Prognostic value of preoperative high-sensitivity C-reactive protein to albumin ratio in patients with dilated cardiomyopathy receiving pacemaker therapy: A retrospective two-center study in China

Background

Despite receiving pacemaker therapy, patients with heart failure with reduced ejection fraction (HFrEF) due to dilated cardiomyopathy (DCM) remain at an increased risk of adverse cardiovascular events. The high-sensitivity C-reactive protein (hs-CRP)-to-albumin ratio (CAR) is a novel indicator. This study aimed to assess the prognostic value of preoperative CAR in this population.

Methods

Patients with DCM who underwent cardiac resynchronization therapy (CRT) or implantable cardiac defibrillator (ICD) implantation for HFrEF between 2018 and 2023 were involved. The primary endpoint was major adverse cardiac events (MACE). Cox regression models were used to investigate predictors for MACE. Receiver operating characteristic (ROC) curve analysis was utilized to evaluate the diagnostic efficacy and identify the optimal cutoff point.

Results

We enrolled 250 patients, of whom 78 experienced MACE. Patients who experienced MACE had a significantly higher CAR than those without MACE (p < 0.001). Multivariate Cox regression analysis indicated CAR as an independent predictor for MACE (hazard ratio = 4.301, 95 % confidence interval [CI] 1.833–10.091, p < 0.001). ROC curve analysis demonstrated the discriminatory ability of CAR in predicting MACE (area under the curve [AUC] = 0.732, 95 % CI 0.666–0.792, p < 0.001), with an optimal threshold of 0.08. Furthermore, the incidence of MACE was significantly higher in the high-CAR (> 0.08) group compared to the low-CAR (≤ 0.08) group (48.8 % vs. 13.6 %, p < 0.001).

Conclusion

Among patients with DCM and HFrEF treated with CRT or ICD, CAR can serve as an independent risk predictor, with higher levels associated with poorer outcomes.