Prognostic value of C-reactive protein in adults with congenital heart disease

• Published in: Heart (British Cardiac Society) Vol. 107; no. 6; pp. 474 - 481
• Main Authors: Geenen, Laurie W, Baggen, Vivan J M, van den Bosch, Annemien E, Eindhoven, Jannet A, Kauling, Robert M, Cuypers, Judith A A E, Roos-Hesselink, Jolien W, Boersma, Eric
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.03.2021; BMJ Publishing Group
• Series: Original research
• Subjects: Age; Biomarkers; Body mass index; Cardiovascular disease; Congenital diseases; Congenital Heart Disease; Heart; Inflammation; Laboratories; Mortality; Patients; complex congenital heart disease
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heartjnl-2020-316813

BackgroundHigh-sensitivity C reactive protein (hs-CRP) has been associated with outcomes in adult congenital heart disease (ACHD). However, its prognostic value beyond N-terminal pro B type natriuretic peptide (NT-proBNP) or troponin T remains unknown. We studied the temporal evolution of hs-CRP, as well as the relation between hs-CRP and adverse clinical outcomes independent of NT-proBNP and troponin T in patients with ACHD.MethodsIn this prospective cohort study, we enrolled 602 patients with ACHD (2011–2013) who underwent baseline and thereafter annual blood sampling during 4 years. Hs-CRP, hs-troponin T and NT-proBNP were measured. The primary endpoint was composed of death or heart failure (HF). Cox regression and Joint Modelling was used to relate 2log hs-CRP levels with the endpoint, with adjustment for baseline characteristics and (repeated) hs-troponin T and NT-proBNP measurements.ResultsHs-CRP was measured at baseline in 591 patients, median age 33 years, 58% men, 90% New York Heart Association I with an average of 4.3 measurements per patient. Median follow-up was 5.9 (IQR 5.3–6.3) years (99.2% complete) and 69 patients met the endpoint. Higher baseline hs-CRP was independently associated with higher risk of death or HF (HR 1.36, 95% CI 1.19 to 1.55). Hs-CRP increased over time prior to death or HF, and repeated hs-CRP measurements were associated with the endpoint, independent of repeated NT-proBNP and hs-troponin T (HR 1.54, 95% CI 1.24 to 1.98).ConclusionsHs-CRP carries incremental prognostic value for the risk of death or HF, beyond NT-proBNP and hs-troponin T. Hs-CRP increased prior to the occurrence of HF or death, supporting the role of inflammation in the clinical deterioration of patients with ACHD.