Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka, 591-8025, Japan.
Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
ESC Heart Fail. 2021 Aug;8(4):2791-2801. doi: 10.1002/ehf2.13350. Epub 2021 May 2.
The impacts of high density lipoprotein cholesterol (HDL-C) as an anti-inflammatory and C reactive protein (CRP) as inflammatory properties on the pathogenesis of heart failure were reported. At present, the clinical significance of the HDL-C/CRP ratio in heart failure with preserved ejection fraction (HFpEF) patients remains unknown.
We examined the data on 796 consecutive HFpEF (left ventricular ejection fraction ≥50%) patients hospitalized due to acute decompensated heart failure from the PURSUIT-HFpEF registry, a prospective, multicentre observational study. We calculated the HDL/CRP ratios and evaluated the relationship between the values and clinical outcomes, including degree of cardiac function. The mean follow-up duration was 420 ± 346 days. All-cause death occurred in 118 patients, of which 51 were cardiac deaths. HDL/CRP ≤ 4.05 was independently and significantly associated with all-cause death (odds ratio = 1.84, 95% CI: 1.06-3.20, P = 0.023), and HDL/CRP ≤ 3.14 was associated with cardiac death by multivariate Cox proportional hazard analysis (odds ratio = 2.86, 95% CI: 1.36-6.01, P = 0.003). HDL-C/CRP ratio significantly correlated with the product of the left atrial volume and left ventricular mass index as well as the tricuspid annular plane systolic excursion by multiple regression analysis (standardized beta-coefficient = -0.085, P = 0.034 and standardized beta-coefficient = 0.081, P = 0.044, respectively).
HDL-C/CRP ratio was a useful marker for predicting all-cause death and cardiac death and correlated with left ventricular diastolic function and right ventricular systolic function in HFpEF patients.
已有研究报道，高密度脂蛋白胆固醇（HDL-C）的抗炎作用和 C 反应蛋白（CRP）的炎症特性对心力衰竭的发病机制有影响。目前，HDL-C/CRP 比值在心衰保留射血分数（HFpEF）患者中的临床意义尚不清楚。
我们对来自前瞻性、多中心观察性研究 PURSUIT-HFpEF 注册登记研究中 796 例因急性失代偿性心力衰竭住院的 HFpEF（左心室射血分数≥50%）患者的数据进行了检查。我们计算了 HDL/CRP 比值，并评估了这些值与临床结局（包括心功能程度）之间的关系。平均随访时间为 420±346 天。共有 118 例患者发生全因死亡，其中 51 例为心源性死亡。多因素 Cox 比例风险分析显示，HDL/CRP≤4.05 与全因死亡独立显著相关（比值比=1.84，95%可信区间：1.06-3.20，P=0.023），HDL/CRP≤3.14 与心脏死亡相关（比值比=2.86，95%可信区间：1.36-6.01，P=0.003）。多元回归分析显示，HDL-C/CRP 比值与左心房容积与左心室质量指数乘积以及三尖瓣环平面收缩期位移显著相关（标准化β系数=-0.085，P=0.034 和标准化β系数=0.081，P=0.044）。
HDL-C/CRP 比值是预测全因死亡和心脏死亡的有用标志物，与 HFpEF 患者的左心室舒张功能和右心室收缩功能相关。
