High-sensitivity C-reactive protein and left ventricular remodeling in patients with acute myocardial infarction

Abstract

Inflammatory cytokines are suspected to play an important role in the pathophysiology of left ventricular (LV) remodeling. We investigated whether high-sensitivity C-reactive protein (CRP) (hs-CRP) is a predictor for LV remodeling in patients with acute myocardial infarction (AMI) with successful reperfusion, and also whether such a situation can be avoided by the administration of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB). The subjects were 139 patients with an initial attack of anterior myocardial infarction successfully treated by reperfusion therapy. They were randomly divided into the following two groups: an angiotensin (AG) group (91 patients treated with ACEI/ARB) and a NON-AG group (48 patients not treated with ACEI/ARB). Levels of hs-CRP, creatine kinase, human atrial natriuretic polypeptide, brain natriuretic peptide (BNP), fasting blood glucose, serum lipids, fibrinogen, fibrin degradation product, prothromloin time, and activated partial thromboplastin time were measured immediately after 1, 2, 3, and 7 days, and 1 months after the onset of AMI. ACEI or ARB administration lowered hs-CRP levels and prevented the development of LV remodeling. Peak CRP levels significantly correlated with BNP levels during the acute stage (r = +0.54, P < 0.0001), end-diastolic volume index (r = +0.78, P < 0.0001), end-systolic volume index (r = +0.36, P = 0.0405), ejection fraction (r = -0.45, P = 0.0052), left ventricular end-diastolic diameter (r = +0.61, P < 0.0001), cardiac output (r = -0.52, P = 0.0005), cardiac index (r = -0.41, P = 0.0099), and systolic pulmonary arterial pressure (r = +0.48, P = 0.0017) 1 month after the onset of AMI in the NON-AG group but not in the AG group. Logistic multivariate analysis revealed that peak CRP alone was an independent risk factor for the development of LV remodeling in the NON-AG group (odds ratio = 1.79, P = 0.002). These results suggest that hs-CRP is a useful factor for predicting LV remodeling. Furthermore, ACEI or ARB administration to AMI patients showing increased hs-CRP levels during the early stage of the disease could prevent LV remodeling.

Left Ventricular Function and C-Reactive Protein Levels in Acute Myocardial Infarction

“…Thus, after MI, MR is not related to intrinsic valvular abnormalities but rather serves as a marker of ventricular remodeling 20. Small case series had suggested that CRP was associated with ventricular remodeling in anterior wall AMI 21,22. The present data extend these reports by indicating that CRP exhibited a robust association with MR independently of clinical and echocardiographic characteristics among all patients presenting with MI in the community.…”

Prognostic Value of Serum Amyloid A Protein in Patients With Acute Myocardial Infarction

“…[1][2][3][4] Previous studies have demonstrated that CRP, a representative acute-phase protein, is associated with various complications, including cardiac events [7][8][9] and LV dysfunction, [10][11][12]23 in AMI. However, the clinical implications of an elevation of SAA, which is also an inflammatory reactant, in the n acute phase of AMI is unknown.…”

Persistent Elevation of C-Reactive Protein May Predict Cardiac Hypertrophy and Dysfunction in Patients Maintained on Hemodialysis

“…The significance of CRP in predicting cardiac diseases has increased recently: one study has shown that CRP level predicts cardiac hypertrophy in hemodialysis patients [4], and another has demonstrated that CRP level is correlated with cardiac systolic function and is a useful marker for predicting LV remodeling [5]. But there are few studies about the association between CRP level and cardiac function as well as LVH in hemodialysis patients.…”

“…C-reactive protein (CRP), which is produced by the liver in response to inflammation, is an acute-phase protein, and a rise in its concentration is associated with increased risk of cardiovascular disease in patients with ESRD [3]. Several studies have shown that CRP level predicts cardiac hypertrophy and is correlated with cardiac systolic function [4, 5]. …”