+44-7360-538437Research Article - Biomedical Research (2017) Volume 28, Issue 10
Hs-CRP and cTnI are associated with left ventricular remodeling in STEMI patients undergoing elective PCI treatment
Lingli Wang, Shifeng Miao, Weiguang Zhou and Jijun Ding*
Department of Cardiovascular Medicine, the Affiliated Aoyang Hospital of Jiangsu University, No.279, Jinggang Road, Zhangjiagang City, Zuzhou City, Jiangsu Province, PR China
- *Corresponding Author:
- Jijun Ding
Department of Cardiovascular Medicine
The Affiliated Aoyang Hospital of Jiangsu University, PR China
Accepted on February 23, 2017
Abstract
Objective: To explore the predictive value of high sensitive C Reactive Protein (hs-CRP) and serum cardiac Troponin I (cTnI) on left ventricular remodeling in patients with acute ST Segment Elevation Myocardial Infarction (STEMI) undergoing elective Percutaneous Coronary Intervention (PCI).
Methods: 140 cases of STEMI were selected accepting the offer PCI treatment in our hospital, after the onset of 3 days and 6 months after onset were measured Left Ventricular End Diastolic Volume (LVEDV), the comparison between LVEDV value, if the increase rate greater than 20% is classified as left ventricular remodeling group (n=80), <20% to for the non-left ventricular remodeling group (n=60). Detection of all patients with 24 h after the onset of serum hs-CRP, cTnI, and the use of logistic regression analysis of hs-CRP, cTnI and left ventricular remodeling.
Results: There was no significant difference (cTnI) in the left ventricular remodeling group after 3 days. The hs-CRP and cTnI of the left ventricular remodeling group were significantly higher than those of the non-reconstruction group (P<0.05) after 6 months; Logistic regression analysis showed that hs-CRP, cTnI were correlated with left ventricular remodeling (P<0.05).
Conclusion: cTnI and hs-CRP are associated with the left ventricular remodeling occurred after PCI treatment in patients with STEMI.
Keywords
hs-CRP, cTnI, Elective PCI, STEMI, Left ventricular remodeling.
Introduction
STEMI is one of common seen Myocardial Infarction (MI) in clinics. Most of them caused by decreased and interrupted coronary blood supply after coronary lesion, which causes severe and lasting myocardium acute ischemia [1]. STEMI have characteristics of severe coronary occlusion and big infarction area. So we treat it scalely after happens. The occurrence rate of Major Adverse Cardiovascular Events (MACE) in the near and specified future date is still high, the most common is left ventricular remodeling [2,3]. Left ventricular remodeling is an important index for predicting congestive heart failure and cardiovascular death after Acute Myocardial Infarction (AMI) [4]. After AMI, myocardial lesions and inflammatory reaction have relations with left ventricular remodeling, which make cTnI and hs-CRP become important indexes for predicting left ventricular remodeling [5]. The thesis aims at studying predictive value of hs-CRP and cTnI for patients with left ventricular remodeling after PCI in STEMI. The following are the detailed reports of this study.
Materials and Methods
Clinical materials
In this study, 140 cases of STEMI accepting selective PCI treatment in our hospital from January 2013 to January 2016 were selected. Within 3 days after onset and 6 months after onset, their Left Ventricular End Diastolic Volumes (LVEDV) were measured respectively, and compared. This research was approved by the animal committee of Ao Yang Hospital. If the increase rate was greater than or equal to 20%, it was classified in the left ventricular remodeling group (n=80), and if it was less than 20%, classified in the non-left ventricular remodeling group (n=60). There were 31 female cases and 49 male cases in the left ventricular remodeling group, aged from 46 to 79 years, and mean age of (65 ± 2) years; in the non-left ventricular remodeling, 25 female cases and 35 male cases, aged from 48 to 78 years, and mean age of (64 ± 3) years. The age, sex, risk factors, various biochemical indexes in both groups were compared, as shown in following Table 1.
| Items | Left ventricular remodeling (n=80) | Non left ventricular remodeling (n=60) | t/χ2 value | P value | |
|---|---|---|---|---|---|
| Sex (Male/female) | 49/31 | 35/25 | 1.104 | 0.062 | |
| Age (year) | 46~79 (65 ± 2) | 48~78 (64 ± 3) | 0.932 | 0.067 | |
| Risk factors (n) | Older age (≥ 65) | 35 | 32 | ||
| Smoke | 47 | 45 | |||
| Hypertension | 54 | 56 | |||
| Hyperlipidemia | 39 | 42 | 1.305 | ||
| Glucose | 27 | 26 | 0.056 | ||
| Biochemical indexes | Blood glucose (mmol/L) | 6.82 ± 1.12 | 6.79 ± 1.43 | ||
| Creatinine (μmol/ L) | 83.26 ± 18.19 | 87.45 ± 13.08 | |||
| uric acid (μmol/ L) | 339.37 ± 64.74 | 345.62 ± 50.34 | 0.953 | 0.085 | |
| Triglyceride (mmol/L) | 1.49 ± 0.46 | 1.58 ± 0.72 | |||
| CHOL (mmol/L) | 4.41 ± 1.15 | 4.31 ± 1.31 | |||
| LDL (mmol/L) | 2.35 ± 0.74 | 2.52 ± 0.65 | |||
| HDL (mmol/L) | 1.09 ± 0.23 | 1.01 ± 0.18 | |||
| Ultrasonic test | EF (EF/%) | 52.32 ± 6.25 | 51.21 ± 7.39 | ||
| LVD (cm) | 5.17 ± 0.27 | 5.32 ± 0.36 | 1.284 | 0.053 | |
| Length of stay (d) | 11.5 ± 3.5 | 12.0 ± 3.0 | 0.783 | 0.091 | |
Table 1. Statistical table of basic information of patients in both groups.
Exclusion criteria
Patients who met any one of the following circumstances should be excluded from this study [5]: 1. Patients with OMI;2. Patients with secondary cardiac rupture, chordae tendinae rupture, acute heart failure and severe valvular disease; 3. Severe liver and kidney function deficiency; 4. Patients with malignant tumors; 5. Patients lost follow-up after operation.
Methods
Medical history, symptoms, sign, electrocardiogram, biochemical indexes of all patients were collected. In the 8 h, 12 h and 24 h after the onset of disease, cTnI was detected by ICMAS through extracting elbow vein blood (maximum was selected in three). Serum hs-CRP value after the onset of 24 h was detected by immunoturbidimetry. LVEDV, LVESV, LVEF, LVEDD and LVESD were measured by echocardiogram during the acute onset of 3 days and 6 months after onset. After onset, emergency treatment was made for patients. Illness state was stabilized. Coronary angiography was operated from the 5 to 7 days of onset (multidimensional, multi-angle and multivessel observation, target vessel stenosis ≥ 50%, it was lesion vessel, stenosis ≥70%, it was target vessel). Stenosis vessel was operated selectively by PCI. Criterion of PCI success as followed: Lesion vessels stenosis reduced fewer than 20%; Patients felt symptoms improved obviously; No acute complications; No severe heart events at the time of hospitalization. Once follow-up per month after patients’ discharged from hospital.
Evaluation index
After the onset of 3 days and 6 months after onset were measured left ventricular end diastolic volume (LVEDV), the comparison between LVEDV value, if the increase rate greater than 20% was classified as left ventricular remodeling group (n=80), <20% to for the non-left ventricular remodeling group (n=60). Detection of all patients with 24 h after the onset of serum hs-CRP, cTnI, and the use of logistic regression analysis of hs-CRP, cTnI and left ventricular remodeling.
Statistical methods
All data in this study were analysed by SPSS19.0 software. T value test was used for measurement data. Chi-square test was used for comparison among groups. Test standard was a=0.05. P<0.05 indicated that there was statistical difference. Regression analysis of hs-CRP, cTnI and left ventricular remodeling were made by logistic. P<0.05 indicated that there was statistical difference.
Results
The levels of hs-CRP, cTnI of patients 3 days after disease onset in both groups
The levels of hs-CRP and cTnI of patients 3 days and 6 months after onset of disease in both groups were shown in the following Table 2.
| Group | Case number (n) | hs-CRP (mg/L) | cTnI (μg/L) | ||
|---|---|---|---|---|---|
| 3 days after onset | 6 months after onset | 3 days after onset | 6 months after onset | ||
| Left ventricular remodeling | 80 | 10.12 ± 2.47 | 43.97 ± 12.74 | 8.75 ± 3.41 | 25.62 ± 5.37 |
| Non left ventricular remodeling | 60 | 10.95 ± 2.75 | 23.25 ± 9.01 | 8.44 ± 4.01 | 14.86 ± 4.02 |
| χ2 | 0.904 | 5.408 | 1.032 | 4.984 | |
| P | 0.062 | 0.017 | 0.074 | 0.028 | |
Table 2. The levels of hs-CRP, cTnI of patients 3 days and 6 months after onset of disease in both groups.
The level of hs-CRP, cTnI after the onset of six months of patients in both groups
Compared with left ventricular remodeling, non-left ventricular remodeling has a significant decrease in hs-CRP and cTnI (χ2=5.408, P=0.017; χ2=4.984, P=0.028, Table 3).
| Group | Case number (n) | hs-CRP (mg/L) | cTnI (μg/L) |
|---|---|---|---|
| Left ventricular remodeling | 80 | 43.97 ± 12.74 | 25.62 ± 5.37 |
| Non left ventricular remodeling | 60 | 23.25 ± 9.01 | 14.86 ± 4.02 |
| χ2 | 5.408 | 4.984 | |
| P | 0.017 | 0.028 |
Table 3. The level of hs-CRP, cTnI after the onset of six months of patients in both groups.
The results of logistic regression analysis
Logistic regression analysis showed that hs-CRP and cTnI had relations with left ventricular remodeling (OR=1.23, P=0.027; OR=1.24, P=0.021) except irrelevant factors. The level of hs- CRP and cTnI got more high, the risk of left ventricular remodeling got more high.
Discussion
In recent years, with the improvement of people’s living level and changes of living modes, the incidence of coronary heart disease is increasing, especially high in the middle-aged and elderly people which stay at a high rate [6]. Coronary heart disease can cause many complications, especially in the advanced stage, it will lead to very dangerous complications, and one common complication is MI. Patients of MI have severe conditions, which need urgent treatment. The common treatments for MI are thrombolytic therapy, vasodialation, decrease of various high-risk factors, etc. But the effect of this therapy is unstable. The thrombolytic therapy will cause many complications with low safety. With the development of intervention therapy in clinics, the PCI is increasingly applied for vascular recanalization of patients with acute MI [7,8].
Myocardial ischemia after acute MI causes regional myocardial contraction. The ventricular remodeling occurs immediately after MI. Ventricular remodeling can be divided into extension phase of early MI and advanced overall ventricular dilatation according to different times [9]. In the early stage, ventricular remodeling can strengthen myocardial contractility and recover cardial pump functions to some extent. However, the long-term ventricular remodeling can cause ventricular dilatation widely, finally cause heart failure. Therefore, ventricular remodeling is an important long-term adverse event of prognosis after MI [10]. If the occurrence risk of ventricular remodeling can be predicted through index of myocardiac enzymology, it will be of great significance to prediction for long-term prognosis of patients with MI and prevention for adverse cardiovascular events.
CRP is a kind of inflammatory acute RP synthesized by the liver, and it is one of the sensitive markers of acute nonspecific inflammation of body. Myocardial tissue ischemia may cause local necrosis and inflammation after MI occurs. Therefore, CRP is regarded as classical protein for MI detection, which can reflect inflammatory degree of Infarct Size (IS) [11]. In this study, there was no significant difference (hs-CRP) in hs- CRP levels between the left ventricular remodeling group and the non-reconstruction group (P>0.05) in the initial stage (within 24 h); for the long-term (6 months), the hs-CRP level in the left ventricular remodeling group was significantly higher than that of the non-reconstruction group (P<0.05); the logistic regression analysis showed that hs-CRP level was correlated with left ventricular remodeling (P<0.05).
cTnI is a specific structural protein of myocardium, which only exists in myocardial tissue. cTnI is released into blood when myocardial injury happens, which increase the level of cTnI in blood. Therefore, cTnI is a sensitive specific marker for MI [12]. In this study, there was no significant difference in the peak cTnI values between the left ventricular remodeling group and the non-reconstruction group in the initial stage (24 h) after MI. The cTnI level of the left ventricular remodeling group was significantly higher than that of the non-reconstruction group (P<0.05) after 6 months (long term after onset of disease); logistic regression analysis showed that cTnI level was correlated with left ventricular remodeling (P<0.05).
In summary, hs-CRP and cTnI can be used to predict whether left ventricular remodeling occurs after selective PCI treatment for STEMI patients.
References
- Juillicre Y, Cambou JP, Bataille V, Mulak G, Galinier M. Heart failure in acute myocardial infarction: a comparison between patients with or without heart failure criteria from the FAST-MI registry. Rev Esp Cardiol (Engl Ed) 2012; 65: 326-333.
- Makrygiannis SS, Ampartzidou OS, Zairis MN, Patsourakos NG, Pitsavos C, Tousoulis D. Prognostic usefulness of serial C-reactive protein measurements in ST-elevation acute myocardial infarction. Am J Cardiol 2013; 111: 26-30.
- Mayr A, Mair J, Schocke M, Klug G, Pedarnig K, Haubner BJ. Predictive value of NT-proBNP after acute myocardial infarction: Relation with acute and chronic infarct size and myocardial function. Int J Cardiol 2011; 147: 118-123.
- Haaf P, Balmelli C, Reichlin T, Twerenbold R, Reiter M. N-terminal pro B-type natriuretic peptide in the early evaluation of suspected acute myocardial infarction. Am J Med 2011; 124: 731-739.
- Arora NP, Ghali JK. Iron deficiency anemia in heart failure. Heart Fail Rev 2013; 18: 485-501.
- Beavers CJ, Alburikan KA, Rodgers JE, Dunn SP, Reed BN. Distinguishing anemia and iron deficiency of heart failure: signal for severity of disease or unmet therapeutic need? Pharmacotherapy 2014; 34: 719-732.
- Jankowska EA, Kasztura M, Sokolski M, Bronisz M, Nawrocka S, Oleskowska-Florek W. Iron deficiency defined as depleted Iron stores accompanied by unmet cellular Iron requirements identifies patients at the highest risk of death after an episode of acute heart failure. Eur Heart J 2014; 35: 2468-2476.
- Shah R, Agarwal AK. Anemia associated with chronic heart failure: current concepts. Clin Interv Aging 2013; 8: 111-122.
- Riegersperger M, Covic A, Goldsmith D. Allopurinol, uric acid and oxidative stress in cardiorenal disease. Int Urol Nephrol 2011; 43: 441-449.
- Jeong HC, Ahn Y, Park KH. Effect of statin treatment in patients with acute myocardial infarction and left ventricular systolic dysfunction according to the level of high-sensitivity C-reactive protein. Int Heart J 2014; 55: 106-112.
- Rashidinejad H, Rashidinejad A, Moazenzadeh M, Azimzadeh BS, Afshar RM, Shahesmaeili A.The role of high-sensitivity C-reactive protein for assessing coronary artery disease severity and left ventricular end diastolic pressure in patients with suspected coronary artery disease. Hung Kong Med J 2013; 19: 328-333.
- Ahmed K, Jeong MH, Chakraborty R, Cho KH, Sim DS, Hong YJ. Prognostic impact of baseline high-sensitivity C-reactive protein in patients with acute myocardial infarction undergoing percutaneous coronary intervention based on body mass index. Korean Circ J 2012; 42: 164-172.