Association of C-Reactive Protein Velocity with Early Left Ventricular Dysfunction in Patients with First ST-Elevation Myocardial Infarction

Magdalena Holzknecht, Christina Tiller, Martin Reindl, Ivan Lechner, Priscilla Fink, Patrick Lunger, Agnes Mayr, Benjamin Henninger, Christoph Brenner, Gert Klug, Axel Bauer, Bernhard Metzler, Sebastian Johannes Reinstadler, Magdalena Holzknecht, Christina Tiller, Martin Reindl, Ivan Lechner, Priscilla Fink, Patrick Lunger, Agnes Mayr, Benjamin Henninger, Christoph Brenner, Gert Klug, Axel Bauer, Bernhard Metzler, Sebastian Johannes Reinstadler

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.

Keywords: C-reactive protein; ST-elevation myocardial infarction; cardiac magnetic resonance imaging; left ventricular function.

Conflict of interest statement

All authors have declared no conflict of interest.

Figures

Figure 1
Figure 1
Boxplot showing the relation between CRPv and LVEF. CRPv = C-reactive protein velocity, LVEF = left ventricular ejection fraction.

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