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High-sensitivity C-reactive protein and left ventricular remodeling in patients with acute myocardial infarction
Kohzou Uehara1, Masahiro Nomura, Yuji Ozaki
1Department of Digestion and Cardiovascular Medicine, School of Medicine, University of Tokushima, 2-50 Kuramoto-cho, Japan.
Insights
High-sensitivity C-reactive protein (hs-CRP) predicts left ventricular (LV) remodeling after acute myocardial infarction (AMI). Angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) administration can prevent this remodeling by lowering hs-CRP levels.
Area of Science:
- Cardiology
- Biomarkers
- Pharmacology
Background:
- Left ventricular (LV) remodeling is a critical process following acute myocardial infarction (AMI).
- Inflammatory cytokines, including high-sensitivity C-reactive protein (hs-CRP), are implicated in the pathophysiology of LV remodeling.
- The role of hs-CRP as a predictor of LV remodeling and the potential preventive effects of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) require further investigation.
Purpose of the Study:
- To investigate whether hs-CRP predicts LV remodeling in patients with AMI who underwent successful reperfusion.
- To determine if ACEI or ARB administration can prevent LV remodeling in these patients.
- To explore the correlation between hs-CRP levels and other cardiac biomarkers and hemodynamic parameters.
Main Methods:
- A study involving 139 patients with anterior AMI treated with reperfusion therapy.
- Randomized division into an angiotensin (AG) group (treated with ACEI/ARB) and a NON-AG group (not treated).
- Measurement of hs-CRP and other biomarkers at multiple time points post-AMI; assessment of LV remodeling parameters one month after AMI.
Main Results:
- ACEI or ARB administration significantly lowered hs-CRP levels and prevented LV remodeling.
- Peak hs-CRP levels correlated significantly with brain natriuretic peptide (BNP), LV volumes, ejection fraction, and pulmonary artery pressure in the NON-AG group.
- Logistic multivariate analysis identified peak hs-CRP as an independent risk factor for LV remodeling in the NON-AG group (odds ratio = 1.79).
Conclusions:
- hs-CRP is a valuable predictor of LV remodeling in patients with AMI.
- Administration of ACEI or ARB to AMI patients with elevated early-stage hs-CRP levels can effectively prevent LV remodeling.
- Targeting inflammation through ACEI/ARB therapy may be a crucial strategy in managing post-AMI cardiac remodeling.
Abstract:
Inflammatory cytokines are suspected to play an important role in the pathophysiology of left ventricular (LV) remodeling. We investigated whether high-sensitivity C-reactive protein (CRP) (hs-CRP) is a predictor for LV remodeling in patients with acute myocardial infarction (AMI) with successful reperfusion, and also whether such a situation can be avoided by the administration of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB). The subjects were 139 patients with an initial attack of anterior myocardial infarction successfully treated by reperfusion therapy. They were randomly divided into the following two groups: an angiotensin (AG) group (91 patients treated with ACEI/ARB) and a NON-AG group (48 patients not treated with ACEI/ARB). Levels of hs-CRP, creatine kinase, human atrial natriuretic polypeptide, brain natriuretic peptide (BNP), fasting blood glucose, serum lipids, fibrinogen, fibrin degradation product, prothromloin time, and activated partial thromboplastin time were measured immediately after 1, 2, 3, and 7 days, and 1 months after the onset of AMI. ACEI or ARB administration lowered hs-CRP levels and prevented the development of LV remodeling. Peak CRP levels significantly correlated with BNP levels during the acute stage (r = +0.54, P < 0.0001), end-diastolic volume index (r = +0.78, P < 0.0001), end-systolic volume index (r = +0.36, P = 0.0405), ejection fraction (r = -0.45, P = 0.0052), left ventricular end-diastolic diameter (r = +0.61, P < 0.0001), cardiac output (r = -0.52, P = 0.0005), cardiac index (r = -0.41, P = 0.0099), and systolic pulmonary arterial pressure (r = +0.48, P = 0.0017) 1 month after the onset of AMI in the NON-AG group but not in the AG group. Logistic multivariate analysis revealed that peak CRP alone was an independent risk factor for the development of LV remodeling in the NON-AG group (odds ratio = 1.79, P = 0.002). These results suggest that hs-CRP is a useful factor for predicting LV remodeling. Furthermore, ACEI or ARB administration to AMI patients showing increased hs-CRP levels during the early stage of the disease could prevent LV remodeling.