Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Marii Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland.
Division of Cardiovascular Medicine, University of California San Diego, 9300 Campus Point Drive MC 7410, La Jolla, CA 92037, USA.
Int J Mol Sci. 2020 Jan 26;21(3):807. doi: 10.3390/ijms21030807.
Acute ST-segment elevation myocardial infarction (STEMI) activates inflammation that can contribute to left ventricular systolic dysfunction (LVSD) and heart failure (HF). The objective of this study was to examine whether high-sensitivity C-reactive protein (CRP) concentration is predictive of long-term post-infarct LVSD and HF. In 204 patients with a first STEMI, CRP was measured at hospital admission, 24 h (CRP), discharge (CRP), and 1 month after discharge (CRP). LVSD at 6 months after discharge (LVSD) and hospitalization for HF in long-term multi-year follow-up were prospectively evaluated. LVSD occurred in 17.6% of patients. HF hospitalization within a median follow-up of 5.6 years occurred in 45.7% of patients with LVSD vs. 4.9% without LVSD ( < 0.0001). Compared to patients without LVSD, the patients with LVSD had higher CRP and CRP and persistent CRP ≥ 2 mg/L. CRP levels were also higher in patients in whom LVSD persisted at 6 months (51% of all patients who had LVSD at discharge upon index STEMI) vs. patients in whom LVSD resolved. In multivariable analysis, CRP ≥ 19.67 mg/L improved the prediction of LVSD with an increased odds ratio of 1.47 ( < 0.01). Patients with LVSD who developed HF had the highest CRP during index STEMI. Elevated CRP concentration during STEMI can serve as a synergistic marker for risk of long-term LVSD and HF.
急性 ST 段抬高型心肌梗死 (STEMI) 会激活炎症反应，从而导致左心室收缩功能障碍 (LVSD) 和心力衰竭 (HF)。本研究旨在探讨高敏 C 反应蛋白 (CRP) 浓度是否可预测梗死后长期 LVSD 和 HF。对 204 例首次发生 STEMI 的患者，在入院时（CRP）、24 小时（CRP）、出院时（CRP）和出院后 1 个月（CRP）检测 CRP 浓度。在长期的多年随访中，前瞻性评估出院后 6 个月时的 LVSD（LVSD）和因 HF 住院情况。17.6%的患者发生了 LVSD。在中位随访时间为 5.6 年时，LVSD 患者中有 45.7%发生 HF 住院，而无 LVSD 患者中仅为 4.9%（<0.0001）。与无 LVSD 患者相比，LVSD 患者的 CRP 和 CRP 持续升高（>2mg/L）更高。在所有因 index STEMI 时发生 LVSD 的患者中，6 个月时 LVSD 持续存在的患者（51%）的 CRP 水平也高于 LVSD 缓解的患者。多变量分析显示，CRP≥19.67mg/L 可提高 LVSD 的预测能力，优势比为 1.47（<0.01）。发生 HF 的 LVSD 患者在 index STEMI 时 CRP 最高。STEMI 期间 CRP 浓度升高可作为长期发生 LVSD 和 HF 的风险的协同标志物。
