Predictive value of C-reactive protein and left ventricular diastolic filling pattern after a non-ST elevation
Achilles Zacharoulis1, Vasiliki Kotseroglou, Stamatios Lerakis
1Cardiology Department, Athens General Hospital G. Genimmatas, Athens, Greece. aazacha@hotmail.com
Insights
C-reactive protein (CRP) has limited value in predicting cardiovascular events in non-ST segment elevation myocardial infarction (NSTEMI) patients. Impaired diastolic left ventricular function 6 months post-infarction, however, can predict adverse outcomes.
Area of Science:
- Cardiology
- Biomarkers
- Cardiovascular Disease
Background:
- Recent studies suggest a lower predictive value for C-reactive protein (CRP) in coronary events.
- The predictive capacity of CRP for long-term events in acute coronary syndrome patients remains unclear.
- This study investigates CRP and left ventricle diastolic function in predicting outcomes for first-time non-ST segment elevation myocardial infarction (NSTEMI) patients.
Purpose of the Study:
- To evaluate the predictive value of serum CRP concentrations in patients with NSTEMI.
- To compare the predictive value of CRP with left ventricle diastolic function in NSTEMI patients.
- To identify reliable predictors of long-term cardiovascular events in NSTEMI survivors.
Main Methods:
- Serum CRP levels and left ventricle diastolic function were assessed in 51 NSTEMI patients at 48 hours, 3 months, and 6 months post-infarction.
- Patients were followed for 1 year to record endpoints including death, myocardial infarction, and revascularization procedures.
- Statistical analysis was performed to correlate CRP levels and diastolic function with event occurrence.
Main Results:
- No significant difference in mean CRP concentration was observed between patients who developed endpoints and those who did not at any time point.
- A strong correlation was found between impaired left ventricle diastolic relaxation 6 months post-infarction and the development of combined adverse endpoints (P < 0.001).
- CRP demonstrated limited predictive value for future cardiovascular events in this NSTEMI cohort.
Conclusions:
- C-reactive protein (CRP) has limited utility in predicting long-term cardiovascular events in patients with NSTEMI.
- Left ventricle diastolic function, assessed 6 months after infarction, emerged as a significant predictor of adverse outcomes.
- Further research into novel biomarkers or combinations thereof is warranted for improved risk stratification in NSTEMI patients.
Background:
Recent studies have shown that the odds ratio for high-sensitivity C-reactive protein (CRP) in predicting a coronary events in healthy subjects is 1.4, a value substantially less than previously reported. It is unclear whether this extends to acute coronary syndrome patients or if CRP would predict long-term events in this population. We evaluated the predictive value of CRP in patients with non-ST segment elevation myocardial infarction (NSTEMI) as their first manifestation of coronary artery disease and compared it with that of left ventricle diastolic function.
Methods:
Serum CRP concentration measurement and left ventricle diastolic function evaluation were performed in 51 consecutive patients with NSTEMI 48 hours, 3 months, and 6 months after infarction. Patients were followed for 1 year and events comprising the endpoints of death, new myocardial infarction, percutaneous coronary intervention, and coronary artery bypass grafting were reported.
Results:
Thirty of 51 patients developed the endpoints. Mean CRP concentration in patients who developed any endpoint and those who did not was similar at 48 hours, 3 months, and 6 months. A strong correlation between the presence of impaired relaxation 6 months after the infarction and development of the combined endpoints was noted (P < 0.001).
Conclusion:
CRP has limited value in predicting future cardiovascular events in subjects with NSTEMI. Other biomarkers or a combination of other biomarkers may be needed to identify patients at high risk. Evaluation of diastolic left ventricular function not during the acute phase but 6 months later could predict adverse outcome in our series.
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