急性心肌梗死后左心室功能与C反应蛋白水平的相关性

目的检测急性心肌梗死(AMI)后患者的左心室(LV)功能,评估其与C反应蛋白(CRP)(早期炎症反应的标志物)之间的相关性。方法我们检测了发生AMI后患者的早期CRP水平,并将其与心脏早期结构和功能的改变相联系。从2005年11月至2011年12月,我们前瞻性地检测了514例(平均年龄(60±15)岁,59%为男性)发生AMI患者的CRP水平,并获得了超声心动图结果。测定了中位数为6.1h的早期CRP,中值CRP水平为4.8mg/L,超声心动图是发生AMI后中位数为1d的情况下测量的。结果室壁运动评分指数、左心室射血分数和左心室直径在整个CRP三分位数(所有P>0.05)范围内都非常类似。更高的CRP水平与存在中度或重度的舒张功能障碍(P=0.002)和中度或重度二尖瓣回流(P<0.001)相关。更高的CRP水平与中度或重度二尖瓣回流之间的相关性与临床特点和ST段抬高状态相独立。结论在AMI的初始阶段,CRP升高与存在严重的二尖瓣回流和舒张功能障碍有关。这表明,炎症与心室重构过程有关,而与左心室收缩功能无关。

Left ventricular function and C-reactive protein levels in acute myocardial infarction

Objective To examine left ventricular （LV） function in patients after acute myocardial in- faretion （AMI） and assess its relation to C-reactive protein （CRP） as a measure of the early inflammatory re- sponse. Methods We measured the CRP levels early after AMI and correlated them. with the early structural and functional cardiac alterations. From November 2005 to December 2011, we prospectively enrolled commu- nity subjects who had experienced an AMI, measured the CRP level, and obtained an echocardiogram. The study consisted of 514 patients （ mean age 60 ~ 15 years, 59% men）. CRP was measured early after symptom onset （median 6. 1 hours）. The median CRP level was 4. 8 mg/L. The echocardiograms were obtained at a me- dian of 1 day after AMI. Results The wall motion score index, LV ejection fraction, and LV diameter were similar across the CRP tertiles （ all P 〉 0. 05）. Greater CRP levels were associated with the presence of moder- ate or severe diastolic dysfunction （ P = O. 002） and moderate or severe mitral regurgitation （ P 〈0. 001 ）. The association with moderate or severe mitral regurgitation was independent of the clinical characteristics and ST- segment elevation status. Conclusion At the initial phase of AMI, CRP elevation was associated with the pres- ence and severity of mitral regurgitation and diastolic dysfunction. This suggests that inflammation is related to the ventricular remodeling processes, independently of LV systolic function.