hs-CRP in Adult Congenital Heart Disease

Study Questions:

What are the clinical correlates and prognostic value of high-sensitivity C-reactive protein (hs-CRP) in adults with congenital heart disease (ACHD)?

Methods:

A prospective cohort study was performed at a single ACHD referral center. The study enrolled outpatients with CHD ≥18 years old between 2012 and 2016. Subjects underwent measurement of serum hs-CRP in conjunction with a clinical assessment. The primary outcome was a combined outcome of all-cause mortality or nonelective cardiovascular hospitalization.

Results:

A total of 707 patients were studied, with a mean age of 39 ± 14 years. Higher hs-CRP was strongly associated with measures of functional status including New York Heart Association class and peak oxygen uptake, as well as with comorbidities including atrial arrhythmias. Over an average follow-up of 815 ± 536 days, 114 patients (16%) met the primary outcome, including 29 deaths (4%). Elevated hs-CRP in the highest quartile (≥2.98 mg/L) as compared with the lower quartiles was associated with increased risk for the primary outcome (30.5% vs. 11.3%, adjusted hazard ratio [HR], 2; 95% confidence interval [CI], 1.35-2.97; p = 0.0006) as well as all-cause mortality (11.9% vs. 1.5%, adjusted HR, 4.23; 95% CI, 1.98-9.59; p = 0.0006). The association between hs-CRP and adverse outcomes was consistent across the various ACHD subgroups and patient characteristics.

Conclusions:

Elevated hs-CRP in ACHD patients is associated with both worse functional status as well as increased risk for death or nonelective cardiovascular hospitalization.

Perspective:

This is the first large study to assess the prognostic value of hs-CRP on clinical outcomes in ACHD. The study demonstrated a relationship between hs-CRP and functional status and hard outcomes of death or nonelective hospitalization for cardiovascular indications. Chronic inflammation has been implicated previously in atherosclerotic cardiovascular disease, with ongoing efforts to understand the impact of anti-inflammatory therapies on the disease process. However, in CHD patients, the mechanism of inflammation, its role in pathophysiology, and therapeutic implications remain unknown. This study presents a new area for investigation in ACHD, along with the potential for new therapeutic modalities in the future.

Clinical Topics: Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Acute Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: Arrhythmias, Cardiac, Atherosclerosis, Biological Markers, Atrial Fibrillation, C-Reactive Protein, Heart Defects, Congenital, Heart Failure, Inflammation, Outcome Assessment (Health Care), Risk


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