High-sensitivity C-reactive Protein in Heart Failure with Preserved Ejection Fraction: Findings from TOPCAT.

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.