Shacham Yacov, Topilsky Yan, Leshem-Rubinow Eran, Arbel Yaron, Ben Assa Eyal, Keren Gad, Roth Arie, Steinvil Arie
Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
J Cardiol. 2014 Jun;63(6):402-8. doi: 10.1016/j.jjcc.2013.10.013. Epub 2013 Dec 2.
An elevated C-reactive protein (CRP) level is associated with adverse outcomes in patients with acute myocardial infarction (AMI). Although CRP levels have been shown to be associated with left ventricular (LV) systolic function and remodeling in AMI, little is known about their relation to early LV diastolic function.
We retrospectively studied 173 consecutive patients <75 years of age with first ST-segment elevation MI (STEMI) that was treated by primary percutaneous coronary intervention (PPCI). They had presented within 24h of chest pain onset and their CRP levels were determined within 6h of hospital admission. They all underwent echocardiography within 3 days of admission and were stratified by CRP tertiles.
The cut-off points for the CRP tertiles were <2.6 mg/L, 2.6-7.9 mg/L, and >7.9 mg/L. Patients with higher CRP levels had a significantly higher mean mitral inflow E wave velocity (68 ± 16 cm/s vs 77 ± 19 cm/s vs 76 ± 17 cm/s; p=0.02), a higher E/average e' (8.9 ± 1.9 vs 9.8 ± 2.8 vs 10.4±3.2; p=0.02), and a higher systolic pulmonary artery pressure (27 ± 6 mmHg vs 30 ± 8 mmHg vs 32 ± 10 mmHg; p=0.04). Elevated CRP levels were associated with more advanced diastolic dysfunction than normal CRP levels (p=0.04). The admission CRP level was an independent predictor of average E/e' ratio (multivariate analysis).
Admission CRP levels are associated with echocardiographic parameters of elevated LV filling pressure in patients with STEMI treated with PPCI.
C反应蛋白（CRP）水平升高与急性心肌梗死（AMI）患者的不良预后相关。虽然CRP水平已被证明与AMI患者的左心室（LV）收缩功能及重构有关，但其与早期LV舒张功能的关系却知之甚少。
我们回顾性研究了173例年龄<75岁、因首次ST段抬高型心肌梗死（STEMI）接受直接经皮冠状动脉介入治疗（PPCI）的连续患者。他们在胸痛发作24小时内就诊，入院6小时内测定CRP水平。所有患者均在入院3天内接受超声心动图检查，并根据CRP三分位数进行分层。
CRP三分位数的切点分别为<2.6 mg/L、2.6 - 7.9 mg/L和>7.9 mg/L。CRP水平较高的患者平均二尖瓣流入E波速度显著更高（68±16 cm/s对77±19 cm/s对76±17 cm/s；p = 0.02），E/平均e'更高（8.9±1.9对9.8±2.8对10.4±3.2；p = 0.02），收缩期肺动脉压更高（27±6 mmHg对30±8 mmHg对32±10 mmHg；p = 0.04）。与正常CRP水平相比，CRP水平升高与更严重的舒张功能障碍相关（p = 0.04）。入院时CRP水平是平均E/e'比值的独立预测因素（多变量分析）。
入院时CRP水平与接受PPCI治疗的STEMI患者左心室充盈压升高的超声心动图参数相关。
