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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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2
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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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3
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Sun J, Zhang Q, Liu X, Shang X. Downregulation of IFIT3 relieves the inflammatory response and myocardial fibrosis of mice with myocardial infarction and improves their cardiac function. Exp Anim 2021; 70:522-531. [PMID: 34234081 PMCID: PMC8614010 DOI: 10.1538/expanim.21-0060] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Myocardial infarction (MI) is a common cardiovascular disease with high morbidity and mortality. In this study, we explored the role of interferon-induced protein with tetratricopeptide repeats 3 (IFIT3) in MI. MI was induced by ligation of the left anterior descending coronary artery. Lentivirus-mediated RNA interference of IFIT3 expression was performed by tail vein injection 72 h before MI modeling. Cardiac injury indexes and inflammatory response were examined 3 days after MI. Cardiac function indexes, infarct size, and cardiac fibrosis were assessed 4 weeks after MI. IFIT3 expression was upregulated in myocardial tissues at both 3 days and 4 weeks after MI. Knockdown of IFIT3 significantly relieved the myocardial injury, as evidenced by the decrease in serum levels of cTnI and CK-MB. In addition, IFIT3 knockdown significantly reduced the number of CD68+ macrophages and the levels of interleukin-1β, interleukin-6, and tumor necrosis factor-α, indicating that the inflammatory response was relieved. Moreover, IFIT3 silencing also significantly improved cardiac function and reduced infarct size, myocardial fibrosis, and collagen content in mice with MI. Mechanically, the present study showed that the activation of the mitogen-activated protein kinase (MAPK) pathway was observed in myocardial tissues of MI mice, which was blocked by IFIT3 knockdown, as indicated by the decreased phosphorylation of JNK, p-38, and ERK. Collectively, our results revealed the role of IFIT3 in the inflammatory response and myocardial fibrosis after MI, indicating that IFIT3 might be a potential target for MI treatment.
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Affiliation(s)
- Jianhua Sun
- Department of Internal Medicine, Hebei Medical University.,Department of Cardiology, Tangshan Gongren Hospital Affiliated to Hebei Medical University
| | - Qi Zhang
- Department of Internal Medicine, Hebei Medical University
| | - Xiaokun Liu
- Department of Internal Medicine, Hebei Medical University
| | - Xiaoming Shang
- Department of Internal Medicine, Hebei Medical University
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Sheriff A, Kayser S, Brunner P, Vogt B. C-Reactive Protein Triggers Cell Death in Ischemic Cells. Front Immunol 2021; 12:630430. [PMID: 33679775 PMCID: PMC7934421 DOI: 10.3389/fimmu.2021.630430] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/22/2021] [Indexed: 01/08/2023] Open
Abstract
C-reactive protein (CRP) is the best-known acute phase protein. In humans, almost every type of inflammation is accompanied by an increase of CRP concentration. Until recently, the only known physiological function of CRP was the marking of cells to initiate their phagocytosis. This triggers the classical complement pathway up to C4, which helps to eliminate pathogens and dead cells. However, vital cells with reduced energy supply are also marked, which is useful in the case of a classical external wound because an important substrate for pathogens is disposed of, but is counterproductive at internal wounds (e.g., heart attack or stroke). This mechanism negatively affects clinical outcomes since it is established that CRP levels correlate with the prognosis of these indications. Here, we summarize what we can learn from a clinical study in which CRP was adsorbed from the bloodstream by CRP-apheresis. Recently, it was shown that CRP can have a direct effect on blood pressure in rabbits. This is interesting in regard to patients with high inflammation, as they often become tachycardic and need catecholamines. These two physiological effects of CRP apparently also occur in COVID-19. Parts of the lung become ischemic due to intra-alveolar edema and hemorrhage and in parallel CRP increases dramatically, hence it is assumed that CRP is also involved in this ischemic condition. It is meanwhile considered that most of the damage in COVID-19 is caused by the immune system. The high amounts of CRP could have an additional influence on blood pressure in severe COVID-19.
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Affiliation(s)
- Ahmed Sheriff
- Pentracor GmbH, Hennigsdorf, Germany.,Medizinische Klinik m.S. Gastroenterologie/Infektiologie/Rheumatologie, Charité Universitätsmedizin, Berlin, Germany
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Kayser S, Brunner P, Althaus K, Dorst J, Sheriff A. Selective Apheresis of C-Reactive Protein for Treatment of Indications with Elevated CRP Concentrations. J Clin Med 2020; 9:E2947. [PMID: 32932587 PMCID: PMC7564224 DOI: 10.3390/jcm9092947] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 01/08/2023] Open
Abstract
Almost every kind of inflammation in the human body is accompanied by rising C-reactive protein (CRP) concentrations. This can include bacterial and viral infection, chronic inflammation and so-called sterile inflammation triggered by (internal) acute tissue injury. CRP is part of the ancient humoral immune response and secreted into the circulation by the liver upon respective stimuli. Its main immunological functions are the opsonization of biological particles (bacteria and dead or dying cells) for their clearance by macrophages and the activation of the classical complement pathway. This not only helps to eliminate pathogens and dead cells, which is very useful in any case, but unfortunately also to remove only slightly damaged or inactive human cells that may potentially regenerate with more CRP-free time. CRP action severely aggravates the extent of tissue damage during the acute phase response after an acute injury and therefore negatively affects clinical outcome. CRP is therefore a promising therapeutic target to rescue energy-deprived tissue either caused by ischemic injury (e.g., myocardial infarction and stroke) or by an overcompensating immune reaction occurring in acute inflammation (e.g., pancreatitis) or systemic inflammatory response syndrome (SIRS; e.g., after transplantation or surgery). Selective CRP apheresis can remove circulating CRP safely and efficiently. We explain the pathophysiological reasoning behind therapeutic CRP apheresis and summarize the broad span of indications in which its application could be beneficial with a focus on ischemic stroke as well as the results of this therapeutic approach after myocardial infarction.
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Affiliation(s)
| | | | - Katharina Althaus
- Department of Neurology, University of Ulm, 89081 Ulm, Germany; (K.A.); (J.D.)
| | - Johannes Dorst
- Department of Neurology, University of Ulm, 89081 Ulm, Germany; (K.A.); (J.D.)
| | - Ahmed Sheriff
- Pentracor GmbH, 16761 Hennigsdorf, Germany;
- Medizinische Klinik m.S. Gastroenterologie/Infektiologie/Rheumatologie, Charité Universitätsmedizin, 12203 Berlin, Germany
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Xi XY, Zhang F, Wang J, Gao W, Tian Y, Xu H, Xu M, Wang Y, Yang MF. Functional significance of post-myocardial infarction inflammation evaluated by 18F-fluorodeoxyglucose imaging in swine model. J Nucl Cardiol 2020; 27:519-531. [PMID: 31741330 DOI: 10.1007/s12350-019-01952-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 10/25/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aim of the study was to investigate the relationship between post-myocardial infarction (MI) inflammation and left ventricular (LV) remodeling in a swine model by 18F-fluorodeoxyglucose (FDG) imaging. METHODS MI was induced in swine by balloon occlusion of the left anterior descending coronary artery. A series of FDG positron emission tomography (PET) images were taken within 2 weeks post-MI, employing a comprehensive strategy to suppress the physiological uptake of cardiomyocytes. Echocardiography was applied to evaluate LV volume, global and regional function. CD68+ macrophage and glucose transporters (GLUT-1, -3 and -4) were investigated by immunostaining. RESULTS The physiological uptake of myocardium was adequately suppressed in 92.3% of PET scans verified by visual analysis, which was further confirmed by the minimal expression of myocardial GLUT-4. Higher FDG uptake was observed in the infarct than in the remote area and persisted within the observational period of 2 weeks. The FDG uptake of infarcted myocardium on day 1 post-MI was correlated with LV global remodeling, and the FDG uptake of infarcted myocardium on days 1 and 8 post-MI had a trend of correlating with regional remodeling of the infarct area. CONCLUSIONS We here report a feasible swine model for investigating post-MI inflammation. FDG signal in the infarct area of swine persisted for a longer duration than has been reported in small animals. FDG activity in the infarct area could predict LV remodeling.
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Affiliation(s)
- Xiao-Ying Xi
- Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China
| | - Feifei Zhang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Changzhou, 213003, Jiangsu, China
| | - Jianfeng Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Changzhou, 213003, Jiangsu, China
| | - Wei Gao
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yi Tian
- Department of Nuclear Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hongyu Xu
- Department of Pathology, Fuwai Hospital, The National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Xu
- Department of Echocardiogram, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Yuetao Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Changzhou, 213003, Jiangsu, China.
| | - Min-Fu Yang
- Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China.
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Ries W, Heigl F, Garlichs C, Sheriff A, Torzewski J. Selective C-Reactive Protein-Apheresis in Patients. Ther Apher Dial 2019; 23:570-574. [PMID: 30924312 DOI: 10.1111/1744-9987.12804] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/22/2019] [Accepted: 03/26/2019] [Indexed: 10/27/2022]
Abstract
C-reactive protein (CRP), the prototype human acute-phase protein, is a well-known marker of inflammation. However, CRP may also mediate tissue damage in various human diseases like atherosclerosis, acute myocardial infarction, dilated cardiomyopathy, stroke, and potentially autoimmune disease. Therefore, CRP elimination from human plasma may indeed be a widely usable therapeutic approach. Recently, a first-in-man case report of selective CRP-apheresis in a patient with acute ST-segment elevation myocardial infarction (STEMI) has been published. Here, the method is further elucidated by detailed description of 13 patients receiving CRP-apheresis at two study centers. Thirteen patients received two sequential CRP-apheresis treatments with the PentraSorb CRP adsorber starting 24 ± 12 h after STEMI and successful percutaneous coronary intervention (PCI). CRP was measured immediately before and after each treatment, and additionally twice a day for a period of 96 h after symptom onset. Compared to the initial (before-treatment) CRP plasma concentration, CRP-apheresis resulted in an average 53.4% ± 11.9% CRP depletion. First apheresis was performed 27.5 ± 4.6 h after symptom onset at a mean CRP concentration of 25.1 ± 11.1 mg/L. Mean CRP concentration after the first treatment was 12.1 ± 6.4 mg/L. Second apheresis started 47.9 ± 5.4 h after symptom onset at a mean CRP concentration of 30.2 ± 21.4 mg/L. After the second treatment, mean CRP concentration was reduced to 13.9 ± 10.9 mg/L. No severe apheresis-associated side effects were observed. Patients tolerated selective CRP-apheresis without any side effects. The new method is feasible and safe and significantly reduces CRP plasma concentration in humans.
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Affiliation(s)
- Wolfgang Ries
- Diakonissenhospital Flensburg Medical Clinic, Flensburg, Germany
| | - Franz Heigl
- Medical Care Center Kempten-Allgäu, Kempten, Germany
| | | | - Ahmed Sheriff
- Department of Gastroenterology, Infectiology and Rheumatology-Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Torzewski
- Cardiovascular Center Oberallgäu-Kempten, Kempten, Germany
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Mattecka S, Brunner P, Hähnel B, Kunze R, Vogt B, Sheriff A. PentraSorb C-Reactive Protein: Characterization of the Selective C-Reactive Protein Adsorber Resin. Ther Apher Dial 2019; 23:474-481. [PMID: 30697961 DOI: 10.1111/1744-9987.12796] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/24/2019] [Accepted: 01/28/2019] [Indexed: 12/18/2022]
Abstract
C-reactive protein (CRP) is well known as a general marker of inflammation. It furthermore represents a reliable risk factor for cardiac events and mediates tissue damage in acute myocardial infarction (AMI). It has been demonstrated that selective CRP depletion by extracorporeal apheresis in a porcine AMI model had beneficial effects on the infarcted area and the cardiac output. We therefore developed a novel adsorber for CRP apheresis from human plasma (PentraSorb CRP). It is intended for use in the clinic as therapy for patients suffering from AMI or other acute inflammatory diseases with elevated CRP plasma levels. The PentraSorb resin specifically bound CRP from human blood plasma and almost no other proteins as determined via Sodium dodecyl sulfate polyacrylamide gel electropheresis (SDS-PAGE). The resin further efficiently and selectively depleted CRP from plasma with low as well as high CRP concentrations (10-100 mg/L) at different flow rates, ranging from 17 to 40 mL/min. The resin was regenerable for up to 200 times without losing its CRP binding capacity or affecting biocompatibility. The depletion of CRP from plasma was comparable between the utilized small-scale column (0.5 mL resin) and the PentraSorb CRP adsorber (20 mL resin volume). The established features can therefore be applied to the clinical setting. In summary, PentraSorb CRP provides a novel, specific, and efficient CRP-binding resin that could be used in apheresis therapy for patients suffering from inflammatory diseases such as AMI, stroke, acute pancreatitis, and Crohn's disease.
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Affiliation(s)
| | | | | | | | | | - Ahmed Sheriff
- Pentracor GmbH, Hennigsdorf, Germany.,Department of Gastroenterology, Infectiology and Rheumatology, Charité University Medicine, Berlin, Germany
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Ishida M, Itoh T, Nakajima S, Ishikawa Y, Shimoda Y, Kimura T, Fusazaki T, Morino Y. A Low Early High-density Lipoprotein Cholesterol Level Is an Independent Predictor of In-hospital Death in Patients with Acute Coronary Syndrome. Intern Med 2019; 58:337-343. [PMID: 30210100 PMCID: PMC6395125 DOI: 10.2169/internalmedicine.0264-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective In patients with acute coronary syndrome (ACS), low high-density lipoprotein cholesterol (HDL-C) levels in samples collected after an overnight fast are diagnostic indicators and well-established predictors of adverse outcomes. However, the relationship between the HDL-C levels in samples collected just after arrival (early HDL-C) and in-hospital mortality remains unknown. The purposes of the present ACS study were to (1) evaluate the association between the early HDL-C levels of patients and in-hospital mortality and (2) compare the early HDL-C level with other well-known determinants associated with in-hospital mortality. Methods This retrospective study surveyed 638 consecutive ACS patients and then assessed the possible determinants of in-hospital mortality. All initial blood samples, including that for early HDL-C, were drawn within one hour of arrival. Results In the present study, the overall in-hospital mortality was 5.9%. A multivariable analysis showed that a low early HDL-C [odds ratio (OR) 2.53, 95% confidence interval (CI) 1.14-5.62], elevated troponin T (OR 4.40, 95% CI 1.26-15.29) and high Killip class (OR 15.41, 95% CI 7.29-32.59) were independent predictors of in-hospital mortality. A Kaplan-Meier survival analysis indicated that there the in-hospital outcome for the low early HDL-C group was significantly worse than that for the high early HDL-C group (age- and gender-adjusted hazard ratio 2.40, 95% CI 1.15-5.00, p=0.02). Conclusion ACS patients with low early HDL-C levels had higher in-hospital mortalities than those who did not have low early HDL-C levels. In addition to the already well-known determinants, low early HDL-C should also be considered as an independent predictor of in-hospital mortality in ACS patients who present to a cardiac care unit.
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Affiliation(s)
- Masaru Ishida
- Department of Internal Medicine, Division of Cardiology, Iwate Medical University, Japan
| | - Tomonori Itoh
- Department of Internal Medicine, Division of Cardiology, Iwate Medical University, Japan
| | - Satoshi Nakajima
- Department of Internal Medicine, Division of Cardiology, Iwate Medical University, Japan
| | - Yu Ishikawa
- Department of Internal Medicine, Division of Cardiology, Iwate Medical University, Japan
| | - Yudai Shimoda
- Department of Internal Medicine, Division of Cardiology, Iwate Medical University, Japan
| | - Takumi Kimura
- Department of Internal Medicine, Division of Cardiology, Iwate Medical University, Japan
| | - Tetsuya Fusazaki
- Department of Internal Medicine, Division of Cardiology, Iwate Medical University, Japan
| | - Yoshihiro Morino
- Department of Internal Medicine, Division of Cardiology, Iwate Medical University, Japan
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C-reactive protein velocity and the risk of acute kidney injury among ST elevation myocardial infarction patients undergoing primary percutaneous intervention. J Nephrol 2019; 32:437-443. [PMID: 30706372 DOI: 10.1007/s40620-019-00594-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/28/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Elevated C-reactive protein (CRP) was shown to be associated with an increased risk for acute kidney injury (AKI) in ST elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI), however, the optimal time frame to measure CRP for risk stratification is not known. We evaluated the relation between the change in CRP over time (CRP velocity-CRPv) and AKI among STEMI patients treated with primary PCI. METHODS We included 801 STEMI who presented between 2007 and 2017 and had their CRP measured with a wide range assay (wr-CRP) at least twice during the 24 h after admission. CRPv was defined as the change in wr-CRP concentration (mg/l) divided by the change in time (in h) between the two measurements. Patient's medical records were reviewed for occurrence of AKI. RESULTS Mean age was 62 ± 16 and 80% were males. Patients with AKI had significantly higher CRPv (1.47 versus 0.4 mg/l/h, p < 0.001). In a multivariate regression model CRPv was independently associated with AKI (OR 1.03, 95% CI 1.01-1.0 5, p = 0.001). On receiver operating characteristic (ROC) curve the optimal cutoff value of CRPv to predict AKI was measured as more than 0.8 mg/l/h, with 70% sensitivity and 65% specificity (AUC 0.712, 95% CI 0.64-0.78, p < 0.001). CONCLUSION CRPv might be an independent and rapidly measurable biomarker for AKI following primary PCI in STEMI patients.
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Rozenbaum Z, Ravid D, Margolis G, Khoury S, Kaufman N, Keren G, Milwidsky A, Shacham Y. Association of pre-admission statin therapy and the inflammatory response in ST elevation myocardial infarction patients. Biomarkers 2018; 24:17-22. [PMID: 29620476 DOI: 10.1080/1354750x.2018.1460765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To demonstrate the possible association of statin therapy with C reactive protein (CRP) serial measurements in ST elevation myocardial infarction (STEMI) patients. MATERIALS AND METHODS STEMI patients between 2008 and 2016 with available CRP data from admission were divided into two groups according to pre-admission statin therapy. A second CRP measurement was noted following primary coronary intervention (within 24 h from admission). The difference between the two measurements was designated ΔCRP. RESULTS The cohort consisted of 1134 patients with a median age of 61 (IQR52-70), 81% males. Patients on statins prior to admission (336/1134, 26%) were more likely to have CRP levels within normal range (≤5 mg/l) compared to patients without prior treatment, both at admission (75 vs. 24%, p = 0.004) and at 24 h (70 vs. 48%, p = 0.029). The prevalence of patients with pre-admission statin therapy decreased as ΔCRP increased (p = 0.004; n = 301). The likelihood of ΔCRP to be above 5 mg/l in patients with pre-admission statin therapy was reduced after age and gender adjustments (OR 0.54, 95% CI 0.32-0.92, p = 0.023) and in multivariate (OR 0.57, 95% CI 0.33-0.99, p = 0.048) analysis. CONCLUSIONS Pre-admission statin therapy is associated with a less robust inflammatory response in STEMI patients, highlighting statin's pathophysiological importance.
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Affiliation(s)
- Zach Rozenbaum
- a Department of Cardiology , Tel Aviv Sourasky Medical Center; Affiliated to the Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Dor Ravid
- a Department of Cardiology , Tel Aviv Sourasky Medical Center; Affiliated to the Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Gilad Margolis
- a Department of Cardiology , Tel Aviv Sourasky Medical Center; Affiliated to the Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Shafik Khoury
- a Department of Cardiology , Tel Aviv Sourasky Medical Center; Affiliated to the Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Natalia Kaufman
- a Department of Cardiology , Tel Aviv Sourasky Medical Center; Affiliated to the Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Gad Keren
- a Department of Cardiology , Tel Aviv Sourasky Medical Center; Affiliated to the Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Assi Milwidsky
- a Department of Cardiology , Tel Aviv Sourasky Medical Center; Affiliated to the Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Yacov Shacham
- a Department of Cardiology , Tel Aviv Sourasky Medical Center; Affiliated to the Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
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Tillmanns J, Fraccarollo D, Galuppo P, Wollert KC, Bauersachs J. Changes in concentrations of circulating fibroblast activation protein alpha are associated with myocardial damage in patients with acute ST-elevation MI. Int J Cardiol 2017; 232:155-159. [DOI: 10.1016/j.ijcard.2017.01.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 11/27/2016] [Accepted: 01/04/2017] [Indexed: 12/12/2022]
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13
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Kircher M, Lapa C. Novel Noninvasive Nuclear Medicine Imaging Techniques for Cardiac Inflammation. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017; 10:6. [PMID: 28357026 PMCID: PMC5352761 DOI: 10.1007/s12410-017-9400-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Inflammation is a key player in a wide range of cardiovascular and myocardial diseases. Given the numerous implications of inflammatory processes in disease initiation and progression, functional imaging modalities including positron emission tomography (PET) represent valuable diagnostic, prognostic, and monitoring tools in patient management. Since increased glucose metabolism is a hallmark of inflammation, PET using the radiolabeled glucose analog [18F]-2-deoxy-2-fluoro-d-glucose (FDG) is the mainstay diagnostic test for nuclear imaging of (cardiac) inflammation. Recently, new approaches using more specific tracers to overcome the limited specificity of FDG have emerged. RECENT FINDINGS PET imaging has proven its value in a number of inflammatory conditions of the heart including myocarditis, endocarditis, sarcoidosis, or reactive changes after myocardial infarction. In infection-related endocarditis, FDG-PET and white blood cell scintigraphy have been implemented in current guidelines. FDG-PET is considered as nuclear medical gold standard in myocarditis, pericarditis, or sarcoidosis. Novel strategies, including targeting of somatostatin receptors or C-X-C motif chemokine receptor CXCR4, have shown promising results in first studies. SUMMARY Nuclear medicine techniques offer valuable information in the assessment of myocardial inflammation. Given the possibility to directly visualize inflammatory activity, they represent useful tools for diagnosis, risk stratification, and therapy monitoring.
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Affiliation(s)
- Malte Kircher
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Constantin Lapa
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
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Milwidsky A, Ziv-Baran T, Letourneau-Shesaf S, Keren G, Taieb P, Berliner S, Shacham Y. CRP velocity and short-term mortality in ST segment elevation myocardial infarction. Biomarkers 2017; 22:383-386. [DOI: 10.1080/1354750x.2017.1279218] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Assi Milwidsky
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tomer Ziv-Baran
- Department of Epidemiology and Preventative Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sevan Letourneau-Shesaf
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gad Keren
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Philippe Taieb
- Department of Internal Medicine “E”, Tel-Aviv Sourasky Medical Center affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shlomo Berliner
- Department of Internal Medicine “E”, Tel-Aviv Sourasky Medical Center affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yacov Shacham
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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15
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Ruparelia N, Chai JT, Fisher EA, Choudhury RP. Inflammatory processes in cardiovascular disease: a route to targeted therapies. Nat Rev Cardiol 2016; 14:133-144. [PMID: 27905474 DOI: 10.1038/nrcardio.2016.185] [Citation(s) in RCA: 311] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Inflammatory processes are firmly established as central to the development and complications of cardiovascular diseases. Elevated levels of inflammatory markers have been shown to be predictive of future cardiovascular events. The specific targeting of these processes in experimental models has been shown to attenuate myocardial and arterial injury, reduce disease progression, and promote healing. However, the translation of these observations and the demonstration of clear efficacy in clinical practice have been disappointing. A major limitation might be that tools currently used to measure 'inflammation' are insufficiently precise and do not provide information about disease site and activity, or discriminate between functionally important activation pathways. The challenge, therefore, is to make measures of inflammation that are more meaningful, and which can guide specific targeted therapies. In this Review, we consider the roles of inflammatory processes in the related pathologies of atherosclerosis and acute myocardial infarction, by providing an evaluation of the known and emerging inflammatory pathways. We highlight contemporary techniques to characterize and quantify inflammation, and consider how they might be used to guide specific treatments. Finally, we discuss emerging opportunities in the field, including their current limitations and challenges that are the focus of ongoing study.
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Affiliation(s)
- Neil Ruparelia
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, Oxford, OX3 9DU, UK
| | - Joshua T Chai
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, Oxford, OX3 9DU, UK.,Acute Vascular Imaging Centre, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Edward A Fisher
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, Oxford, OX3 9DU, UK.,The Center for the Prevention of Cardiovascular Disease and the Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York 10016, USA
| | - Robin P Choudhury
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, Oxford, OX3 9DU, UK.,Acute Vascular Imaging Centre, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
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16
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Kim D, Choi DH, Kim BB, Choi SW, Park KH, Song H. Prediction of Infarct Transmurality From C-Reactive Protein Level and Mean Platelet Volume in Patients With ST-Elevation Myocardial Infarction: Comparison of the Predictive Values of Cardiac Enzymes. J Clin Lab Anal 2016; 30:930-940. [PMID: 27075615 DOI: 10.1002/jcla.21959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/24/2016] [Accepted: 01/30/2016] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND High C-reactive protein (CRP) and mean platelet volume (MPV) levels are associated with poor prognosis in patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to evaluate the relationship between CRP level or MPV and infarct transmurality in patients with STEMI. METHODS We retrospectively reviewed CRP level, MPV, and infarct transmurality in 112 STEMI patients who were assessed with contrast-enhanced cardiac magnetic resonance imaging. RESULTS When the cut-off peak CRP level and MPV were set at 2.35 mg/dl and 7.3 fl using receiver operating characteristic curves analysis, the sensitivity was 67.3/69.2% and specificity was 76.7/76.7% for differentiating between the groups with and those without transmural involvement. Peak CRP level, MPV, peak creatine kinase-MB (CK-MB) level, and peak high-sensitivity cardiac troponin T (hs-cTnT) level had comparable predictive values for transmural involvement (area under the curve, 0.749, 0.761, 0.680, and 0.696, respectively). High peak CRP level and MPV were independent predictors of transmural involvement after adjusting for the peak CK-MB level, peak hs-cTnT level, baseline thrombolysis in myocardial infarction flow grade, and left ventricular ejection fraction (odds ratio: 5.16/5.42, 95% confidence interval: 1.84-14.50/2.03-14.47, P = 0.002/0.001, respectively) in the logistic regression analysis. CONCLUSION The results of this study show that peak CRP level and MPV are predictive markers for transmural involvement. Their predictive power for transmural involvement is independent of and comparable to that of peak CK-MB and hs-cTnT levels.
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Affiliation(s)
- DongHun Kim
- Department of Radiology, Chosun University School of Medicine, Gwangju, Republic of Korea
| | - Dong-Hyun Choi
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Republic of Korea.
| | - Bo-Bae Kim
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Republic of Korea
| | - Seo-Won Choi
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Republic of Korea
| | - Keun Ho Park
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Republic of Korea
| | - Heesang Song
- Department of Biochemistry and Molecular Biology, Chosun University School of Medicine, Gwangju, Republic of Korea
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17
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Cao RY, Zheng H, Guo J, Redfearn DP. Prognostic value of plasma biomarkers in patients with acute coronary syndrome: a review of advances in the past decade. Biomark Med 2016; 10:525-35. [PMID: 27089223 DOI: 10.2217/bmm-2015-0029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Acute coronary syndrome (ACS), especially myocardial infarction, commonly known as a heart attack, is a serious life-threatening cardiovascular disease. Despite dramatic therapeutic advances, there have still been more than 20% patients with ACS suffering recurrent adverse cardiovascular events 3 years after disease onset. Therefore, the aim to prevent cardiac death caused by the heart attack remains challenging. Plasma biomarkers, originally developed to complement clinical assessment and electrocardiographic examination for the diagnosis of ACS, have been reported to play important prognostic roles in predicting adverse outcomes. These biomarkers mirror different pathophysiological mechanisms in association with ACS. In this review, we focus on advances of prognostic biomarkers in the past decade for short- and long-term risk assessment and management of patients with ACS.
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Affiliation(s)
- Richard Y Cao
- Department of Cardiology, Shanghai Xuhui Central Hospital/Shanghai Clinical Research Center, Chinese Academy of Sciences, Shanghai, China
| | - Hongchao Zheng
- Department of Cardiology, Shanghai Xuhui Central Hospital/Shanghai Clinical Research Center, Chinese Academy of Sciences, Shanghai, China
| | - Junjun Guo
- Department of Cardiology, Shanghai Xuhui Central Hospital/Shanghai Clinical Research Center, Chinese Academy of Sciences, Shanghai, China
| | - Damian P Redfearn
- Department of Biomedical & Molecular Sciences, Queen's University, Kingston, Ontario, Canada.,Department of Medicine, Kingston General Hospital, Kingston, Ontario, Canada
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18
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Petricoin EF, Ross MM, Zhou W, Tamburro D, Luchini A, Liotta LA, Herman EH, Scully RE, Miller TL, Franco VI, Sallan SE, Lipshultz SE. Development and pilot evaluation of a new nanoparticle-capture workflow for doxorubicin-induced toxicity biomarker identification. PROGRESS IN PEDIATRIC CARDIOLOGY 2015. [DOI: 10.1016/j.ppedcard.2015.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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19
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Sheriff A, Schindler R, Vogt B, Abdel-Aty H, Unger JK, Bock C, Gebauer F, Slagman A, Jerichow T, Mans D, Yapici G, Janelt G, Schröder M, Kunze R, Möckel M. Selective apheresis of C-reactive protein: a new therapeutic option in myocardial infarction? J Clin Apher 2014; 30:15-21. [PMID: 25044559 DOI: 10.1002/jca.21344] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 06/17/2014] [Accepted: 06/20/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is substantial evidence that C-reactive protein (CRP) mediates secondary damage of the myocardium after acute myocardial infarction (AMI). The aim of this animal trial in pigs was to specifically deplete CRP from porcine plasma after AMI and to study possible beneficial effects of the reduced CRP concentration on the infarcted area. METHODS Ten pigs received balloon catheter-induced myocardial infarction. CRP was depleted from five animals utilizing a new specific CRP-adsorber, five animals served as controls. The area of infarction was analyzed by cardiovascular magnetic resonance imaging on day 1 and day 14 after AMI. Porcine CRP levels were determined by ELISA. RESULTS CRP-apheresis resulted in a mean reduction of the CRP levels up to 48.3%. The area of infarction was significantly reduced by 30 ± 6% (P = 0.003) within 14 days in the treatment group, whereas it increased by 19 ± 11% (P = 0.260) in the controls. Fourteen days after infarction, the infarcted area revealed compact, transmural scars in the controls, whereas animals receiving CRP-apheresis showed spotted scar morphology. In the interventional group, a significantly higher left ventricular ejection fraction (LVEF) was observed after 14 days as compared to the controls (57.6 ± 2.4% vs. 46.4 ± 2.7%; P = 0.007). CONCLUSIONS In a pig model for AMI, we observed that selective CRP-apheresis significantly reduces CRP levels and the volume of the infarction zone after AMI. Additionally, it changes the morphology of the scars and preserves cardiac output (LVEF).
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Affiliation(s)
- Ahmed Sheriff
- Department of Nephrology and Internal Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
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20
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Makrygiannis SS, Ampartzidou OS, Zairis MN, Patsourakos NG, Pitsavos C, Tousoulis D, Prekates AA, Foussas SG, Cokkinos DV. Prognostic usefulness of serial C-reactive protein measurements in ST-elevation acute myocardial infarction. Am J Cardiol 2013; 111:26-30. [PMID: 23040593 DOI: 10.1016/j.amjcard.2012.08.041] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Revised: 08/21/2012] [Accepted: 08/21/2012] [Indexed: 10/27/2022]
Abstract
It has been reported that increased levels of C-reactive protein are related to adverse long-term prognosis in the setting of ST-segment elevation acute myocardial infarction (MI). In previous studies, the timing of C-reactive protein determination has varied widely. In the present study, serial high-sensitivity C-reactive protein (hsCRP) measurements were performed to investigate if any of the measurements is superior regarding long-term prognosis. A total of 861 consecutive patients admitted for ST-segment elevation MI and treated with intravenous thrombolysis within the first 6 hours from the index pain were included. HsCRP levels were determined at presentation and at 24, 48, and 72 hours. The median follow-up time was 3.5 years. New nonfatal MI and cardiac death were the study end points. By the end of follow-up, cardiac death was observed in 22.4% and nonfatal MI in 16.1% of the patients. HsCRP levels were found to be increasing during the first 72 hours. Multivariate Cox regression analysis demonstrated that hsCRP levels at presentation were an independent predictor of the 2 end points (relative risk [RR] 2.8, p = 0.002, and RR 2.1, p = 0.03, for MI and cardiac death, respectively), while hsCRP levels at 24 hours did not yield statistically significant results (RR 1.4, p = 0.40, and RR 1.1, p = 0.80, for MI and cardiac death, respectively). The corresponding RRs at 48 hours were 1.2 (p = 0.5) for MI and 3.2 (p = 0.007) for cardiac death and at 72 hours were 1.6 (p = 0.30) for MI and 3.9 (p <0.001) for cardiac death. In conclusion, hsCRP levels at presentation represent an independent predictor for fatal and nonfatal events during long-term follow-up. HsCRP levels at 48 and 72 hours, which are close to peak hsCRP levels, independently predict only cardiac death.
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21
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Yoshizaki T, Umetani K, Ino Y, Takahashi S, Nakamura M, Seto T, Aizawa K. Activated inflammation is related to the incidence of atrial fibrillation in patients with acute myocardial infarction. Intern Med 2012; 51:1467-71. [PMID: 22728476 DOI: 10.2169/internalmedicine.51.7312] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the relationship between the new onset of atrial fibrillation (AF) and inflammation in the early phase of acute myocardial infarction (AMI). Background Serial interaction between inflammation and the incidence of AF is not fully understood in the early phase of AMI. METHODS Two hundred fifty-nine consecutive patients with AMI were studied. electrocardiogram monitoring was recorded continuously for >7 days. Serial inflammation markers, cardiac enzymes, coronary angiogram and echocardiography were obtained in all patients. RESULTS One hundred seventy-six patients were enrolled. AF was present in 24 patients (14%), and occurred on day 2.7 ± 1.4 after admission. Serial measurements of WBC and C-reactive protein (CRP) with/without AF were as follows. WBC levels of day 5-7 were 9.3 ± 3.5 vs. 7.5 ± 2.4 × 10(3)/µL, p=0.04, and CRP levels of day 2-4, 5-7, 8-14 were 12.6 ± 9.4 vs. 4.7 ± 5.3 mg/dL, p<0.001, 12.3 ± 10.4 vs. 5.2 ± 5.2 mg/dL, p=0.01, and 8.5 ± 7.7 vs. 2.7 ± 4.2 mg/dL, p=0.005, respectively. Those were significantly higher in the patients with AF. In multivariate logistic regression analysis, CRP levels of day 2-4 were independently higher in the patients with AF (odds ratio (OR) 1.15, 95% confidence (CI) 1.04-1.27). CONCLUSION AF in the early phase of AMI occurs a few days after the onset of AMI, which is independently related to the activated inflammation. AF in this period persists for only a short duration.
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Affiliation(s)
- Tohru Yoshizaki
- Cardiology Department, Yamanashi Prefectural Central Hospital, Japan.
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22
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Waks JW, Scirica BM. Established and novel biomarkers in ST-elevation myocardial infarction. Future Cardiol 2011; 7:523-46. [PMID: 21797748 DOI: 10.2217/fca.11.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cardiac biomarkers assist in the diagnosis of and risk stratification in acute coronary syndromes. In ST-elevation myocardial infarction (STEMI), rapid diagnosis and initiation of reperfusion via primary percutaneous coronary intervention or fibrinolysis is often based on the clinical history and presenting ECG, but measurement of biomarkers in the early and/or late phases of STEMI may allow the selection of patients who are at increased or decreased risk of subsequent complications. Although the measurement of only three biomarkers (troponin, natriuretic peptides and C-reactive protein) are currently included in practice guidelines, more than 20 other novel cardiac biomarkers have been proposed to provide improved risk stratification after a STEMI.
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Affiliation(s)
- Jonathan W Waks
- Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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23
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Veselka J, Hájek P, Malý M, Zemánek D, Adlová R, Tomašov P, Martinkovičová L, Tesař D, Červinka P. Predictors of coronary intervention-related myocardial infarction in stable angina patients pre-treated with statins. Arch Med Sci 2011; 7:67-72. [PMID: 22291735 PMCID: PMC3258701 DOI: 10.5114/aoms.2011.20606] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 08/15/2010] [Accepted: 08/24/2010] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Peri-procedural myocardial infarction (PMI) is a frequent and prognostically important complication of percutaneous coronary intervention (PCI). This study was designed to determine the predictors of PMI in patients pre-treated with statins. MATERIAL AND METHODS A total of 418 stable angina pectoris patients taking statins and aspirin were included. All the patients underwent PCI. Serum concentrations of creatine kinase (CK-MB mass) and troponin I (TnI) were measured prior to and then within 16 to 24 hours after PCI. The incidence of PMI was assessed using the established criteria (≥ 3 times upper limit of normal). RESULTS Four hundred and eighteen stable patients (63 ±10 years, 68% males) were treated by PCI. The technical success rate of PCI was 99%. The incidence of PMI based on CK-MB mass or TnI release was 12% (PMI group). There were no significant differences in baseline clinical and procedural characteristics between PMI and non-PMI groups except for the balloon inflation time (40 ±44 s vs. 26 ±27 s; p = 0.02) and the proportion of treated type C lesions (42% vs. 28%; p = 0.03). In multivariate analysis, the independent predictors of PMI were balloon inflation time (OR = 1.01; 95% CI 1.001-1.020; p = 0.02) and pre-procedural level of C-reactive protein (OR = 1.38; 95% CI 1.059-1.808; p = 0.02). CONCLUSIONS These results suggest that C-reactive protein and balloon ischaemic time are independent predictors of PMI in stable angina patients pre-treated with statins.
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Affiliation(s)
- Josef Veselka
- Department of Cardiology, 2 Medical School, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Petr Hájek
- Department of Cardiology, 2 Medical School, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Martin Malý
- Department of Cardiology, 2 Medical School, Charles University, University Hospital Motol, Prague, Czech Republic
| | - David Zemánek
- Department of Cardiology, 2 Medical School, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Radka Adlová
- Department of Cardiology, 2 Medical School, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Pavol Tomašov
- Department of Cardiology, 2 Medical School, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Lucie Martinkovičová
- Department of Cardiology, 2 Medical School, Charles University, University Hospital Motol, Prague, Czech Republic
| | - David Tesař
- Department of Cardiology, 2 Medical School, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Pavel Červinka
- Department of Cardiology, Masaryk Hospital, Ústí nad Labem, Czech Republic
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Roubille F, Cayla G, Picot MC, Pradet V, Massin F, Gervasoni R, Pasquie JL, Macia JC, Piot C, Leclercq F. Intérêt de la C-reactive protein (CRP) dans l’évaluation pronostique de l’infarctus du myocarde revascularisé. Rev Med Interne 2008; 29:868-74. [DOI: 10.1016/j.revmed.2008.01.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Revised: 01/23/2008] [Accepted: 01/23/2008] [Indexed: 10/22/2022]
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25
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Elmariah S, Smith SC, Fuster V. Late medical versus interventional therapy for stable ST-segment elevation myocardial infarction. ACTA ACUST UNITED AC 2008; 5:42-52. [DOI: 10.1038/ncpcardio1056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Accepted: 09/27/2007] [Indexed: 11/09/2022]
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26
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Lim P, Collet JP, Moutereau S, Guigui N, Mitchell-Heggs L, Loric S, Bernard M, Benhamed S, Montalescot G, Randé JLD, Guéret P. Fetuin-A Is an Independent Predictor of Death after ST-Elevation Myocardial Infarction. Clin Chem 2007; 53:1835-40. [PMID: 17702860 DOI: 10.1373/clinchem.2006.084947] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background: Fetuin-A inhibits inflammation and has a protective effect against myocardial ischemia. Its deficiency has been found to be associated with cardiovascular death in patients with end-stage renal failure disease. We investigated the association between plasma fetuin-A and clinical outcome after ST-elevation acute myocardial infarction (STEMI).
Methods: We measured fetuin-A in 284 consecutive patients with STEMI and correlated these data with the occurrence of death at 6 months (n = 25). We also measured fetuin-A in a control group and chose the 95th percentile as the cutoff to define abnormality.
Results: Patient mean (SD) age was 60 (14) years, and creatinine clearance was 83 (31) mL/min; 82% were men. Mean (SD) plasma fetuin-A concentrations at admission [188 (69) mg/L, P = 0.01] and at day 3 [163 (57) mg/L, P <0.0001] were lower in patients than in controls [219 (39) mg/L; 95th percentile 140 mg/L]. Fetuin-A <140 mg/L was observed in 20% of patients at admission vs 40% at day 3 (P <0.001). Fetuin-A concentrations did not correlate with peak cardiac troponin values but did correlate inversely with C-reactive protein (CRP) and NT-pro-brain natriuretic peptide (NT-proBNP). Fetuin-A <140 mg/L at admission (OR = 3.3, P = 0.03) and at day 3 (OR = 6.3, P = 0.002) was an independent correlate of death at 6 months, irrespective of NT-proBNP, CRP, or Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) risk score. Conversely, fetuin-A ≥140 mg/L was associated with an excellent survival rate [negative predictive value (NPV) = 97% overall], even in high-risk populations with CADILLAC risk score ≥6 (NPV = 90% in patients).
Conclusions: Fetuin-A is an important predictor of death at 6 months in STEMI patients independent of NT-proBNP, CRP, and CADILLAC risk score.
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Affiliation(s)
- Pascal Lim
- Department of Cardiology, Assistance Publique Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France.
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27
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Lin JW, Dai DF, Chou YH, Huang LY, Hwang JJ. Exploring the Effects of C-Reactive Protein (CRP) and Interleukin-1 β Single Nucleotide Polymorphisms on CRP Concentration in Patients With Established Coronary Artery Disease . Int Heart J 2007; 48:463-75. [PMID: 17827818 DOI: 10.1536/ihj.48.463] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE This study was designed to illustrate the effects of C-reactive protein (CRP) and interleukin polymorphisms on serum CRP levels. METHODS A total of 390 patients with coronary heart disease (CHD) were recruited and high-sensitivity CRP levels were measured. Six polymorphic alleles on the genes of CRP, IL-1, and the IL-1 receptor antagonist were identified. A classification tree was applied to determine their effects and interactions on serum CRP levels. RESULTS In the hypertensive CHD patients, the presence of CRP + 1059 GC heterozygotes was associated with a lower risk for elevated CRP levels (OR = 0.318, P = 0.001). The coexistence of CRP + 1059 GC and IL-1beta-511 (CT or TT) might result in reduction in the CRP levels compared to IL-1beta-511 CC (OR = 0.222, P = 0.088 and OR = 0.148, P = 0.060, respectively). CONCLUSION The results demonstrated the distribution of CRP-related polymorphisms and the interactions in Taiwanese patients with CHD.
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Affiliation(s)
- Jou-Wei Lin
- Cardiovascular Center, National Taiwan University Hospital, Yun-Lin Branch
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