Plasma C-reactive protein predicts left ventricular remodeling and function after a first acute anterior wall myocardial infarction treated with coronary angioplasty: comparison with brain natriuretic peptide.
BACKGROUND
C-reactive protein (CRP) directly participates in the myocardial injury of acute myocardial infarction (MI). Although high plasma CRP levels in the acute phase strongly indicate a poor early clinical outcome of patients with MI, the impact of CRP levels on late left ventricular (LV) function and remodeling, which are closely associated with long-term prognosis, remains unknown.


OBJECTIVE
Acute plasma CRP levels may predict late LV function and remodeling after MI.


METHODS
We prospectively studied 12 consecutive patients with a first acute anterior MI recanalized by angioplasty. We measured plasma CRP levels on Days 0, 1, 2, 3, 4, and 7, and calculated the area under the curve (AUC). We also measured plasma brain natriuretic peptide (BNP) levels on Day 3 as the referential indicator of LV dysfunction and late LV remodeling. Late LV indices were independently assessed on a left ventriculogram obtained at 5.3 months to estimate the extent of LV remodeling.


RESULTS
Plasma CRP reached its peak at Day 2.8 (8.68+/-4.57 mg/dl). On linear regression analysis, the AUC of CRP (35.21+/-19.33 mg/dl x day) correlated positively with BNP (316.5+/-418.6 pg/ml) (r = 0.646, p = 0.023). The AUC of CRP, peak CRP, and BNP correlated significantly with late LV indices. Among these, the AUC of CRP showed the best correlation with end-diastolic volume index (r = 0.765, p = 0.004), end-systolic volume index (r = 0.907, p < 0.001), and ejection fraction (r = -0.862, p < 0.001).


CONCLUSIONS
Patients with high plasma CRP levels may be at risk for late LV dysfunction and remodeling; theoretically, their long-term prognosis may be poor. Measuring plasma CRP levels may provide valuable information for long-term risk stratification after MI.
Morishima
Itsuro
I
Department of Cardiology, Ogaki Municipal Hospital, Japan. morishima-1@muc.biglobe.ne.jp
Sone
Takahito
T
Tsuboi
Hideyuki
H
Kondo
Junichiro
J
Mukawa
Hiroaki
H
Kamiya
Hiroki
H
Hieda
Nobuyuki
N
Okumura
Kenji
K
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000628:therapy*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009419:Nerve Tissue Proteins / Q000097:blood; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018487:Ventricular Dysfunction, Left / Q000097:blood* / Q000503:physiopathology; D020257:Ventricular Remodeling / Q000502:physiology*
D015415:Biomarkers; D009419:Nerve Tissue Proteins; D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein