Prognostic Role of Post-Infarction C-Reactive Protein in Implantable Cardioverter Defibrillator Patients: Results of the Cami Guide Study.

Biasucci, Luigi M.; Bellocci, Fulvio; Landolina, Maurizio; Crea, Filippo; Orazi, Serafino; Sassara, Massimo; Castro, Antonio; Massa, Riccardo; Kheir, Antoine; Zaccone, Gabriele; Achilli, F.; Piacenti, Marcello; Golzio, Pier Giorgio; Accardi, Francesco

doi:10.1016/s0735-1097(10)60137-4

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“…16–18, 37–39 Among healthy men in the Physicians’ Health Study, hsCRP was significantly associated with SCD risk over the ensuing 17 years, independent of the occurrence of MI. 18 Elevated hsCRP has been associated with an increased risk of appropriate ICD discharges in patients with ischemic LV dysfunction, also independently of acute ischemia/infarction.…”

Section: Discussionmentioning

confidence: 98%

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Combined Cardiac Magnetic Resonance Imaging and C-Reactive Protein Levels Identify a Cohort at Low Risk for Defibrillator Firings and Death

Gerstenblith

Güallar

et al. 2012

Circ: Cardiovascular Imaging

104

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Background Annually, ~80,000 Americans receive guideline-based primary prevention implantable cardioverter defibrillators (ICDs), but appropriate firing rates are low. Current selection criteria for ICDs rely on LVEF, which lacks sensitivity and specificity. Because scar-related, myocardial tissue heterogeneity is a substrate for life-threatening arrhythmias, we hypothesized that cardiac magnetic resonance (CMR) identification of myocardial heterogeneity improves risk stratification through: (1) its association with adverse cardiac events independent of clinical factors and biomarker levels; and (2) its ability to identify particularly high- and low-risk subgroups. Methods and Results In 235 ischemic and nonischemic patients with LVEF≤35%, undergoing clinically-indicated primary prevention ICD, gadolinium-enhanced CMR was prospectively performed to quantify the amount of heterogeneous myocardial tissue (gray zone-GZ) and dense core scar. Serum high sensitivity C-reactive protein (hsCRP) and other biomarkers were assayed. The primary endpoint was appropriate ICD shock for ventricular tachycardia/fibrillation or cardiac death, which occurred in 45 patients (19%) at 3.6 year median follow-up. On univariable analysis, only diuretics, hsCRP, GZ and core were associated with outcome. After multivariable adjustment, GZ and hsCRP remained independently associated with outcome (p<0.001). Patients in the lowest tertile for both GZ and hsCRP (n=42) were at particularly low risk (0.7%/year event rate) while those in the highest tertile for both GZ and hsCRP (n=32) had an event rate of 16.1%/year, p<0.001. Conclusions In a cohort of primary prevention ICD candidates, combining a myocardial heterogeneity index with an inflammatory biomarker identified a subgroup with a very low risk of adverse cardiac events, including ventricular arrhythmias. This novel approach warrants further investigation to confirm its value as a clinical risk stratification tool. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00181233.

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Section: Discussionmentioning

confidence: 98%

“…16, 17 A recent prospective observational study of 294 post-infarction patients examined whether hsCRP ≤ versus >3 mg/L predicted arrhythmic outcomes. 38 While patients with hsCRP>3 mg/L did not have a worse prognosis, 37 follow-up was relatively short at 2 years. In our study, half of all events occurred >1.6 years after enrollment.…”

Section: Discussionmentioning

confidence: 99%