C-Reactive Protein Level, Could Be a Useful Predictor of LV Systolic Dysfunction Post Myocardial Infarction

Background: C-reactive protein is an acute phase protein that is produced predominantly by hepatocytes under the influence of cytokines such as interleukin (IL)-6 and tumor necrosis factor-alpha, which increased in response to infection, ischemia, trauma, burns, and inflammatory conditions. Ligand-bound or aggregated C-reactive protein binds C1q and in so doing activates the classical complement pathway. A growing number of studies suggest that C-reactive protein is an independent risk factor for vascular disease, the baseline plasma concentration of C-reactive protein predicts the risk of future myocardial infarction and stroke and is associated with a poor prognosis in unstable angina. C-reactive protein estimation can help in predicting short-and long-term prognosis after acute myocardial infarction. High plasma C-reactive protein level in the acute phase strongly indicates a poor clinical outcome of the patients with myocardial infarction. Aim of the Study: To assess the relationship between the admission C-reactive protein levels and left ventricular function in patients with acute myocardial infarction. Patients and Methods: Thirty patients 26 males (86.6%) and 4 females (13.4%) with a mean age of 52±9.82 years, with recent ST elevation myocardial infarction were included in the study over the period from August 2004 to July 2005. All patients included in the study were presenting with symptoms of recent myocardial infarction. Following admission all patients were subjected to full medical history, clinical examination, standard 12-lead ECG, and routine laboratory investigations including cardiac enzymes (CK, CK-MB and LDH) and venous blood samples for C-reactive protein were obtained at time of admission. Assessment of left ventricular function by echocardiography was done to all patients on day 2 or 3 of hospitalization. Result: Based on C-reactive protein level we classified the patients into two groups. Group A: Including patients with CRP level ≤2.5mg/dl, (mean 1.36±0.81mg/dl), (n=16). Group B: Including patients with CRP level 2.5mg/dl, (mean 6.42±3.87mg/dl), (n=14). The mean C-reactive protein level was significantly higher in group B than group A (6.42±3.87 Vs 1.36±0.81), p value 0.05 and the mean CK and CK-MB level was higher in Group B (528±691.5 46.3±2.7U/L) than in Group A (342.3±589.3 30.1±2.1U/L) respectively, but the p value was not significant. LVEDV was significantly higher in group B than group A (79.17±17.2 Vs 62.3±18.6) p value 0. 04, LVESV also was significantly higher in group B than group A (39.4±12.2 Vs 26.9±10.6) p value 0.035. And LV EF was significantly lower in group B Compared to group A (46.7±11.9% Vs 56.9±7.7%) p value 0.02. And the Severity of diastolic dysfunction was significantly greater in Group B (diastolic dysfunction grade II-III; E/A ratio 1.8±0.3) than in Group A (diastolic dysfunction grade I-II; E/A ratio 1.1±0.2). In Conclusion: C-reactive protein could be used as an index of the severity of myocardial necrosis and prediction of LV systolic dysfunction.