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In patients with mild dilated cardiomyopathy (MDCM), elevated concentrations of highly sensitive C-reactive protein (hs-CRP) are associated with increased levels of N-terminal brain natriuretic peptide (NT-proBNP) in patients with mild dilated cardiomyopathy (MDCM). ), although there is no evidence to support a predictive effect associated with patient outcomes. The results were published in the ESC Heart Failure journal.
A retrospective analysis of patients with dilated cardiomyopathy (DCM) and left ventricular ejection fraction less than 50% admitted to Fuwai Hospital in Beijing, China from December 2006 to October 2017 was performed. The investigators sought to compare the biomarkers NT-proBNP and hs-CRP in MDCM patients and DCM patients. In this study, MDCM was defined as a left ventricular end-diastolic diameter index (LVEDDi) of 33 mm/m2 or less in men and 34 mm/m2 in women.
A total of 640 participants were included in the analysis, of which 17% were classified as having MDCM and 83% were classified as having DCM at baseline. Overall, 24.8% of the participants were women. The mean age of the patients was 49 years.
Compared to DCM participants, MDCM patients were younger, had higher blood pressure, a higher incidence of diabetes, a lower rate of nonsustained ventricular tachycardia, a higher body mass index, and a shorter hospital stay. Regarding cardiac biomarkers, patients with MDCM had significantly lower median NT-proBNP levels compared with patients with DCM (2203 pg/mL vs 1448 pg/mL, respectively; P <.001). Regarding biomarkers, patients with MDCM had significantly lower median NT-proBNP levels compared with patients with cardiac DCM (2203 pg/mL vs 1448 pg/mL, respectively; P <.001). Что касается сердечных биомаркеров, у пациентов с MDCM средний уровень NT-proBNP был значительно ниже по сравнению с пациентами с DCM (2203 пг/мл против 1448 пг/мл соответственно; P < 0,001). In terms of cardiac biomarkers, MDCM patients had significantly lower mean NT-proBNP levels compared to DCM patients (2203 pg/mL vs. 1448 pg/mL, respectively; P < 0.001).关于心脏生物标志物，与DCM 患者相比，MDCM 患者的NT-proBNP 水平中位数显着降低（分别为2203 pg/mL 和1448 pg/mL；P <.001）。 MDCM 患者的NT-proBNP 水平中位数显着降低（分别，与2203 pg/mL 和L0.0 pg/mL 和L0.0 Что касается сердечных биомаркеров, у пациентов с MDCM средний уровень NT-proBNP был значительно ниже по сравнению с пациентами с DCM (2203 пг/мл и 1448 пг/мл соответственно; P < 0,001). In terms of cardiac biomarkers, mean NT-proBNP levels were significantly lower in MDCM patients compared to DCM patients (2203 pg/mL and 1448 pg/mL, respectively; P < 0.001). In contrast, mean hs-CRP levels were higher in MDCM patients than in DCM patients (3.09 mg/L and 2.79 mg/L, respectively; P = 0.39).
Among 282 patients who underwent echocardiographic follow-up at intervals of 6 months or longer, 7 patients with MDCM (11.1%) developed DCM, while 70 patients with DCM (32.0%) returned to MDCM, as did a change in LVEDDi was observed.
Baseline MDCM patients had a lower combined risk of all-cause mortality, heart transplant, and readmission for heart failure compared to DCM participants (adjusted hazard ratio [aHR], 0.63; 95% CI, 0.43–0.93 ; P = 0.019).
Both hs-CRP and NT-proBNP levels were independently associated with the combined endpoint across the entire study cohort (hs-CRP, aHR, 1.07; 95% CI, 1.00-1.15 and NT-proBNP: aHR , 1.11, 95% CI, 1.02–1.22, p = 0.019).
After comparing propensity scores between MDCM and DCM, the association between high levels of NT-proBNP and the combined endpoint was consistent with that reported before comparing patients with DCM (RR, 1.83; 95% CI, 1.05–3.20; P = 0.034), but not in patients with MDCM (HR, 1.54, 95% CI, 0.76–3.11, P = 0.227). In contrast, hs-CRP levels were still significantly associated with prognosis in patients with MDCM (RR 3.19; 95% CI 1.52–6.66; P = 0.002), but not in patients with DCM (RR 1.04 ; 95% CI). 0.61–1.79; p = 0.88).
A limitation of the study is that the phenotype of patients may change during follow-up, although the number of people who underwent repeat echocardiography was quite small, so predictors of phenotypic change were not analyzed. In addition, due to the small sample size of MDCM patients in the study, potential confounding factors were not fully adjusted for in the multivariate analysis.
“Baseline hs-CRP was associated with combined outcomes in MDCM patients before and after adjusting for covariates, while NT-proBNP was only associated with outcomes in DCM,” the study authors note. “Further studies are needed to investigate predictors of changes in ventricular geometry and cardiac function, especially in patients with MDCM, to provide more accurate risk stratification.”
Disclosure: None of the study authors claimed affiliation with biotech, pharmaceutical, and/or device companies.
Feng J, Tian P, Liang L, et al. Outcome and prognostic value of N-terminal pro-brain natriuretic peptide and high-sensitivity C-reactive protein in mild and dilated cardiomyopathies. ESC heart failure. Published online March 4, 2022 doi: 10.1002/ehf2.13864
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