Arroyo-Espliguero Ramón, Avanzas Pablo, Quiles Juan, Kaski Juan Carlos
Division of Cardiology, Hospital General Universitario, Guadalajara, Spain.
Atherosclerosis. 2009 Jul;205(1):319-24. doi: 10.1016/j.atherosclerosis.2008.12.018. Epub 2008 Dec 14.
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.
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.
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.
Hs-CRP serum concentrations showed an inverse correlation with LVEF and were an independent predictor of NYHA functional class in patients with CSA.
C反应蛋白（CRP）是心血管风险的标志物，但也可能参与动脉粥样硬化和心肌损伤的发病机制。我们试图研究慢性稳定型心绞痛（CSA）患者中CRP、左心室射血分数（LVEF）和充血性心力衰竭（CHF）症状之间的关系。
我们研究了841例接受冠状动脉造影的CSA患者（63±10岁，72%为男性）。使用纽约心脏协会（NYHA）功能分级评估CHF症状。在诊断性冠状动脉造影时，采用高敏（hs-）免疫测定法进行CRP测量。
基线血清hs-CRP水平与LVEF显著相关（r=-0.11；P=0.004），中重度CHF的患病率与血清hs-CRP四分位数相关（P趋势<0.0001）。调整后，年龄（P=0.004）、女性（P=0.03）、体重指数（P<0.0001）和hs-CRP（OR 2.2[1.3-3.6]CI 95%；P=0.002）是NYHA功能分级III-IV级的独立预测因素，与LVEF和CAD的血管造影严重程度无关。CRP值为3.2mg/L时，检测功能分级受损的敏感性为72%，特异性为75%，阴性预测值为96%。
血清hs-CRP浓度与LVEF呈负相关，是CSA患者NYHA功能分级的独立预测因素。
