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Elevated C-reactive protein levels and coronary microvascular dysfunction in patients with coronary artery disease
Fabrizio Tomai1, Flavio Ribichini, Anna S Ghini
1Division of Cardiology and Cardiac Surgery, Università di Roma Tor Vergata, European Hospital, via Portuense 700, 00149 Rome, Italy. f.tomai@tiscali.it
Insights
Elevated C-reactive protein levels, a marker of inflammation, are linked to impaired coronary microvascular function in coronary artery disease (CAD) patients. This dysfunction affects both endothelium-dependent and independent blood flow responses.
Area of Science:
- Cardiology
- Vascular Biology
- Inflammation Research
Background:
- Coronary artery disease (CAD) is a leading cause of mortality worldwide.
- Coronary microcirculatory dysfunction (CMD) plays a significant role in the pathophysiology of CAD.
- The precise role of systemic inflammation, indicated by C-reactive protein (CRP), in CMD remains unclear.
Purpose of the Study:
- To investigate the association between elevated C-reactive protein (CRP) levels and coronary microcirculatory function in patients with CAD.
- To evaluate the impact of CRP on endothelium-dependent and endothelium-independent coronary blood flow (CBF) responses.
Main Methods:
- A study involving 28 patients with single-vessel CAD.
- Patients were categorized into normal (<5 mg/L) and elevated (>5 mg/L) CRP groups.
- Coronary blood flow (CBF) was measured using intracoronary Doppler and quantitative coronary angiography during substance P and adenosine infusions.
Main Results:
- Patients with elevated CRP exhibited significantly reduced increases in CBF in response to both substance P and adenosine compared to those with normal CRP.
- Multivariable analysis identified elevated CRP as an independent predictor of impaired endothelium-dependent and endothelium-independent CBF responses.
- These findings suggest a direct link between systemic inflammation and microvascular dysfunction in CAD.
Conclusions:
- Systemic inflammation, evidenced by elevated CRP, is independently associated with coronary microvascular dysfunction in CAD patients.
- This dysfunction may contribute to myocardial ischemia, particularly in unstable patients.
- Targeting inflammation could be a potential therapeutic strategy for improving microvascular function in CAD.
Aims:
It is still unknown whether elevated C-reactive protein levels are responsible for coronary microcirculatory dysfunction in patients with coronary artery disease (CAD). This study was aimed at evaluating the association between C-reactive protein levels and endothelium-dependent and endothelium-independent coronary blood flow (CBF) responses in non-culprit arteries of patients with CAD.
Methods And Results:
We studied 28 patients (14 with normal and 14 with elevated C-reactive protein levels, >5 mg/L) with single-vessel disease and otherwise angiographically normal coronary arteries undergoing percutaneous transluminal coronary angioplasty (PTCA). CBF was measured in the non-PTCA vessel using an intracoronary Doppler guide wire and quantitative coronary angiography at baseline, after intracoronary infusion of substance P and of adenosine, and expressed as per cent change from baseline. The increases in CBF during infusion of substance P and of adenosine were lesser in patients with elevated than in those with normal C-reactive protein levels (34+/-22 vs. 61+/-34%, P=0.04 and 131+/-53 vs. 189+/-89%, P=0.03, respectively). Multivariable analysis identified elevated C-reactive protein level as the only independent predictor of reduced response to substance P (P=0.01) and adenosine (P=0.02).
Conclusion:
In patients with CAD, evidence of systemic inflammation is independently associated with endothelium-dependent and endothelium-independent coronary microvascular dysfunction, which, in turn, may be critical to precipitate myocardial ischaemia, in particular, in unstable patients.
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