Abstract 16678: Role of C-Reactive Protein in Distinguishing Diastolic Heart Failure Induced Pulmonary Hypertension From Pulmonary Arterial Hypertension
Background: Diastolic heart failure is associated with multiple chronic medical conditions including pulmonary hypertension (DHF-PH). DHF-PH has significant echocardiographic overlap with Pulmonary Arterial Hypertension (PAH) complicating non-invasive diagnosis. High sensitivity C-reactive protein (hs-CRP) has been shown to be elevated in DHF-PH but not PAH. Current diagnostic algorithms are limited in distinguishing DHF-PH from PAH. We therefore sought to determine if CRP, an easily obtainable peripheral blood measurement, would assist in differentiating DHF-PH from PAH.
Methods: Patients with mPAP >25 mmHg by right heart catheterization and EF ≥50% by echocardiography were divided into DHF-PH (PCWP ≥15 mm Hg, transpulmonary gradient [TPG] <12mmHg, PA-diastolic PCWP gradient ≤5 mmHg) and PAH (PCWP < 15 mm Hg, transpulmonary gradient ≤[TPG] 12 mm Hg, PA-diastolic PCWP gradient >5 mmHg ). Logistic procedure was used and a Receiver Operating Characteristics (ROC) Curve was produced to evaluate the predictive role of hs-CRP with and without demographic data in distinguishing DHF-PH from PAH.
Results: A total of 27 DHF-PH and 33 PAH patients were included in the analysis. ROC curve of demographic parameters (BMI, age, race, sex) differentiating DHF-PH from PAH are shown in figure A (Area under ROC curve [AUC] of 0.81 sensitivity 70%, specificity 82%). ROC curve of elevated hs-CRP with and without demographic parameters differentiating DHF-PH from PAH are shown in figure B,C,D (hs-CRP cutoff of 8.3mg/L; AUC of 0.869, 0.891, 0.954 respectively).
Conclusion: Elevated hs-CRP alone is superior to demographic data alone in differentiating DHF-PH and PAH. When demographic data is included with elevated hs-CRP the utility of hs-CRP increases. Thus, CRP may assist in the non-invasive differentiation of DHF-PH from PAH.
- © 2013 by American Heart Association, Inc.