Association of C-Reactive Protein Velocity with Early Left Ventricular Dysfunction in Patients with First
Magdalena Holzknecht1, Christina Tiller1, Martin Reindl1
1University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
Insights
C-reactive protein velocity (CRPv) predicts early left ventricular dysfunction in ST-elevation myocardial infarction (STEMI) patients. This marker offers additive value over troponin T for risk assessment after primary PCI.
Area of Science:
- Cardiology
- Biomarkers
- Myocardial Infarction Research
Background:
- C-reactive protein velocity (CRPv) is a potential early risk predictor in ST-elevation myocardial infarction (STEMI).
- The association between CRPv and early left ventricular (LV) dysfunction post-STEMI remains largely unexplored.
- Understanding early LV dysfunction is crucial for managing STEMI patients.
Purpose of the Study:
- To investigate the relationship between CRPv and early LV dysfunction in patients experiencing their first STEMI.
- To determine if CRPv is an independent predictor of LV dysfunction.
- To assess the additive predictive value of CRPv over established biomarkers like cardiac troponin T (cTnT).
Main Methods:
- Analysis of 432 STEMI patients from the prospective MARINA-STEMI cohort.
- CRPv calculated as the change in C-reactive protein levels (24 ± 8 h vs. admission) divided by the time interval.
- Cardiac magnetic resonance (CMR) imaging used to assess LV function (LVEF) and infarct characteristics at a median of 3 days post-primary PCI.
Main Results:
- CRPv was significantly correlated with LVEF (rS = -0.397, p < 0.001).
- In multivariable analysis, CRPv was independently associated with LVEF and the presence of LV dysfunction (LVEF ≤ 40%).
- The combination of peak cTnT and CRPv demonstrated a higher predictive value for LVEF ≤ 40% compared to peak cTnT alone (AUC: 0.81 vs. AUC difference: 0.04, p = 0.009).
Conclusions:
- CRPv is independently associated with early left ventricular dysfunction following STEMI.
- CRPv provides additive predictive value beyond peak cTnT in assessing LV dysfunction after primary PCI.
- CRPv may serve as a valuable early risk stratification tool in STEMI management.
Abstract:
C-reactive protein velocity (CRPv) has been proposed as a very early and sensitive risk predictor in patients with ST-elevation myocardial infarction (STEMI). However, the association of CRPv with early left ventricular (LV) dysfunction after STEMI is unknown. The aim of this study was to investigate the relationship between CRPv and early LV dysfunction, either before or at hospital discharge, in patients with first STEMI. This analysis evaluated 432 STEMI patients that were included in the prospective MARINA-STEMI (Magnetic Resonance Imaging In Acute ST-elevation Myocardial Infarction. ClinicalTrials.gov Identifier: NCT04113356) cohort study. The difference of CRP 24 ± 8 h and CRP at hospital admission divided by the time (in h) that elapsed during the two examinations was defined as CRPv. Cardiac magnetic resonance (CMR) imaging was conducted at a median of 3 (IQR 2-4) days after primary percutaneous coronary intervention (PCI) for the determination of LV function and myocardial infarct characteristics. The association of CRPv with the CMR-derived LV ejection fraction (LVEF) was investigated. The median CRPv was 0.42 (IQR 0.21-0.76) mg/l/h and was correlated with LVEF (rS = -0.397, p < 0.001). In multivariable linear as well as binary logistic regression analysis (adjustment for biomarkers and clinical and angiographical parameters), CRPv was independently associated with LVEF (β: 0.161, p = 0.004) and LVEF ≤ 40% (OR: 1.71, 95% CI: 1.19-2.45; p = 0.004), respectively. The combined predictive value of peak cardiac troponin T (cTnT) and CRPv for LVEF ≤ 40% (AUC: 0.81, 95% CI 0.77-0.85, p < 0.001) was higher than it was for peak cTnT alone (AUC difference: 0.04, p = 0.009). CRPv was independently associated with early LV dysfunction, as measured by the CMR-determined LVEF, revealing an additive predictive value over cTnT after acute STEMI treated with primary PCI.
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