Integrating Plasma High-Sensitivity C-Reactive Protein and Myeloperoxidase for Risk Prediction in Chronic Systolic Heart Failure

Abstract

Various inflammatory biomarkers predict long-term outcomes in patients with acute and chronic heart failure (HF). Their relative contributions when measured in combination have not been evaluated. The authors measured both plasma levels of high-sensitivity C-reactive protein (hsCRP) and myeloperoxidase (MPO) in 136 patients with chronic systolic HF (left ventricular ejection fraction ≤ 40%), and performed echocardiography with prospective follow-up of adverse clinical events (death, cardiac transplant, and HF hospitalizations) over 34 ± 17 months. A lack of significant correlation between log-transformed hsCRP and MPO (Spearman's r = 0.11, P = .185) was observed. Within the lower two hsCRP tertiles (<5.34 mg/L), patients with plasma MPO above median levels demonstrated a 2.9-fold increased risk in adverse clinical events (95% confidence interval [CI], 1.2-8.1; P < .05), whereas within lower plasma MPO levels (<303 pM), increase in hsCRP demonstrated a 1.9-fold increased risk (95% CI, 0.56-6.2; P = not significant). Combined analysis of hsCRP and MPO levels demonstrated a 6-fold increased risk (95% CI, 2.4-16.8; P < .01) when both markers were elevated. Stratifying patients according to hsCRP, MPO, and amino-terminal pro-B-type natriuretic peptide cutoff values provided a stepwise increment of risk prediction of adverse clinical events. Combining hsCRP and MPO measurements provided distinct and complementary prognostic value in a patient cohort of chronic systolic HF.