C-Reactive Protein is not an Independent Risk Factor for Ventricular Thrombus

Öz

C-reactive protein (CRP) is a standard and widely used acute phase reactant. It is a prototypic marker of inflammation and an adverse event indicator. Elevated CRP levels have been found to be correlated with higher risk for potential adverse cardiac events in patients with acute myocardial infarction, stable and unstable coronary artery disease. However the relationship between presence of left ventricular thrombus (LVT) and levels of CRP have not been investigated in the patients undergoing left ventricular restorative operations. In order to investigate the correlation and seek out the ability of the predictive value of CRP levels in patients with left ventricular aneurysm (LVA), we studied operational and biochemical findings of our patients with LVA, who underwent coronary revascularization operations. We found that CRP levels do not predict presence of LVT. Key words: C-Reactive Protein; Left Ventricular Aneurysm; Left Ventricular Restoration; Coronary Revascularization.

Anahtar Kelimeler

• C-Reactive Protein; Left Ventricular Aneurysm; Left Ventricular Restoration; Coronary Revascularization.

C-Reaktif Protein Ventriküler Trombus Varlığı İçin Bağımsız Bir Risk Faktörü Değildir!

Öz

C-reaktif protein (CRP) yaygın kullanılan ve standart bir akut faz reaktanıdır. Yüksek CRP değerlerinin akut miyokard enfarktüsü, stabil ve anstabil koroner arter hastalığında ileride oluşabilecek olumsuz (advers) kardiyak olaylarda ilişkili olduğu gösterilmiştir. Ancak sol ventrikül onarımları yapılan hastalarda sol ventrikül trombüsü (SVT) ve CRP değerleri arasında bir ilişkinin varlığı araştırılmamıştır. Biz böyle bir korelasyonun var olup olmadığını ve sol ventrikül anevrizması (SVA) olan hastalardan alınan CRP değerlerinin trombüs varlığı konusundaki prediktif değerlerini araştırmak için SVA olup koroner revaskülarizasyon ameliyatına giden hastalarımızın cerrahi ve biyokimyasal verilerini gözden geçirdik. CRP değerlerinin SVT varlığı üzerinde önceden belirleyici (prediktif) değerinin olmadığını tespit ettik. Anahtar kelimeler: C-Reaktif Protein; Sol Ventrikül Anevrizması; Sol Ventrikül Onarımı; Koroner Revaskülarizasyon.

Anahtar Kelimeler

• C-Reaktif Protein; Sol Ventrikül Anevrizması; Sol Ventrikül Onarımı; Koroner Revaskülarizasyon.

Kaynakça

1. Gaudino M, Nasso G, Andreotti F, et al. Preoperative C- reactive protein level and outcome following coronary surgery. Eur J Cardio-thorac Surg 2002; 22: 521-6. DOI: 10.1016/S1010-7940(02)00436-0
2. Devaraj S, Singh U, Jialal I. The evolving rule of C- reactive protein in atherothrombosis. Clin Chem 2009; 55: 229-38. DOI: 10.1373/clinchem.2008.108886
3. Yasojima K, Schwab C, McGeer EG, McGeer PL. Generation of C-reactive protein and complement components in atherosclerotic plaques. Am J Pathol 2001; 158: 1039-51. DOI: 10.1016/S0002-9440(10)64051-5
4. Paffen E, Vos HL, Bertina RM. C-reactive protein does not directly induce tissue factor in human monocytes. Arterioscler hromb Vasc Biol 2004; 24: 975-81. DOI: 10.1161/01.ATV.0000126681.16619.69
5. Çelik S, Baykan M, Erdöl C, et al. C-reactive protein as a risk factor for left ventricular thrombus in patients with acute myocardial infarction. Clin Cardiol 2001; 24: 615-9. DOI: 10.1002/clc.4960240909
6. Anzai T, Yoshikawa T, Kaneko H, et al. Association between serum C-reactive protein elevation and left ventricular thrombus formation after first myocardial infarction. Chest 2004; 125: 384-9. DOI: 10.1378/chest.125.2.384
7. Sabatine MC, Morrow DA, Jablonski KA, et al. PEACE investigators. Prognostic significance of the centers for disease control/American Heart Association high sensitivity C-reactive protein cut points for cardiovascular and other outcomes in patients with stable coronary artery disease. Circulation 2007; 115: 1528-36. DOI: 10.1161/CIRCULATIONAHA.106.649939
8. Versaci F, Gaspardone A, Tomai F, et al. Predictive value of C-reactive protein in patients with unstable angina pectoris undergoing coronary artery stent implantation. Am J Cardiol 2000; 85: 92-5. DOI: 10.1016/S0002- 9149(99)00612-8

9. Biancari F, Lahtinen J, Lepojärvi S, et al. Preoperative C- reactive protein and outcome after coronary artery bypass surgery. Ann Thorac Surg 2003;76: 2007-12. DOI: 10.1016/S0003-4975(03)01067-1
10. Bisoendial RJ, Kastelein JJ, Levels JH, et al. Activation of inflammation and coagulation after infusion of C-reactive protein in humans. Circ Res 2005; 96: 714-6. DOI: 10.1161/01.RES.0000163015.67711.AB
11. Palmerini T, Marzocchi A, Reggiani LB, et al. Preoperative C-reactive protein levels predict 9-month mortality after coronary artery bypass surgery for the treatment of left main coronary artery stenosis. Eur J Cardiothorac Surg 2007; 31: 685-90. DOI: 10.1016/j.ejcts.2006.12.029
12. Seo Y, Maeda H, Ishizu T, et al. Peak C-reactive protein concentration correlates with left ventricular thrombus formation diagnosed by contrast echocardiographic left ventricular opacification in patients with a first anterior acute myocardial infarction. Circ J 2006; 70: 1290-6. DOI: 10.1253/circj.70.1290
13. Toss H, Lindahl B, Siegbahn A, Wallentin L, for the FRISC study group. Prognosticinfluence of increased fibrinogen and C-reactive protein levels in unstable coronary artery disease. Circulation 1997; 96: 4204-10.
14. Danenberg HD, Szalai AJ, Swaminathan RV, et al. Increased thrombosis after arterial injury in human C- reactive protein-transgenic mice. Circulation 2003; 108: 512-15. DOI: 10.1161/01.CIR.0000085568.13915.1E
15. Singh U, Devaraj S, Jialal I. C-reactive protein decreases tissue plasminogen activator activity in human aortic endothelial cells: Evidence that C-reactive protein is a procoagulant. Arterioscler Thromb Vasc Biol 2005; 25: 2216-21. DOI: 10.1161/01.ATV.0000183718.62409.ea
16. Pandolfi A. C-reactive protein: A potential new molecular link between inflammation, thrombosis and vascular cell proliferation? Cardiovasc Res 2005; 68: 3-4. DOI: 10.1016/j.cardiores.2005.07.019
17. Cirillo P, Golino P, Calabró P, et al. C-reactive protein induces tissue factor expression and promotes smooth muscle and entrhelial cell proliferation. Cardiovasc Res 2005; 68: 47-55. DOI: 10.1016/j.cardiores.2005.05.010
18. Cermak J, Key NS, Bach RR, et al. C-reactive protein induces human peripheral blood monocytes to synthesize tissue factor. Blood 1993; 82: 513-20.
19. Balciunas M, Bagdonaite L, Samalavicius R, Griskevicius L, Vuylsteke A. Pre-operative high sensitive C-reactive protein predicts cardiovascular events after coronary artery bypass grafting surgery: A prospective observational study. Ann Card Anaesth 2009; 12: 127-32. DOI: 10.4103/0971-9784.53442
20. Clearfield MB. C-reactive protein: A new risk assessment tool for cardiovascular disease. JAOA 2005; 105: 409-16.
21. How to cite this article: Demirtürk OS, Gülcan Ö,
22. Coşkun İ, Türköz R. C-Reactive Protein is not an
23. Independent Risk Factor for Ventricular Thrombus.
24. JIUMF 2012; 19(2): 66-70. DOI:
25. 7247/jiumf.19.2.1