AUTHOR=Tong David C. , Whitbourn Robert , MacIsaac Andrew , Wilson Andrew , Burns Andrew , Palmer Sonny , Layland Jamie 

TITLE=High-Sensitivity C-Reactive Protein Is a Predictor of Coronary Microvascular Dysfunction in Patients with Ischemic Heart Disease

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=4

YEAR=2018

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2017.00081

DOI=10.3389/fcvm.2017.00081

ISSN=2297-055X

ABSTRACT=<sec id="ST1"><title>Background</title><p>Inflammation and microvascular dysfunction (MVD) are independently associated with adverse cardiovascular outcomes in patients with ischemic heart disease. This study aimed to assess the relationship between inflammation, MVD, and myocardial injury.</p></sec><sec id="ST2"><title>Methods</title><p>Coronary microvascular function was assessed in 74 patients undergoing percutaneous coronary intervention (PCI) using the index of microvascular resistance (IMR) by a pressure–temperature sensor-tipped wire. Serum high-sensitivity C-reactive protein (hsCRP) level was quantified by rate turbidimetry. Severe MVD was defined as IMR ≥ 30. Pearson correlation was computed to assess the relationships between hsCRP, troponin, and IMR of culprit vessel. Predictors of severe MVD were assessed by regression analysis.</p></sec><sec id="ST3"><title>Results</title><p>Acute coronary syndromes (ACSs) represented 49% of the total cohort. Study cohort was divided into low C-reactive protein (CRP) (hsCRP &lt; 3 mg/L) and high CRP (hsCRP ≥ 3 mg/L) groups. There was higher representation of smokers (78 vs. 52%), diabetics (39 vs. 18%), and ACS (61 vs. 33%), as well as higher body mass index (29.4 ± 4.6 vs. 27.2 ± 4.1) in the high CRP group. Pre-PCI and post-PCI IMR were significantly elevated in the high CRP group compared to the low CRP group (pre-PCI IMR: 29.0 ± 13.9 vs. 17.4 ± 11.1, <italic>p</italic> &lt; 0.0001; post-PCI IMR: 23.0 ± 16.8 vs. 15.5 ± 8.4, <italic>p</italic> = 0.02). Peak troponin levels were significantly raised in the high CRP group (9.96 ± 17.19 vs. 1.17 ± 3.00 μg/L, <italic>p</italic> = 0.002). There was a strong positive correlation between hsCRP and pre-PCI IMR (<italic>r</italic> = 0.85, <italic>p</italic> &lt; 0.0001). Pre- and post-PCI IMR levels were correlated with peak troponin level (<italic>r</italic> = 0.45, <italic>p</italic> &lt; 0.0001; <italic>r</italic> = 0.33, <italic>p</italic> = 0.005, respectively). Predictors of severe MVD include male gender (OR 3.0), diabetes (OR 3.7), smoking history (OR 4.0), ACS presentation (OR 8.5), and hsCRP ≥ 3 mg/L (OR 5.6).</p></sec><sec id="ST4"><title>Conclusion</title><p>hsCRP is a significant predictor of MVD while MVD is associated with myocardial injury, supporting the central role of inflammation and MVD in the pathophysiology and complications of coronary artery disease.</p></sec><sec id="ST5"><title>Clinical Trial Registration</title><p>Australian New Zealand Clinical Trials Registry (ACTRN): 12617000648325. Universal Trial Number (UTN): U1111-1196-2246.</p></sec>