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Observational Study
. 2021 Aug;8(4):2791-2801.
doi: 10.1002/ehf2.13350. Epub 2021 May 2.

High density lipoprotein cholesterol / C reactive protein ratio in heart failure with preserved ejection fraction

Masamichi Yano  1 , Masami Nishino  1 , Kohei Ukita  1 , Akito Kawamura  1 , Hitoshi Nakamura  1 , Yutaka Matsuhiro  1 , Koji Yasumoto  1 , Masaki Tsuda  1 , Naotaka Okamoto  1 , Akihiro Tanaka  1 , Yasuharu Matsunaga-Lee  1 , Yasuyuki Egami  1 , Ryu Shutta  1 , Jun Tanouchi  1 , Takahisa Yamada  2 , Yoshio Yasumura  3 , Shunsuke Tamaki  2 , Takaharu Hayashi  4 , Akito Nakagawa  3   5 , Yusuke Nakagawa  6 , Shinichiro Suna  7 , Daisaku Nakatani  7 , Shungo Hikoso  7 , Yasushi Sakata  7 ; Osaka CardioVascular Conference (OCVC)-Heart Failure Investigators
Affiliations
Observational Study

High density lipoprotein cholesterol / C reactive protein ratio in heart failure with preserved ejection fraction

Masamichi Yano et al. ESC Heart Fail. 2021 Aug.

Abstract

Aims: 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.

Methods and results: 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).

Conclusions: 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.

Keywords: Heart failure with preserved ejection fraction; High density lipoprotein cholesterol/C reactive protein ratio; Inflammation; Left ventricular diastolic function; Right ventricular systolic function.

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Conflict of interest statement

Daisaku Nakatani has received honoraria from Roche Diagnostics. Shungo Hikoso has received personal fees from Daiichi Sankyo Company, Bayer, Astellas Pharma, Pfizer Pharmaceuticals, and Boehringer Ingelheim Japan and received grants from Roche Diagnostics, FUJIFILM Toyama Chemical, and Actelion Pharmaceuticals. Yasushi Sakata received personal fees from Otsuka Pharmaceutical, Ono Pharmaceutical, Daiichi Sankyo Company, Mitsubishi Tanabe Pharma Corporation, and Actelion Pharmaceuticals and received grants form Roche Diagnostic, FUJIFILM Toyama Chemical, Abbott Medical Japan, Otsuka Pharmaceutical, Daiichi Sankyo Company, Mitsubishi Tanabe Pharma Corporation, and Biotronik. Other authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
ROC analysis of HDL‐C/CRP ratio in predicting (A) all‐cause death and (B) cardiac death. AUC, area under the curve; CRP, C reactive protein; HDL‐C, high density lipoprotein cholesterol; ROC, receiver operating characteristics.
Figure 2
Figure 2
(A) Kaplan–Meier analysis of all‐cause death between the patients with HDL‐C/CRP ratio ≤4.05 and HDL‐C/CRP ratio >4.05. (B) Kaplan–Meier analysis of cardiac death between the patients with HDL‐C/CRP ratio ≤3.14 and HDL‐C/CRP ratio >3.14. CRP, C reactive protein; HDL‐C, high density lipoprotein cholesterol.
Figure 3
Figure 3
Relationship between HDL/CRP ratio and clinical outcome in HFpEF patients. Exacerbation factors and deterioration of heart failure promote inflammatory status and give myocardial injury. The damage induces left ventricular diastolic dysfunction and right ventricular systolic dysfunction and lead to poor clinical outcomes. CRP, C reactive protein; HDL‐C, high density lipoprotein cholesterol; HFpEF, heart failure with preserved ejection fraction; LV, left ventricle, RV, right ventricle.
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