and ≥2 mg/L groups.
- Cox regression models assessed hsCRP association with outcomes.
Main Results:
- Patients with hsCRP ≥2 mg/L (62%) had more HF hospitalizations, COPD, orthopnea, higher BMI, and worse quality-of-life.
- hsCRP ≥2 mg/L was linked to increased risk of cardiovascular death and HF hospitalizations (aHR 2.36).
- Spironolactone did not impact hsCRP levels at 12 months.
Conclusions:
- Elevated hsCRP (≥2 mg/L) identifies high-risk HFpEF patients.
- hsCRP is a valuable prognostic marker for HF events and mortality in HFpEF.
- Spironolactone showed no effect on hsCRP levels over 12 months.
Background:
Inflammation plays a central role in the genesis and progression of heart failure with preserved ejection fraction (HFpEF). C-reactive protein (CRP) is widely used as means to assess systemic inflammation, and elevated levels of CRP have been associated with poor HF prognosis. Identification of chronic low-grade inflammation in outpatients can be performed measuring high-sensitivity CRP (hsCRP). The clinical characteristics and outcome associations of a pro-inflammatory state among outpatients with HFpEF requires further study.
Aims:
Using a biomarker subset of TOPCAT-Americas (NCT00094302), we aim to characterize HFpEF patients according to hsCRP levels and study the prognostic associations of hsCRP.
Methods:
hsCRP was available in a subset of 232 participants. Comparisons were performed between patients with hsCRP <2 mg/L and ≥ 2 mg/L. Cox regression models were used to study the association between hsCRP and the study outcomes.
Results:
Compared to patients with hsCRP <2 mg/L (n = 89, 38%), those with hsCRP ≥2 mg/L (n = 143, 62%) had more frequent HF hospitalizations prior to randomization, chronic obstructive pulmonary disease, orthopnea, higher body mass index, and worse health-related quality-of-life. A hsCRP level ≥ 2 mg/L was associated with an increased risk of cardiovascular death and HF hospitalizations: hsCRP ≥2 mg/L vs <2 mg/L adjusted HR 2.36, 95%CI 1.27-4.38, P = 0.006. Spironolactone did not influence hsCRP levels from baseline to month 12: gMean ratio = 1.11, 95%CI 0.87-1.42, P = 0.39.
Conclusions:
A hsCRP ≥2 mg/L identified HFpEF patients with a high risk of HF events and cardiovascular mortality. Spironolactone did not influence hsCRP levels at 12 months.
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