Serum C-reactive protein elevation in left ventricular remodeling after acute myocardial infarction--role of neurohormones and cytokines.
BACKGROUND
We previously reported that increased peak serum C-reactive protein (CRP) level after acute myocardial infarction (AMI) was a major predictor of cardiac rupture and long-term outcome. The aim of this study was to clarify the role of serum CRP elevation as a possible marker of left ventricular (LV) remodeling after AMI.


METHODS
We prospectively studied 31 patients who underwent primary angioplasty for a first anterior Q-wave AMI. Peak serum CRP level was determined by serial measurements after admission. LV volume and the plasma levels of various neurohormones and cytokines were measured on admission, and 2 weeks and 6 months after AMI.


RESULTS
Patients with higher peak CRP levels (above the median) had a greater increase in LV end-diastolic volume during 2 weeks after AMI (+21+/-14 vs. +5+/-6 ml/m(2), P=0.001) and a lower ejection fraction (45+/-11 vs. 53+/-7%, P=0.02) than those with lower CRP levels, associated with a higher incidence of pump failure, atrial fibrillation, and LV aneurysm. Plasma levels of norepinephrine, brain natriuretic peptide, and interleukin-6 2 weeks after AMI were higher in the high CRP group than in the low CRP group.


CONCLUSIONS
Increased peak serum CRP level was associated with a greater increase in LV volume after anterior AMI. Plasma norepinephrine and interleukin-6 levels were increased in patients with higher CRP levels, suggesting a possible role of sympathetic activation and enhanced immune response in the development of LV remodeling after AMI.
Takahashi
Toshiyuki
T
Cardiopulmonary Division, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
Anzai
Toshihisa
T
Yoshikawa
Tsutomu
T
Maekawa
Yuichiro
Y
Asakura
Yasushi
Y
Satoh
Toru
T
Mitamura
Hideo
H
Ogawa
Satoshi
S
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002097:C-Reactive Protein / Q000032:analysis*; D016207:Cytokines / Q000097:blood* / Q000502:physiology*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000503:physiopathology* / Q000628:therapy; D018377:Neurotransmitter Agents / Q000097:blood* / Q000502:physiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013997:Time Factors; D020257:Ventricular Remodeling / Q000502:physiology*
D016207:Cytokines; D018377:Neurotransmitter Agents; D002097:C-Reactive Protein