Copciag Ruxandra, Bratu Vladimir, Rimbas Roxana, Magda Stefania, Lungeanu Laura, Corlan Alexandru, Schiopu Alexandru, Simionescu Maya, Vinereanu Dragos
"Carol Davila" University of Medicine and Pharmacy, University and Emergency Hospital of Bucharest, Department of Cardiology and Cardiovascular Surgery, Bucharest, Romania.
University and Emergency Hospital of Bucharest, Bucharest, Romania.
Maedica (Bucur). 2025 Jun;20(2):168-175. doi: 10.26574/maedica.2025.20.2.168.
Left ventricular (LV) remodeling plays a pivotal role in the pathophysiology of heart failure (HF) following acute coronary syndrome (ACS). Left ventricular ejection fraction (LVEF), left ventricular (LV) volumes and, more recently, speckle tracking echocardiography (STE) are used to describe LV performance. Myocardial work (MW) is a new noninvasive imaging method that integrates loading conditions and can be used to detect early myocardial dysfunction before LVEF decreases.
This study aims to characterize the relationship between MW, high-sensitivity troponin (hs-cTn I) and C-reactive protein (CRP) as an inflammation biomarker. Their use as predictors for LV dysfunction in the acute phase of ACS is of particular interest but is still under debate.
Complete clinical examination and two-dimensional echocardiography (2-DE), with speckle-tracking and myocardial work measurements, were performed in the first 24 hours after admission. Locally available biomarkers were assessed in the same timeframe, with special interest in hs-cTn I and CRP, as a marker for inflammation. A follow-up visit, including the same clinical, biological, and echocardiographic measurements, was performed six to eight weeks after the index event.
We evaluated 56 patients (53 ± 10 years, 45 men) with ACS. Baseline hs-cTn I significantly correlated with baseline global longitudinal strain (GLS) (r=0.43, p=0.001) and baseline MW parameters (GWI: r=-0.44, p=0.001; GCW: r=-0.40, p=0.002). A correlation between hs-cTn I and LVEF was not statistically relevant. C-reactive protein, which was used to assess systemic inflammation, also failed to correlate with LVEF. However, CRP significantly correlated with relevant MW parameters (GWE: r=-0.53, p<0.001 and GWW: r=0.48, p<0.001). C-reactive protein levels above 28 mg/L correlated with a decrease in MW performance assessed by GWE, suggesting a possible tendency to adverse remodeling.
C-reactive protein level in the first 24 hours after ACS and its correlation with MW parameters may be a potential indicator of future LV dysfunction and heart failure.
左心室（LV）重构在急性冠状动脉综合征（ACS）后心力衰竭（HF）的病理生理学中起关键作用。左心室射血分数（LVEF）、左心室（LV）容积，以及最近的斑点追踪超声心动图（STE）被用于描述左心室功能。心肌做功（MW）是一种新的非侵入性成像方法，它整合了负荷条件，可用于在LVEF降低之前检测早期心肌功能障碍。
本研究旨在描述MW、高敏肌钙蛋白（hs-cTn I）和作为炎症生物标志物的C反应蛋白（CRP）之间的关系。它们作为ACS急性期左心室功能障碍预测指标的应用尤其受到关注，但仍存在争议。
入院后24小时内进行全面临床检查和二维超声心动图（2-DE）检查，包括斑点追踪和心肌做功测量。在同一时间范围内评估当地可用的生物标志物，特别关注hs-cTn I和CRP，将其作为炎症标志物。在索引事件发生后六至八周进行随访，包括相同的临床、生物学和超声心动图测量。
我们评估了56例ACS患者（53±10岁，45名男性）。基线hs-cTn I与基线整体纵向应变（GLS）显著相关（r=0.43，p=0.001）以及基线MW参数（GWI：r=-0.44，p=0.001；GCW：r=-0.40，p=0.002）。hs-cTn I与LVEF之间的相关性无统计学意义。用于评估全身炎症的C反应蛋白也与LVEF无相关性。然而，CRP与相关MW参数显著相关（GWE：r=-0.53，p<0.001；GWW：r=0.48，p<0.001）。CRP水平高于28mg/L与GWE评估的MW性能下降相关，提示可能存在不良重构倾向。
ACS后24小时内的C反应蛋白水平及其与MW参数的相关性可能是未来左心室功能障碍和心力衰竭的潜在指标。
