High-sensitivity C-Reactive Protein and left ventricular remodeling in patients with type II diabetes mellitus and acute myocardial infarction

Author: Moldovan CarmenCo-authors: Opincariu Diana Balan Daniel

University of Medicine and Pharmacy Tg. MuresCardiology Clinic, Mures Emergency Clinical

CountyHospital,Prof. Benedek Imre, MD, Head of Clinic

Coordinators: Prof. Dr. Benedek Theodora

Prof. Dr. Benedek Imre

Key stages in the development of Acute Coronary Syndrome

1. Ischemic cascade2. Plaque formation and

rupture 3. Coronary occlusion

and MI4. Ventricular

remodeling

REMODELING PREVENTION

Pharmacological intervention:

-ACE-inhibitors

-Beta-blockers-Diuretics-Ca-blockers and other

PTCA

AIMWe aimed at assessing the correlation between the amplitude of the left ventricular remodeling and persistence of elevated circulating levels of an inflammation marker -highly sensitive CRP - at 7 +/- 2 days after an AMI in patients with type 2 DM. 

MATERIALS AND METHODS45 patients

Inclusion criteria:

Acute myocardial infarction

DM type II Optimal medical

treatment Primary PCI

• Exclusion criteria:

History of cardiac surgery Previous myocardial

infarction Age under 18

The LV function and remodeling were assessed at baseline and at 6 months after the infarction.

MATERIALS AND METHODS

Patients underwent through several steps:

Clinical examination Laboratory examination ECG Echocardiography Coronarography

The study population was divided into 2 groups:

Group 1: 22patients with low-to-intermediate risk (hsCRP<3mg/l)

Group 2: 23 patients with high-risk (hsCRP>3mg/l)

Characteristics of the study population at baseline

FEATURE GROUP 1 GROUP 2 P value

Age 60.59 +/- 8.7 61.30 +/- 10.70 0.8

Gender , male 16 (68.18%) 13 (56.5%) 0.3

Presence of hypertension

16 (68.18%) 19 (82.6%) 0.76

Dyslipidemia 14 (63.3%) 15 (65.2%) 1

Obesity 5 (22.7%) 6 (26.1%) 0.9

Smoker* 10 (45.4%) 6 (26.1%) 0.22

*past or present

Characteristics of the study populationat baseline

FEATURE GROUP 1 GROUP2 P value

Ejection fraction 95% confidence interval

48.88+/-4.6444.19 – 48.36

46.26 +/- 4.8438.62 – 43.08

0.07

LVED volume95% confidence interval

127.1 +/- 16.5119.8 - 134.4

134.4 +/- 16.1127.45 – 141.33

0.14

hs-CRP 95% confidence interval

1.71+/-0.78 mg/l1.36 – 2.06

12.3+/-11.1 mg/l7.5 – 17.1

0.0001

Number of diseased coronary arteries95% confidence interval

1.86 +/- 0.88

1.46 – 2.25

2.94 +/- 0.64

2.07 – 2.6

0.04

The echocardiographic and angiographic assessments at baseline revealed no statistically significant differences between the groups in regards to the ejection fraction , the LVED volume and the location of the infarction.

Results FEATURE GROUP 1 GROUP 2 P value

Ejection fraction at 6 months (%)95% confidence interval

46.27 +/- 4.7

44.19 – 48.36

40.85 +/- 5.16

38.62 – 43.08

0.0006

LVED volume at 6 months95% confidence interval

142.5 +/- 16.54

135.16 – 149.84

157.82 +/- 15.3

151.2 – 164.46

<0.002

Decrease in EF at 6 months (%)95% confidence interval

5.25 +/- 4.68

3.18 – 7.33

11.3 +/- 10.17

6.9 – 15.7

0.01

Remodeling index95% confidence interval

12.49 +/- 6.76

9.49 – 15.49

17.85 +/- 5.6

15.43 – 20.27

0.005

Positive remodeling (PR) was defined as an increase in the LV end-diastolic global volume >15% compared with baseline.

RESULTS

Major Cardiovascular Events in the study population (MACE)

MACE GROUP 1 GROUP 2 P value

Death 1 (4.54%) 0 (0%) 0.4

Reinfarction 1 (4.54%) 2 (8.69%) 1

Revascularization

1 (4.54%) 1 (4.34%) 1

Rehospitalisation

2 (9.09%) 5 (21.74%) 0.4

Total MACE 5 (22.7%) 8 (34.78%) 0.5

Conclusions• The persistence of a marked inflammation at

seven days post-infarction is associated with a more severe impairment of ventricular function in patients with type 2 DM and acute myocardial infarction.

• The diabetic patients with persistently high levels of hs-CRP at seven days post-infarction have a poorer outcome, as reflected by lower ejection fractions, marked enlargement of the ventricular cavities and the development of ventricular remodeling at six months following the infarction.

THANK YOU FOR YOUR ATTENTION!

Special recognition to members of Cardiology Clinic, of the MURES

COUNTY EMERGENCY CLINICAL HOSPITAL - Prof. Dr. Benedek Imre

Prof. Dr. Benedek Theodora