Impact of Serum C-Reactive Protein Elevation on the Left Ventricular Spherical Change and the Development of Mitral Regurgitation after Anterior Acute Myocardial Infarction

Abstract

Background/Aims: Mitral regurgitation (MR) is frequently observed in patients with acute myocardial infarction (AMI), and is known to convey an adverse prognosis. We sought to clarify the relationship between MR and left ventricular (LV) remodeling, in association with serum C-reactive protein (CRP) elevation. Methods/Results: A total of 181 patients with first anterior ST-elevation AMI were examined. MR was detected in 68 patients by color Doppler echocardiography 2 weeks after AMI, and the patients with MR were associated with higher incidence of readmission for heart failure. Serum CRP was serially measured, and the peak serum CRP level was markedly increased in patients with MR compared with those without MR. Multiple logistic regression analysis showed that peak CRP tertile was an independent determinant of MR after AMI (p < 0.0001). In the substudy, the increases in LV end-diastolic volume and sphericity index were higher in patients with MR than in those without MR. Conclusions: MR during the early phase of anterior AMI was associated with LV spherical change and late-phase heart failure, in association with increased serum CRP level. These findings suggest an important role of the inflammatory response in the development of ischemic MR and 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.…”

Abnormal Fetal Findings Associated With a Global Sphericity Index of the 4‐Chamber View Below the 5th Centile

“…Alterations of the geometric shape of the left and right ventricles have been reported in adult and pediatric patients as markers of cardiac dysfunction in which the ventricle appears to be flattened or rounded, depending on the underlying abnormality . One method used for evaluation of ventricular shape involves measuring the end‐diastolic BAL and TL for the right and left ventricular chambers and computing the GSI using either BAL/TL or TL/BAL (Figure ) …”

“…Alterations of the geometric shape of the left and right ventricles have been reported in adult and pediatric patients as markers of cardiac dysfunction in which the ventricle appears to be flattened or rounded, depending on the underlying abnormality. [21][22][23][24][25][26][27][28][29][30][31][32][33][34] One method used for evaluation of ventricular shape involves measuring the end-diastolic BAL and TL for the right and left ventricular chambers and computing the GSI using either BAL/TL or TL/BAL (Figure 4). 8,21,35 Once an abnormal GSI was identified, the only group that showed a significant increase in the TL, thus leading to a more globular-shaped heart, was the group of fetuses with cardiac dysfunction (Table 5), which was similar in fetuses with an estimated fetal weight below the 10th centile (27.7%) and above the 10th centile (29.5%).…”

24‐segment sphericity index: a new technique to evaluate fetal cardiac diastolic shape

“…The sphericity index (SI) is used to evaluate the shape of the right and left ventricles of the heart and is derived by calculating the ratio between the end-diastolic mid-basal-apical and transverse lengths (Figure 1a). SI has been examined in adult and pediatric patients and found to be a useful tool to detect abnormal cardiac function resulting from remodeling of the ventricular chamber [1][2][3][4][5][6][7][8][9][10][11][12][13] . Only six studies have evaluated the SI of the fetal heart [14][15][16][17][18][19] .…”