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Association between C-reactive protein level and echocardiography assessed left ventricular function in first
Yacov Shacham1, Yan Topilsky1, Eran Leshem-Rubinow1
1Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Insights
Elevated C-reactive protein (CRP) levels after ST-segment elevation myocardial infarction (STEMI) correlate with impaired left ventricular diastolic function. Higher CRP indicates worse diastolic dysfunction and elevated filling pressures in STEMI patients treated with primary percutaneous coronary intervention.
Area of Science:
- Cardiology
- Biomarkers
- Echocardiography
Background:
- Elevated C-reactive protein (CRP) is linked to adverse outcomes in acute myocardial infarction (AMI).
- CRP's association with left ventricular (LV) systolic function in AMI is known, but its relation to early diastolic function is unclear.
Purpose of the Study:
- To investigate the association between admission C-reactive protein (CRP) levels and early left ventricular (LV) diastolic function in patients with ST-segment elevation myocardial infarction (STEMI).
Main Methods:
- Retrospective study of 173 patients (<75 years) with first STEMI treated with primary percutaneous coronary intervention (PPCI).
- CRP levels measured within 6 hours of admission; echocardiography performed within 3 days.
- Patients stratified by CRP tertiles (<2.6 mg/L, 2.6-7.9 mg/L, >7.9 mg/L).
Main Results:
- Higher CRP tertiles showed significantly increased mitral inflow E wave velocity and E/average e' ratio.
- Elevated CRP levels were associated with higher systolic pulmonary artery pressure and more advanced diastolic dysfunction (p=0.04).
- Admission CRP level independently predicted the average E/e' ratio in multivariate analysis.
Conclusions:
- Admission CRP levels correlate with echocardiographic markers of elevated LV filling pressure in STEMI patients undergoing PPCI.
- Higher CRP levels indicate more significant diastolic dysfunction and elevated filling pressures.
Background:
An elevated C-reactive protein (CRP) level is associated with adverse outcomes in patients with acute myocardial infarction (AMI). Although CRP levels have been shown to be associated with left ventricular (LV) systolic function and remodeling in AMI, little is known about their relation to early LV diastolic function.
Methods:
We retrospectively studied 173 consecutive patients <75 years of age with first ST-segment elevation MI (STEMI) that was treated by primary percutaneous coronary intervention (PPCI). They had presented within 24h of chest pain onset and their CRP levels were determined within 6h of hospital admission. They all underwent echocardiography within 3 days of admission and were stratified by CRP tertiles.
Results:
The cut-off points for the CRP tertiles were <2.6 mg/L, 2.6-7.9 mg/L, and >7.9 mg/L. Patients with higher CRP levels had a significantly higher mean mitral inflow E wave velocity (68 ± 16 cm/s vs 77 ± 19 cm/s vs 76 ± 17 cm/s; p=0.02), a higher E/average e' (8.9 ± 1.9 vs 9.8 ± 2.8 vs 10.4±3.2; p=0.02), and a higher systolic pulmonary artery pressure (27 ± 6 mmHg vs 30 ± 8 mmHg vs 32 ± 10 mmHg; p=0.04). Elevated CRP levels were associated with more advanced diastolic dysfunction than normal CRP levels (p=0.04). The admission CRP level was an independent predictor of average E/e' ratio (multivariate analysis).
Conclusion:
Admission CRP levels are associated with echocardiographic parameters of elevated LV filling pressure in patients with STEMI treated with PPCI.
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