Abstract
C-reactive protein velocity (CRPv), defined as the change in wide-range CRP concentration divided by time, is an inflammatory biomarker associated with increased morbidity and mortality in patients with ST elevation myocardial infarction (STEMI) treated with primary percutaneous intervention (PCI). However, data regarding CRPv association with echocardiographic parameters assessing left ventricular systolic and diastolic function is lacking. Echocardiographic parameters and CRPv values were analyzed using a cohort of 1059 patients admitted with STEMI and treated with primary PCI. Patients were stratified into tertiles according to their CRPv. A receiver operating characteristic (ROC) curve was used to evaluate CRPv optimal cut-off values for the prediction of severe systolic and diastolic dysfunction. Patients with high CRPv tertiles had lower left ventricular ejection fraction (LVEF) (49% vs. 46% vs. 41%, respectively; p < 0.001). CRPv was found to independently predict LVEF ≤ 35% (HR 1.3 CI 95% 1.21–1.4; p < 0.001) and grade III diastolic dysfunction (HR 1.16 CI 95% 11.02–1.31; p = 0.02). CRPv exhibited a better diagnostic profile for severe systolic dysfunction as compared to CRP (area under the curve 0.734 ± 0.02 vs. 0.608 ± 0.02). In conclusion, For STEMI patients treated with primary PCI, CRPv is a marker of both systolic and diastolic dysfunction. Further larger studies are needed to support this finding.
Highlights
In acute ST-elevation myocardial infarction (STEMI), ischemic injury and myocardial necrosis incite an inflammatory reaction resulting in the release of various markers
Recent research demonstrated that increased C-reactive Protein (CRP) velocity (CRPv) is associated with short-term complications in patients presenting with acute myocardial infarction [4,5], little is known about its possible association to left ventricular systolic and diastolic function
The aim of this study was to evaluate the association between CRPv with left ventricular (LV) systolic and diastolic function in patients presenting with STEMI and treated with primary percutaneous angiography intervention (PCI)
Summary
In acute ST-elevation myocardial infarction (STEMI), ischemic injury and myocardial necrosis incite an inflammatory reaction resulting in the release of various markers. While CRP has been proven to be a useful biomarker for predicting many adverse outcomes in STEMI patients, the CRP level changes over time—CRP velocity (CRPv), may be a more sensitive biomarker for identifying patients’ inflammatory state and risk of developing subsequent heart failure. Recent research demonstrated that increased CRPv is associated with short-term complications in patients presenting with acute myocardial infarction [4,5], little is known about its possible association to left ventricular systolic and diastolic function. Past studies proved that an elevation in CRP levels is associated with a reduced diastolic left ventricular (LV) function as well as systolic heart failure in the setting of STEMI [1,6]. The aim of this study was to evaluate the association between CRPv with LV systolic and diastolic function in patients presenting with STEMI and treated with primary percutaneous angiography intervention (PCI)
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