Abstract 2049: Risk Stratification Using C-Reactive Protein and Brain Natriuretic Peptide in Patients with Non-Ischemic Chronic Heart Failure
Background: Brain natriuretic peptide (BNP) is an established prognostic predictor in patients with chronic heart failure (CHF). Recent studies have shown that C-reactive protein (CRP) is increased in patients with CHF. We investigated whether the combination of CRP and BNP would be useful for risk stratification in patients with non-ischemic CHF (NICHF).
Methods: We measured CRP and BNP in 86 patients with NICHF and in 29 controls. Patients were classified into 4 groups using the median value of CRP (0.23 mg/dl) and BNP (181.9 ng/ml).
Results: Both CRP and BNP were higher in patients with NICHF than in controls (CRP: 0.41±0.79 vs 0.12±0.08 mg/dl, p=0.048, BNP: 305.8±357.2 vs 11.3±3.7 ng/ml, p<0.0001). In NICHF patients, CRP was significantly correlated with BNP (r=0.34, p=0.001), atrial natiruretic peptide (r=0.37, p=0.0004), norepinephrine (r=0.52, p<0.0001), CTR (r=0.34, p=0.001) and LVEF (r=−0.22, p=0.04). Over a mean follow-up period of 36 months, 25 patients had cardiac events (9 deaths and 16 readmissions due to worsening CHF). On a stepwise multivariate Cox regression analysis, including 7 variables (age, sex, CRP, BNP, norepinephrine, creatinine, LVEF), both CRP (p=0.01) and BNP (p=0.007) were significantly independent predictors of cardiac events. Kaplan-Meier analysis revealed that the relative risk was significantly higher in patients with both CRP and BNP above the median than in the other 3 groups (Figure⇓).
Conclusions: These results indicate that CRP reflects the severity of NICHF and the combination of CRP and BNP is useful for risk stratification in patients with NICHF.