Related Experiment Video
Updated: May 30, 2026
Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders
Published on: August 18, 2016
C-reactive protein is released in the coronary circulation and causes endothelial dysfunction in patients with acute
Lavinia Forte1, Giovanni Cimmino, Francesco Loffredo
1Department of Cardio-Thoracic and Respiratory Sciences, Second University of Naples, Italy.
Insights
C-reactive protein (CRP) is produced in coronary lesions and released into circulation in acute coronary syndromes (ACS), impairing endothelial function and linking CRP to ACS pathophysiology.
Area of Science:
- Cardiovascular Medicine
- Inflammation Research
- Atherosclerosis Studies
Background:
- C-reactive protein (CRP) plasma levels are linked to cardiovascular events.
- The role of CRP in acute coronary syndromes (ACS) pathophysiology is not well understood.
- Investigating CRP production and its impact on coronary circulation in ACS is crucial.
Purpose of the Study:
- To determine if CRP is produced in culprit lesions and released in the coronary circulation of ACS patients.
- To assess the effect of CRP on coronary endothelial function in ACS.
- To explore the relationship between CRP and ACS pathophysiology.
Main Methods:
- Simultaneous blood sampling from aorta (Ao) and coronary sinus (CS) in patients with normal coronary artery, stable angina, and ACS.
- Measurement of plasma CRP levels.
- Evaluation of coronary vasodilation using Doppler Flow Wire in response to acetylcholine and adenosine.
- Analysis of CRP mRNA in coronary plaques via quantitative PCR.
Main Results:
- Significantly higher CRP levels across coronary circulation were observed only in ACS patients with left coronary artery culprit lesions.
- No significant differences in CRP levels between CS and Ao in other patient groups.
- Transcardiac CRP levels correlated with impaired endothelium-dependent vasodilation.
- CRP mRNA was detected exclusively in unstable plaques from ACS patients.
Conclusions:
- CRP is produced and released within the coronary circulation of ACS patients.
- This release is associated with impaired endothelial function.
- Suggests a novel pathophysiological link between CRP and ACS.
Background:
C-reactive protein (CRP) plasma levels correlate with cardiovascular events. Although a direct role for CRP in atherothrombosis has been suggested, at the moment little is known about its involvement in the pathophysiology of acute coronary syndromes (ACS). Thus, the aim of this study was to determine whether CRP is produced in the culprit lesion and released within the coronary circulation of patients with ACS and whether it may affect coronary endothelial function.
Methods:
Blood samples were simultaneously obtained from the aorta (Ao) and the coronary sinus (CS) of patients with normal coronary artery (n=16), stable angina (n=30), and ACS (n=29) for later measurement of plasma CRP levels. Endothelium-dependent and -independent coronary vasodilation were evaluated by means of a Doppler Flow Wire in response to the increasing intracoronary doses of acetylcholine and adenosine, respectively.
Results:
CRP plasma levels were significantly higher across the coronary circulation only in ACS patients with the culprit lesion located in the left coronary artery, while no differences between CS and Ao CRP plasma levels were observed in all other groups. Transcardiac CRP levels were correlated with impairment in coronary endothelium-dependent vasodilation. In six additional patients (SA=3 and ACS=3), subjected to coronary atherectomy, real-time quantitative PCR revealed presence of CRP mRNA only in unstable plaques.
Conclusions:
Thus, CRP is produced and released within the coronary circulation of patients with ACS; this is associated with impairment of endothelial function, suggesting a new pathophysiological link between CRP and ACS.
Related Concept Videos
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome I: Introduction
01:26Coronary Artery Disease II: Pathophysiology
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Coronary Artery Disease I: Introduction