C-reactive protein predicts functional status and correlates with left ventricular ejection fraction in patients with chronic stable angina

Abstract 

C-reactive protein (CRP) is a marker for cardiovascular risk but may also participate in the pathogenesis of atherosclerosis and myocardial injury. We sought to investigate the relationship among CRP, left ventricular ejection fraction (LVEF) and symptoms of congestive heart failure (CHF) in patients with chronic stable angina (CSA) pectoris.

Methods

We studied 841 patients (63±10 years, 72% men) with CSA undergoing coronary angiography. Symptoms of CHF were assessed using the New York Heart Association (NYHA) functional classification. CRP measurements were performed using a high sensitivity (hs-) immunoassay at the time of diagnostic coronary angiography.

Results

Baseline serum hs-CRP levels showed a significant correlation with LVEF (r=−0.11; P=0.004), and prevalence of moderate-to-severe CHF correlated with serum hs-CRP quartiles (P_trend<0.0001). After adjustment, age (P=0.004), female gender (P=0.03), body mass index (P<0.0001) and hs-CRP (OR 2.2 [1.3–3.6] CI 95%; P=0.002) were independent predictors of NYHA functional classes III–IV irrespective of LVEF and angiographic severity of CAD. A CRP value of 3.2mg/L had a sensitivity of 72%, a specificity of 75%, and a negative predictive value of 96% for detecting an impaired functional class.

Interpretation

Hs-CRP serum concentrations showed an inverse correlation with LVEF and were an independent predictor of NYHA functional class in patients with CSA.

Keywords: Inflammation, C-reactive protein, Left ventricular ejection fraction, NYHA functional class, Heart failure, Chronic stable angina