C-reactive protein, clinical presentation, and ischemic activity in patients with chest pain and normal coronary
Juan Cosín-Sales1, Carmine Pizzi, Sue Brown
1Coronary Artery Disease Research Unit, Department of Cardiological Sciences, St. George's Hospital Medical School, London, United Kingdom.
Insights
High-sensitivity C-reactive protein (hs-CRP) levels correlate with chest pain symptoms and ECG markers of myocardial ischemia in patients with chest pain and normal coronary angiograms. This suggests hs-CRP may indicate disease activity in these patients.
Area of Science:
- Cardiology
- Biomarkers
- Ischemic Heart Disease
Background:
- Patients with chest pain and normal coronary angiograms (CPNCA) often exhibit coronary microvascular endothelial dysfunction and myocardial ischemia.
- Elevated high-sensitivity C-reactive protein (hs-CRP) is linked to atherogenesis and endothelial dysfunction.
- The association between hs-CRP and disease activity in CPNCA patients remains underexplored.
Purpose of the Study:
- To investigate the relationship between hs-CRP levels, clinical characteristics, exercise stress test responses, and ST-segment changes in CPNCA patients.
- To determine if hs-CRP can serve as a marker for disease activity in CPNCA.
Main Methods:
- A study involving 137 consecutive CPNCA patients.
- Data collection included standardized angina questionnaires, exercise stress testing, 24-h ambulatory ECG monitoring (Holter), and hs-CRP measurements.
- Statistical analysis utilized multivariate logistic regression.
Main Results:
- Higher hs-CRP levels were observed in patients with more frequent and prolonged chest pain episodes.
- Elevated hs-CRP correlated with ST-segment depression during exercise testing and Holter monitoring.
- hs-CRP was the sole independent predictor of positive findings on both Holter monitoring and exercise testing.
Conclusions:
- hs-CRP levels correlate significantly with symptoms and electrocardiogram (ECG) markers of myocardial ischemia in CPNCA patients.
- Further research is warranted to elucidate the role of hs-CRP in the pathogenesis of angina within this patient group.
Objectives:
We sought to investigate the relationship among C-reactive protein (hs-CRP), clinical characteristics, exercise stress test responses, and ST-segment changes during daily life in patients with typical chest pain and normal coronary angiograms (CPNCA).
Background:
Patients with CPNCA have coronary microvascular endothelial dysfunction and myocardial ischemia. Elevated hs-CRP levels have been related to atherogenesis and endothelial dysfunction. The relationship between hs-CRP and disease activity has not been previously investigated in CPNCA patients.
Methods:
We studied 137 consecutive CPNCA patients (mean age, 57 +/- 9; 33 men). All completed standardized angina questionnaires, underwent exercise stress testing, 24-h ambulatory electrocardiogram (ECG) monitoring (Holter), and hs-CRP measurements at study entry.
Results:
C-reactive protein levels (mg/l) were higher in patients with frequent (2.9 +/- 3.3) and prolonged (3.9 +/- 4.1) chest pain episodes, and in those with ST-segment depression on exercise testing (2.6 +/- 2.8) and Holter monitoring (3.4 +/- 3.1) compared with patients with occasional (1.3 +/- 1.2; p = 0.002) or shorter chest pain (1.5 +/- 1.3; p < 0.001) episodes, negative exercise stress testing (1.1 +/- 1.1; p < 0.001), and no ST-segment shifts on Holter monitoring (0.9 +/- 0.7; p < 0.001). Moreover, we found a correlation between hs-CRP concentration and number of ischemic episodes during Holter monitoring (r = 0.65; p < 0.001) and with the magnitude of ST-segment depression on exercise testing (r = -0.43; p < 0.001). The hs-CRP was the only independent variable (multivariate logistic regression) capable of predicting positive findings on Holter monitoring (odds ratio [OR], 3.8; confidence interval [CI], 2.3 to 6.2) and exercise testing (OR, 1.7; CI, 1.2 to 2.2).
Conclusions:
The hs-CRP correlates with symptoms and ECG markers of myocardial ischemia in CPNCA patients. Whether hs-CRP is related to the pathogenesis of angina in these patients deserves further investigation.
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