C-Reactive Protein Levels Predict Outcomes in Continuous-Flow Left Ventricular Assist Device Patients: An INTERMACS Analysis.
Journal
ASAIO journal (American Society for Artificial Internal Organs : 1992)
ISSN: 1538-943X
Titre abrégé: ASAIO J
Pays: United States
ID NLM: 9204109
Informations de publication
Date de publication:
01 08 2021
01 08 2021
Historique:
pubmed:
3
2
2021
medline:
16
10
2021
entrez:
2
2
2021
Statut:
ppublish
Résumé
CRP is an established inflammatory biomarker with prognostic value in patients with chronic heart failure, yet its role in continuous-flow left ventricular assist device (LVAD) patients is largely unknown. 5,183 patients from the INTERMACS registry who underwent durable LVAD between 2008 and 2017 and had preimplant CRP levels were included. The sample was stratified into two groups based on preimplant CRP levels: CRP of 0-10 mg/L (low) and >10 mg/L (high). Kaplan-Meier survival estimates were used to assess outcomes at 2 years after LVAD implantation, with log-rank testing used to compare groups. Cox proportional hazard models were used for multivariable adjustment. Patients with high preimplant CRP were younger, more likely to be INTERMACS class I, and had a higher need for temporary mechanical circulatory support before LVAD implant compared to those with lower CRP levels (all P < 0.001). The high CRP group had higher WBC counts and BNP levels (all P < 0.001). After adjustment, higher CRP (>10 mg/L) was associated with greater risk of mortality, RV failure, and stroke postimplant (P < 0.001). In addition, elevated postimplant CRP level at 3 months was associated with increased mortality and stroke on LVAD support (P < 0.001). CRP is a predictor of death and complications on LVAD support. Future studies are necessary to explore the mechanisms underlying this finding and the potential role of antiinflammatory therapies in this population.
Identifiants
pubmed: 33528160
doi: 10.1097/MAT.0000000000001327
pii: 00002480-202108000-00010
doi:
Substances chimiques
C-Reactive Protein
9007-41-4
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
884-890Informations de copyright
Copyright © ASAIO 2021.
Déclaration de conflit d'intérêts
Disclosures: The authors have no conflicts of interest to report.
Références
Kirklin JK, Pagani FD, Kormos RL, et al.: Eighth annual INTERMACS report: special focus on framing the impact of adverse events. J Heart Lung Transplant. 36: 1080–1086, 2017.
Cowger J, Sundareswaran K, Rogers JG, et al.: Predicting survival in patients receiving continuous flow left ventricular assist devices: The heartmate II risk score. J Am Coll Cardiol. 61: 313–321, 2013.
Yang JA, Kato TS, Shulman BP, et al.: Liver dysfunction as a predictor of outcomes in patients with advanced heart failure requiring ventricular assist device support: Use of the Model of End-stage Liver Disease (MELD) and MELD eXcluding INR (MELD-XI) scoring system. J Heart Lung Transplant. 31: 601–610, 2012.
Adamo L, Nassif M, Tibrewala A, et al.: The heartmate risk score predicts morbidity and mortality in unselected left ventricular assist device recipients and risk stratifies INTERMACS class 1 patients. JACC Heart Fail. 3: 283–290, 2015.
Grimm JC, Shah AS, Magruder JT, et al.: MELD-XI score predicts early mortality in patients after heart transplantation. Ann Thorac Surg. 100: 1737–1743, 2015.
Kanwar MK, Lohmueller LC, Kormos RL, et al.: Low accuracy of the heartmate risk score for predicting mortality using the INTERMACS registry data. ASAIO J. 63:251–256, 2017.
Arroyo-Espliguero R, Avanzas P, Cosín-Sales J, Aldama G, Pizzi C, Kaski JC: C-reactive protein elevation and disease activity in patients with coronary artery disease. Eur Heart J. 25: 401–408, 2004.
Bogaty P, Poirier P, Simard S, et al.: Biological profiles in subjects with recurrent acute coronary events compared with subjects with long-standing stable angina. Circulation. 103: 3062–3068, 2001.
Lamblin N, Mouquet F, Hennache B, et al.: High-sensitivity C-reactive protein: Potential adjunct for risk stratification in patients with stable congestive heart failure. Eur Heart J. 26: 2245–2250, 2005.
Mueller C, Laule-Kilian K, Christ A, Brunner-La Rocca HP, Perruchoud AP: Inflammation and long-term mortality in acute congestive heart failure. Am Heart J. 151: 845–850, 2006.
Park JJ, Choi DJ, Yoon CH, et al.; KorHF Registry: Prognostic value of C-reactive protein as an inflammatory and N-terminal probrain natriuretic peptide as a neurohumoral marker in acute heart failure (from the Korean Heart Failure registry). Am J Cardiol. 113: 511–517, 2014.
Kang S, Fan LY, Chen M, Li J, Liu ZM: Relationship of high-sensitivity C-Reactive protein concentrations and systolic heart failure. Curr Vasc Pharmacol. 15: 390–396, 2017.
Myers GL, Rifai N, Tracy RP, et al.; CDC; AHA: CDC/AHA Workshop on markers of inflammation and cardiovascular disease: Application to clinical and public health practice: Report from the laboratory science discussion group. Circulation. 110: e545–e549, 2004.
Myers GL, Christenson RH, Cushman M, et al.: National academy of clinical biochemistry laboratory medicine practice guidelines: Emerging biomarkers for primary prevention of cardiovascular disease. Clin Chem. 55: 378–384, 2009.
Canada JM, Fronk DT, Cei LF, et al.: Usefulness of C-reactive protein plasma levels to predict exercise intolerance in patients with chronic systolic heart failure. Am J Cardiol. 117: 116–120, 2016.
Anand IS, Latini R, Florea VG, et al.; Val-HeFT Investigators: C-reactive protein in heart failure: Prognostic value and the effect of valsartan. Circulation. 112: 1428–1434, 2005.
Grosman-Rimon L, McDonald MA, Jacobs I, et al.: Markers of inflammation in recipients of continuous-flow left ventricular assist devices. ASAIO J. 60: 657–663, 2014.
Grosman-Rimon L, Jacobs I, Tumiati LC, et al.: Longitudinal assessment of inflammation in recipients of continuous-flow left ventricular assist devices. Can J Cardiol. 31: 348–356, 2015.
Critsinelis A, Kurihara C, Volkovicher N, et al.: Model of End-Stage Liver Disease-eXcluding International Normalized Ratio (MELD-XI) scoring system to predict outcomes in patients who undergo left ventricular assist device implantation. Ann Thorac Surg. 106: 513–519, 2018.
Argiriou M, Kolokotron SM, Sakellaridis T, et al.: Right heart failure post left ventricular assist device implantation. J Thorac Dis. 6(suppl 1): S52–S59, 2014.
Lampert BC, Teuteberg JJ: Right ventricular failure after left ventricular assist devices. J Heart Lung Transplant. 34: 1123–1130, 2015.
Tang PC, Haft JW, Romano MA, et al.: Right ventricular failure following left ventricular assist device implantation is associated with a preoperative pro-inflammatory response. J Cardiothorac Surg. 14: 80, 2019.
Kormos RL, Teuteberg JJ, Pagani FD, et al.; HeartMate II Clinical Investigators: Right ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device: Incidence, risk factors, and effect on outcomes. J Thorac Cardiovasc Surg. 139: 1316–1324, 2010.
Matthews JC, Koelling TM, Pagani FD, Aaronson KD: The right ventricular failure risk score a pre-operative tool for assessing the risk of right ventricular failure in left ventricular assist device candidates. J Am Coll Cardiol. 51: 2163–2172, 2008.
Deswal A, Petersen NJ, Feldman AM, Young JB, White BG, Mann DL: Cytokines and cytokine receptors in advanced heart failure: An analysis of the cytokine database from the Vesnarinone trial (VEST). Circulation. 103: 2055–2059, 2001.
Colombo PC, Onat D, Harxhi A, et al.: Peripheral venous congestion causes inflammation, neurohormonal, and endothelial cell activation. Eur Heart J. 35: 448–454, 2014.
Maeda K, Tsutamoto T, Wada A, et al.: High levels of plasma brain natriuretic peptide and interleukin-6 after optimized treatment for heart failure are independent risk factors for morbidity and mortality in patients with congestive heart failure. J Am Coll Cardiol. 36: 1587–1593, 2000.