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Zhao X, Gao C, Chen H, Chen X, Liu T, Gu D. C-Reactive Protein: An Important Inflammatory Marker of Coronary Atherosclerotic Disease. Angiology 2024:33197241273360. [PMID: 39126663 DOI: 10.1177/00033197241273360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
Cardiovascular disease (CVD) is the most common cause of death worldwide, with coronary atherosclerotic heart disease (CHD) accounting for the majority of events. Evidence demonstrates that inflammation plays a vital role in the development of CHD. The association between C-reactive protein (CRP), a representative inflammatory biomarker, and atherosclerosis (AS), CHD, and inflammation has attracted attention. Therefore, we conducted an extensive search on PubMed using the aforementioned terms as search criteria and identified a total of 1246 articles published from January 2000 to April 2024. Both review and research-based articles consistently indicate CRP as a risk enhancer for CVD, contributing to the refinement of risk stratification and early identification of apparently healthy at-risk populations. Additionally, CRP reflects disease progression and predicts the prognosis of recurrent cardiovascular events. Anti-inflammatory therapeutic strategies targeting CRP also provide new treatment options for patients. This review focuses on the link between CRP and CHD, highlighting how CRP is involved in the pathological progression of AS and its potential value for clinical applications.
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Affiliation(s)
- Xiaona Zhao
- Guangxi University of Chinese Medicine, Nanning, China
- Department of Laboratory Medicine, Shenzhen Institute of Translational Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Cheng Gao
- Department of Laboratory Medicine, Shenzhen Institute of Translational Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Hongfang Chen
- School of Public Health, Dongguan Key Laboratory of Environmental Medicine, Guangdong Medical University, Guangdong, China
| | - Xi Chen
- Medical Department, Shenzhen Luohu People's Hospital, Shenzhen, China
| | - Tonggong Liu
- Department of Laboratory Medicine, Shenzhen Institute of Translational Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Dayong Gu
- Department of Laboratory Medicine, Shenzhen Institute of Translational Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
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Di Vito L, Di Giusto F, Bruscoli F, Scalone G, Silenzi S, Mariani L, Selimi A, Delfino D, Grossi P. Recurrent events after acute ST-segment elevation myocardial infarction: predictors and features of plaque progression and stent failure. Coron Artery Dis 2024; 35:277-285. [PMID: 38241028 DOI: 10.1097/mca.0000000000001331] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVES Patients with acute ST-segment elevation myocardial infarction (STEMI) are at high risk for recurrent coronary events (RCE). Non-culprit plaque progression and stent failure are the main causes of RCEs. We sought to identify the incidence and predictors of RCEs. METHODS Eight hundred thirty patients with STEMI were enrolled and followed up for 5 years. All patients underwent blood test analysis at hospital admission, at 1-month and at 12-month follow-up times. Patients were divided into RCE group and control group. RCE group was further categorized into non-culprit plaque progression and stent failure subgroups. RESULTS Among 830 patients with STEMI, 63 patients had a RCE (7.6%). At hospital admission, HDL was numerically lower in RCE group, while LDL at both 1-month and 12-month follow-up times were significantly higher in RCE group. Both HDL at hospital admission and LDL at 12-month follow-up were independently associated with RCEs (OR 0.90, 95% CI 0.81-0.99 and OR 1.041, 95% CI 1.01-1.07, respectively). RCEs were due to non-culprit plaque progression in 47.6% of cases, while in 36.5% due to stent failure. The mean time frame between pPCI and RCE was significantly greater for non-culprit plaque progression subgroup as compared to stent failure subgroup (27 ± 18 months and 16 ± 14 months, P = 0.032). CONCLUSION RCEs still affect patients after pPCI. Low levels of HDL at admission and high levels of LDL at 12 months after pPCI significantly predicted RCEs. A RCE results in non-culprit plaque progression presents much later than an event due to stent failure.
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Affiliation(s)
| | | | | | | | | | - Luca Mariani
- University Hospital Riuniti of Ancona, Ancona, Italy
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3
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Sheriff A, Kunze R, Brunner P, Vogt B. Being Eaten Alive: How Energy-Deprived Cells Are Disposed of, Mediated by C-Reactive Protein-Including a Treatment Option. Biomedicines 2023; 11:2279. [PMID: 37626775 PMCID: PMC10452736 DOI: 10.3390/biomedicines11082279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/09/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
In medicine, C-reactive protein (CRP) has become established primarily as a biomarker, predicting patient prognosis in many indications. Recently, however, there has been mounting evidence that it causes inflammatory injury. As early as 1999, CRP was shown to induce cell death after acute myocardial infarction (AMI) in rats and this was found to be dependent on complement. The pathological effect of CRP was subsequently confirmed in further animal species such as rabbit, mouse and pig. A conceptual gap was recently closed when it was demonstrated that ischemia in AMI or ischemia/hypoxia in the severe course of COVID-19 causes a drastic lack of energy in involved cells, resulting in an apoptotic presentation because these cells cannot repair/flip-flop altered lipids. The deprivation of energy leads to extensive expression on the cell membranes of the CRP ligand lysophosphatidylcholine. Upon attachment of CRP to this ligand, the classical complement pathway is triggered leading to the swift elimination of viable cells with the appearance of an apoptotic cell by phagocytes. They are being eaten alive. This, consequently, results in substantial fibrotic remodeling within the involved tissue. Inhibiting this pathomechanism via CRP-targeting therapy has been shown to be beneficial in different indications.
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Affiliation(s)
- Ahmed Sheriff
- Department of Gastroenterology, Infectiology, Rheumatology, Charité University Medicine Berlin, 10117 Berlin, Germany
- Pentracor GmbH, 16761 Hennigsdorf, Germany (P.B.); (B.V.)
| | - Rudolf Kunze
- Pentracor GmbH, 16761 Hennigsdorf, Germany (P.B.); (B.V.)
| | | | - Birgit Vogt
- Pentracor GmbH, 16761 Hennigsdorf, Germany (P.B.); (B.V.)
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Zhou L, Hu X, Zhang H, Lu H, Lin Y, Wang W, Yu B, Liang W, Zhou Y, Li G, Dong H. Effects of atorvastatin and rosuvastatin on dysfunctional coronary circulation in patients with ST-segment elevation myocardial infarction. J Int Med Res 2023; 51:3000605231182547. [PMID: 37377087 DOI: 10.1177/03000605231182547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE Evidence of therapy for dysfunctional coronary circulation in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) is limited. This study was performed to compare the effects of atorvastatin and rosuvastatin on dysfunctional coronary circulation. METHODS This retrospective study enrolled 597 consecutive patients with STEMI who underwent pPCI in 3 centers from June 2016 to December 2019. Dysfunctional coronary circulation was defined by the thrombolysis in myocardial infarction (TIMI) grade and the TIMI myocardial perfusion grade (TMPG). Logistic regression analysis was used to evaluate the impact of different statin types on dysfunctional coronary circulation. RESULTS The incidence of TIMI no/slow reflow did not differ between the two groups, but the incidence of TMPG no/slow reflow was significantly lower in the atorvastatin than rosuvastatin group (44.58% vs. 57.69%, respectively). After multivariate adjustment, the odds ratio with 95% confidence interval of rosuvastatin was 1.72 (1.17-2.52) for after pretreatment TMPG no/slow reflow and 1.73 (1.16-2.58) for after stenting TMPG no/slow reflow. Atorvastatin and rosuvastatin showed no significant differences in clinical outcomes during hospitalization. CONCLUSIONS Compared with rosuvastatin, atorvastatin was associated with better coronary microcirculatory perfusion in patients with STEMI who underwent pPCI.
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Affiliation(s)
- Langping Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Xiangming Hu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Haotian Zhang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Haoyu Lu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yan Lin
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Department of Cardiology, Shantou University Medical College, Shantou, China
| | - Weimian Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Bingyan Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Wensheng Liang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yingling Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Guang Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Haojian Dong
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Department of Cardiology, Nyingchi People's Hospital, Nyingchi, China
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5
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Chang Z, Li H. KLF9 deficiency protects the heart from inflammatory injury triggered by myocardial infarction. THE KOREAN JOURNAL OF PHYSIOLOGY & PHARMACOLOGY : OFFICIAL JOURNAL OF THE KOREAN PHYSIOLOGICAL SOCIETY AND THE KOREAN SOCIETY OF PHARMACOLOGY 2023; 27:177-185. [PMID: 36815257 PMCID: PMC9968950 DOI: 10.4196/kjpp.2023.27.2.177] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/17/2022] [Accepted: 12/26/2022] [Indexed: 02/24/2023]
Abstract
The excessive inflammatory response induced by myocardial infarction exacerbates heart injury and leads to the development of heart failure. Recent studies have confirmed the involvement of multiple transcription factors in the modulation of cardiovascular disease processes. However, the role of KLF9 in the inflammatory response induced by cardiovascular diseases including myocardial infarction remains unclear. Here, we found that the expression of KLF9 significantly increased during myocardial infarction. Besides, we also detected high expression of KLF9 in infiltrated macrophages after myocardial infarction. Our functional studies revealed that KLF9 deficiency prevented cardiac function and adverse cardiac remodeling. Furthermore, the downregulation of KLF9 inhibited the activation of NF-κB and MAPK signaling, leading to the suppression of inflammatory responses of macrophages triggered by myocardial infarction. Mechanistically, KLF9 was directly bound to the TLR2 promoter to enhance its expression, subsequently promoting the activation of inflammation-related signaling pathways. Our results suggested that KLF9 is a pro-inflammatory transcription factor in macrophages and targeting KLF9 may be a novel therapeutic strategy for ischemic heart disease.
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Affiliation(s)
- Zhihong Chang
- Department of Cardiology, Heji Hospital of Changzhi Medical College, Changzhi 046011, China
| | - Hongkun Li
- Department of Cardiology, Heji Hospital of Changzhi Medical College, Changzhi 046011, China,Correspondence Hongkun Li, E-mail:
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Sustainability of C-Reactive Protein Apheresis in Acute Myocardial Infarction-Results from a Supplementary Data Analysis of the Exploratory C-Reactive Protein in Acute Myocardial Infarction-1 Study. J Clin Med 2022; 11:jcm11216446. [PMID: 36362673 PMCID: PMC9655548 DOI: 10.3390/jcm11216446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/23/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
In the multicenter, non-randomized, exploratory C-reactive protein (CRP) Apheresis in Myocardial Infarction (CAMI-1) study, CRP apheresis after ST-Elevation Myocardial Infarction (STEMI) significantly decreased blood CRP concentrations in humans. Cardiac damage was assessed by Cardiac Magnetic Resonance (CMR1) 3−9 d after onset of STEMI symptoms and quantified by myocardial infarct size (IS; %), left ventricular ejection fraction (LVEF; %), circumferential strain (CS) and longitudinal strain (LS). Compared with the control group (n = 34), cardiac damage was significantly lower in the apheresis group (n = 32). These findings suggested improved wound healing due to CRP apheresis already within few days after the STEMI event. In the current supplementary data analysis of CAMI-1, we have tested by a follow-up CMR (CMR2) after an average of 88 (65−177) d whether the effect of CRP apheresis is clinically maintained. After this time period, wound healing in STEMI is considered complete. Whereas patients with low CRP production and a CRP gradient cut off of <0.6 mg/L/h in the hours after STEMI (9 of 32 patients in the CRP apheresis group) did not significantly benefit from CRP apheresis in CMR2, patients with high CRP production and a CRP gradient cut off of >0.6 mg/L/h (23 of 32 patients in the CRP apheresis group) showed significant treatment benefit. In the latter patients, CMR2 revealed a lower IS (−5.4%; p = 0.05), a better LVEF (+6.4%; p = 0.03), and an improved CS (−6.1%; p = 0.005). No significant improvement, however, was observed for LS (−2.9%; p = 0.1). These data suggest a sustained positive effect of CRP apheresis on heart physiology in STEMI patients with high CRP production well beyond the period of its application. The data demonstrate the sustainability of the CRP removal from plasma which is associated with less scar tissue.
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Brzezinski RY, Melloul A, Berliner S, Goldiner I, Stark M, Rogowski O, Banai S, Shenhar-Tsarfaty S, Shacham Y. Early Detection of Inflammation-Prone STEMI Patients Using the CRP Troponin Test (CTT). J Clin Med 2022; 11:jcm11092453. [PMID: 35566579 PMCID: PMC9105044 DOI: 10.3390/jcm11092453] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 02/01/2023] Open
Abstract
Elevated concentrations of C-reactive protein (CRP) early during an acute coronary syndrome (ACS) may reflect the magnitude of the inflammatory response to myocardial damage and are associated with worse outcome. However, the routine measurement of both CRP and cardiac troponin simultaneously in the setting of ST-segment myocardial infarction (STEMI) is not used broadly. Here, we sought to identify and characterize individuals who are prone to an elevated inflammatory response following STEMI by using a combined CRP and troponin test (CTT) and determine their short- and long-term outcome. We retrospectively examined 1186 patients with the diagnosis of acute STEMI, who had at least two successive measurements of combined CRP and cardiac troponin (up to 6 h apart), all within the first 48 h of admission. We used Chi-Square Automatic Interaction Detector (CHAID) tree analysis to determine which parameters, timing (baseline vs. serial measurements), and cut-offs should be used to predict mortality. Patients with high CRP concentrations (above 90th percentile, >33 mg/L) had higher 30 day and all-cause mortality rates compared to the rest of the cohort, regardless of their troponin test status (above or below 118,000 ng/L); 14.4% vs. 2.7%, p < 0.01. Furthermore, patients with both high CRP and high troponin levels on their second measurement had the highest 30-day mortality rates compared to the rest of the cohort; 21.4% vs. 3.7%, p < 0.01. These patients also had the highest all-cause mortality rates after a median follow-up of 4.5 years compared to the rest of the cohort; 42.9% vs. 12.7%, p < 0.01. In conclusion, serial measurements of both CRP and cardiac troponin might detect patients at increased risk for short-and long-term mortality following STEMI. We suggest the future use of the combined CTT as a potential early marker for inflammatory-prone patients with worse outcomes following ACS. This sub-type of patients might benefit from early anti-inflammatory therapy such as colchicine and anti-interleukin-1ß agents.
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Affiliation(s)
- Rafael Y. Brzezinski
- Internal Medicine “C”, “D”, and “E”, Tel Aviv Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (R.Y.B.); (A.M.); (S.B.); (O.R.); (S.S.-T.)
| | - Ariel Melloul
- Internal Medicine “C”, “D”, and “E”, Tel Aviv Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (R.Y.B.); (A.M.); (S.B.); (O.R.); (S.S.-T.)
| | - Shlomo Berliner
- Internal Medicine “C”, “D”, and “E”, Tel Aviv Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (R.Y.B.); (A.M.); (S.B.); (O.R.); (S.S.-T.)
| | - Ilana Goldiner
- Department of Clinical Laboratories, Tel Aviv Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (I.G.); (M.S.)
| | - Moshe Stark
- Department of Clinical Laboratories, Tel Aviv Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (I.G.); (M.S.)
| | - Ori Rogowski
- Internal Medicine “C”, “D”, and “E”, Tel Aviv Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (R.Y.B.); (A.M.); (S.B.); (O.R.); (S.S.-T.)
| | - Shmuel Banai
- Department of Cardiology, Tel Aviv Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
| | - Shani Shenhar-Tsarfaty
- Internal Medicine “C”, “D”, and “E”, Tel Aviv Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (R.Y.B.); (A.M.); (S.B.); (O.R.); (S.S.-T.)
| | - Yacov Shacham
- Department of Cardiology, Tel Aviv Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
- Correspondence:
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Buerke M, Sheriff A, Garlichs CD. [CRP apheresis in acute myocardial infarction and COVID-19]. Med Klin Intensivmed Notfmed 2022; 117:191-199. [PMID: 35333926 PMCID: PMC8951661 DOI: 10.1007/s00063-022-00911-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 01/08/2023]
Abstract
C‑reactive protein (CRP) is the best-known acute phase protein. In humans, inflammation and infection are usually accompanied by an increase in CRP levels in the blood, which is why CRP is an important biomarker in daily clinical routine. CRP can mediate the initiation of phagocytosis by labeling damaged cells. This labeling leads to activation of the classical complement pathway (up to C4) and ends in the elimination of pathogens or reversibly damaged or dead cells. This seems to make sense in case of an external wound of the body. However, in the case of "internal wounds" (e.g., myocardial infarction, stroke), CRP induces tissue damage to potentially regenerable tissue by cell labeling, which has corresponding deleterious effects on cardiac and brain tissue or function. The described labeling of ischemic but potentially regenerable cells by CRP apparently also occurs in coronavirus disease 2019 (COVID-19). Parts of the lung become ischemic due to intra-alveolar edema and hemorrhage, and this is accompanied by a dramatic increase in CRP. Use of selective immunoadsorption of CRP from blood plasma ("CRP apheresis") to rapidly and efficiently lower the fulminant CRP load in the body fills this pharmacotherapeutic gap. With CRP apheresis, it is possible for the first time to remove this pathological molecule quickly and efficiently in clinical practice.
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Affiliation(s)
- Michael Buerke
- Kardiologie, Angiologie, Internistische Intensivmedizin, St. Marienkrankenhaus Siegen, Siegen, Deutschland
| | - Ahmed Sheriff
- Medizinische Klinik mit Schwerpunkt Gastroenterologie/Infektiologie/Rheumatologie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Christoph D Garlichs
- Kardiologie, Nephrologie, Angiologie, Internistische Intensivmedizin, DIAKO Krankenhaus gGmbH, Knuthstr. 1, 24939, Flensburg, Deutschland.
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9
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Holzknecht M, Tiller C, Reindl M, Lechner I, Fink P, Lunger P, Mayr A, Henninger B, Brenner C, Klug G, Bauer A, Metzler B, Reinstadler SJ. Association of C-Reactive Protein Velocity with Early Left Ventricular Dysfunction in Patients with First ST-Elevation Myocardial Infarction. J Clin Med 2021; 10:5494. [PMID: 34884196 PMCID: PMC8658672 DOI: 10.3390/jcm10235494] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 12/15/2022] Open
Abstract
C-reactive protein velocity (CRPv) has been proposed as a very early and sensitive risk predictor in patients with ST-elevation myocardial infarction (STEMI). However, the association of CRPv with early left ventricular (LV) dysfunction after STEMI is unknown. The aim of this study was to investigate the relationship between CRPv and early LV dysfunction, either before or at hospital discharge, in patients with first STEMI. This analysis evaluated 432 STEMI patients that were included in the prospective MARINA-STEMI (Magnetic Resonance Imaging In Acute ST-elevation Myocardial Infarction. ClinicalTrials.gov Identifier: NCT04113356) cohort study. The difference of CRP 24 ± 8 h and CRP at hospital admission divided by the time (in h) that elapsed during the two examinations was defined as CRPv. Cardiac magnetic resonance (CMR) imaging was conducted at a median of 3 (IQR 2-4) days after primary percutaneous coronary intervention (PCI) for the determination of LV function and myocardial infarct characteristics. The association of CRPv with the CMR-derived LV ejection fraction (LVEF) was investigated. The median CRPv was 0.42 (IQR 0.21-0.76) mg/l/h and was correlated with LVEF (rS = -0.397, p < 0.001). In multivariable linear as well as binary logistic regression analysis (adjustment for biomarkers and clinical and angiographical parameters), CRPv was independently associated with LVEF (β: 0.161, p = 0.004) and LVEF ≤ 40% (OR: 1.71, 95% CI: 1.19-2.45; p = 0.004), respectively. The combined predictive value of peak cardiac troponin T (cTnT) and CRPv for LVEF ≤ 40% (AUC: 0.81, 95% CI 0.77-0.85, p < 0.001) was higher than it was for peak cTnT alone (AUC difference: 0.04, p = 0.009). CRPv was independently associated with early LV dysfunction, as measured by the CMR-determined LVEF, revealing an additive predictive value over cTnT after acute STEMI treated with primary PCI.
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Affiliation(s)
- Magdalena Holzknecht
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
| | - Christina Tiller
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
| | - Martin Reindl
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
| | - Ivan Lechner
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
| | - Priscilla Fink
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
| | - Patrick Lunger
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
| | - Agnes Mayr
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (A.M.); (B.H.)
| | - Benjamin Henninger
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (A.M.); (B.H.)
| | - Christoph Brenner
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
| | - Gert Klug
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
| | - Axel Bauer
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
| | - Bernhard Metzler
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
| | - Sebastian Johannes Reinstadler
- University Clinic of Internal Medicine III Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (M.H.); (C.T.); (M.R.); (I.L.); (P.F.); (P.L.); (C.B.); (G.K.); (A.B.); (B.M.)
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Acute Coronary Syndromes (ACS)-Unravelling Biology to Identify New Therapies-The Microcirculation as a Frontier for New Therapies in ACS. Cells 2021; 10:cells10092188. [PMID: 34571836 PMCID: PMC8468909 DOI: 10.3390/cells10092188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 12/12/2022] Open
Abstract
In acute coronary syndrome (ACS) patients, restoring epicardial culprit vessel patency and flow with percutaneous coronary intervention or coronary artery bypass grafting has been the mainstay of treatment for decades. However, there is an emerging understanding of the crucial role of coronary microcirculation in predicting infarct burden and subsequent left ventricular remodelling, and the prognostic significance of coronary microvascular obstruction (MVO) in mortality and morbidity. This review will elucidate the multifaceted and interconnected pathophysiological processes which underpin MVO in ACS, and the various diagnostic modalities as well as challenges, with a particular focus on the invasive but specific and reproducible index of microcirculatory resistance (IMR). Unfortunately, a multitude of purported therapeutic strategies to address this unmet need in cardiovascular care, outlined in this review, have so far been disappointing with conflicting results and a lack of hard clinical end-point benefit. There are however a number of exciting and novel future prospects in this field that will be evaluated over the coming years in large adequately powered clinical trials, and this review will briefly appraise these.
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Montone RA, La Vecchia G. Interplay between inflammation and microvascular obstruction in ST-segment elevation myocardial infarction: The importance of velocity. Int J Cardiol 2021; 339:7-9. [PMID: 34311010 DOI: 10.1016/j.ijcard.2021.07.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Rocco A Montone
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy.
| | - Giulia La Vecchia
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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Reindl M, Lechner I, Reinstadler SJ, Metzler B. Transient STEMI - No STEMI at all? Int J Cardiol 2021; 339:12-13. [PMID: 34274409 DOI: 10.1016/j.ijcard.2021.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Ivan Lechner
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Sebastian J Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.
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Holzknecht M, Tiller C, Reindl M, Lechner I, Troger F, Hosp M, Mayr A, Brenner C, Klug G, Bauer A, Metzler B, Reinstadler SJ. C-reactive protein velocity predicts microvascular pathology after acute ST-elevation myocardial infarction. Int J Cardiol 2021; 338:30-36. [PMID: 34147553 DOI: 10.1016/j.ijcard.2021.06.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/08/2021] [Accepted: 06/14/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The role of C-reactive protein velocity (CRPv) as an early and sensitive marker of an excessive inflammatory response in the setting of acute ST-elevation myocardial infarction (STEMI) is only poorly understood. The aim of this study was to investigate, in patients with STEMI treated with primary percutaneous coronary intervention (PCI), the association of CRPv with microvascular infarct pathology. METHODS AND RESULTS This prospective cohort study included a total of 316 patients with STEMI undergoing PCI. CRPv was defined as the difference between CRP 24 ± 8 h and CRP at hospital admission, divided by the time (in h) that have passed during the two examinations. The association of biomarker levels with cardiac magnetic resonance (CMR)-determined microvascular obstruction (MVO) was evaluated. CMR was performed at a median of 3 [interquartile range 2-4] days after PCI. After adjustment for cardiac troponin T (cTnT), anterior infarction and TIMI flow pre and post-PCI, CRPv (odds ratio 2.70, 95% confidence interval (CI) 1.54-4.73; p = 0.001) remained significantly associated with the occurrence of MVO. CRPv (area under the curve [AUC] 0.76, 95% CI 0.71-0.81; p < 0.001) was a better predictor for MVO compared to 24 h CRP (AUC difference: 0.03, p = 0.002). The addition of CRPv to peak cTnT resulted in a higher AUC for MVO prediction than peak cTnT alone (AUC 0.86, 95% CI 0.82-0.90; p < 0.001 vs. AUC 0.84, 95% CI 0.79-0.88; p < 0.001. AUC difference: 0.02, p = 0.042). CONCLUSIONS In patients with STEMI treated with primary PCI, CRPv was associated with microvascular infarct pathology with a predictive value incremental to cTnT, suggesting CRPv as an early and sensitive biomarker for more severe infarct pathology and outcome.
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Affiliation(s)
- Magdalena Holzknecht
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Christina Tiller
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Ivan Lechner
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Felix Troger
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Michael Hosp
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Agnes Mayr
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Christoph Brenner
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Gert Klug
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Axel Bauer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Sebastian Johannes Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria..
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