The level of highly sensitive C-reactive protein and mortality within a year after discharge from the hospital in patients with chronic heart failure with preserved ejection fraction

Abstract

Background. In recent years, there has been a steady trend in the form of an increase in the number of polymorbid patients with chronic heart failure with preserved ejection fraction (CHFpEF) and an increase in the frequency of its decompensation, which leads to an increased risk of adverse outcomes and increased mortality rates.Objective: to study the mortality structure in patients with CHFpEF within 1 year from the moment of discharge after initial hospitalization for decompensation of heart failure, as well as the level of highly sensitive C-reactive protein (hs-CRP) and clinical and laboratory characteristics of patients depending on the outcome.Methods. The data of patients with CHFpEF were retrospectively analyzed within 1 year from the moment of discharge after hospitalization due to decompensation of heart failure (n=372; median age 72.6 [63.3; 82.8] years, women – 44.4 %, NYHA class III and IV chronic heart failure, respectively, had 79.3 % and 15.9 % of patients). The concentration of hs-CRP in serum was determined in all patients during the first 24 hours after admission to the hospital.Results. During the follow-up, 65 deaths were registered (17.5 % of the included patients), of which 56 (86.2 % of all deaths) were caused by cardiovascular and cerebrovascular events – acute myocardial infarction (30 cases, 46.2 %), postinfarction cardiosclerosis (11 cases, 16.9 %), ischemic stroke (10 cases, 15.4 %), and rupture of an aortic aneurysm (1 case, 1.5 %). The level of hs-CRP compared with the surviving patients (4.84 [3.78; 5.88] mg/l) was statistically significantly higher both in the group of deaths from cardiovascular causes (5.22 [4.53; 6.21] mg/l, p=0.029) and in the group of deaths from all causes (5.33[4.49; 6.19] mg/l, p=0.020). A comparative analysis of patient characteristics revealed that patients who died from cardiovascular causes, compared with survivors, had a statistically significantly lower body mass index (p=0.046), higher total cholesterol (p=0.002), and aspartate aminotransferase (p=0.025). When comparing patients who died from all causes with patients without a fatal outcome, statistically significant differences in similar indicators were obtained.Conclusion. In patients with CHFpEF, both cardiovascular mortality and all-cause mortality within 1 year after hospitalization for decompensation of heart failure may be associated with sluggish inflammation, as well as an initially lower body mass index, higher total cholesterol and indirect signs of more pronounced myocardial damage.