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Usefulness of Non-Invasive Myocardial Work and Systemic Inflammation Assessment in Predicting Left Ventricular
Ruxandra Copciag1, Vladimir Bratu1, Roxana Rimbas1
1"Carol Davila" University of Medicine and Pharmacy, University and Emergency Hospital of Bucharest, Department of Cardiology and Cardiovascular Surgery, Bucharest, Romania.
Insights
Inflammation marker C-reactive protein (CRP) in acute coronary syndrome (ACS) correlates with myocardial work (MW) parameters, indicating potential for future left ventricular (LV) dysfunction and heart failure.
Area of Science:
- Cardiology
- Biomarkers
- Echocardiography
Background:
- Left ventricular (LV) remodeling is central to heart failure (HF) pathophysiology after acute coronary syndrome (ACS).
- Traditional measures like ejection fraction (LVEF) and volumes, along with speckle tracking echocardiography (STE), assess LV performance.
- Myocardial work (MW) offers a novel, noninvasive method to detect early myocardial dysfunction by integrating loading conditions.
Purpose of the Study:
- To investigate the relationship between myocardial work (MW), high-sensitivity troponin I (hs-cTn I), and C-reactive protein (CRP) in ACS patients.
- To evaluate MW, hs-cTn I, and CRP as potential early predictors of LV dysfunction post-ACS.
Main Methods:
- Echocardiography with speckle-tracking and MW measurements were performed within 24 hours of ACS admission.
- hs-cTn I and CRP levels were assessed concurrently.
- Clinical, biological, and echocardiographic assessments were repeated at 6-8 weeks follow-up.
Main Results:
- Baseline hs-cTn I correlated with global longitudinal strain (GLS) and MW parameters (GWI, GCW), but not LVEF.
- C-reactive protein (CRP) showed significant correlations with MW parameters (GWE, GWW), despite not correlating with LVEF.
- Elevated CRP levels (>28 mg/L) were associated with reduced MW performance (GWE), suggesting a predisposition to adverse LV remodeling.
Conclusions:
- C-reactive protein (CRP) levels within 24 hours of ACS, and their association with MW parameters, may predict future LV dysfunction.
- This highlights the potential of combining inflammation markers with advanced echocardiographic techniques for early HF risk stratification.
Background:
Left ventricular (LV) remodeling plays a pivotal role in the pathophysiology of heart failure (HF) following acute coronary syndrome (ACS). Left ventricular ejection fraction (LVEF), left ventricular (LV) volumes and, more recently, speckle tracking echocardiography (STE) are used to describe LV performance. Myocardial work (MW) is a new noninvasive imaging method that integrates loading conditions and can be used to detect early myocardial dysfunction before LVEF decreases.
Aim:
This study aims to characterize the relationship between MW, high-sensitivity troponin (hs-cTn I) and C-reactive protein (CRP) as an inflammation biomarker. Their use as predictors for LV dysfunction in the acute phase of ACS is of particular interest but is still under debate.
Method:
Complete clinical examination and two-dimensional echocardiography (2-DE), with speckle-tracking and myocardial work measurements, were performed in the first 24 hours after admission. Locally available biomarkers were assessed in the same timeframe, with special interest in hs-cTn I and CRP, as a marker for inflammation. A follow-up visit, including the same clinical, biological, and echocardiographic measurements, was performed six to eight weeks after the index event.
Results:
We evaluated 56 patients (53 ± 10 years, 45 men) with ACS. Baseline hs-cTn I significantly correlated with baseline global longitudinal strain (GLS) (r=0.43, p=0.001) and baseline MW parameters (GWI: r=-0.44, p=0.001; GCW: r=-0.40, p=0.002). A correlation between hs-cTn I and LVEF was not statistically relevant. C-reactive protein, which was used to assess systemic inflammation, also failed to correlate with LVEF. However, CRP significantly correlated with relevant MW parameters (GWE: r=-0.53, p<0.001 and GWW: r=0.48, p<0.001). C-reactive protein levels above 28 mg/L correlated with a decrease in MW performance assessed by GWE, suggesting a possible tendency to adverse remodeling.
Conclusions:
C-reactive protein level in the first 24 hours after ACS and its correlation with MW parameters may be a potential indicator of future LV dysfunction and heart failure.
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