Association between C-Reactive Protein Velocity and Left Ventricular Function in Patients with ST-Elevated Myocardial Infarction

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.

Special Issue “C-Reactive Protein and Cardiovascular Disease: Clinical Aspects”

“…The relevance of the initial increase in CRP levels in the first approximately 48h for prognosis is described by three articles in this Special Issue [9][10][11]. This is confirmed by several recent articles [8,12]. This is an additional clear indication that attention should be paid to CRP in terms of pathological properties.…”

Sepsis Related Mortality Associated with an Inflammatory Burst in Patients Admitting to the Department of Internal Medicine with Apparently Normal C-Reactive Protein Concentration

“…This study is especially relevant since it is known that the inflammatory response is not only a marker for the severity of the disease, but is involved in pathophysiological changes that could have deleterious effects, especially if exaggerated. This has clearly been shown in several clinical models such as in patients with ST-elevation myocardial infarction (STEMI) [ 16 , 17 , 18 ] as well as in the recent COVID-19 pandemic [ 19 , 20 , 21 ]. What we found is a gradual correlation between the intensity of the inflammatory response and the probability of death from different medical conditions within a relatively short period.…”

Sustainability of C-Reactive Protein (CRP) Apheresis in Acute Myocardial Infarction (AMI) - Results from a Supplementary Data Analysis of the Explorative CAMI-1 Study

“…A predictive value of the initial CRP kinetics for the extent of the myocardial damage has been described several times [1,3,4,12]. The reason for these quantitative relationships between CRP and infarct may be CRP-induced disposal of ischemic cells [7].…”