Elevated C-reactive protein levels and coronary microvascular dysfunction in patients with coronary artery disease.

Autor:	Tomai F; Division of Cardiology and Cardiac Surgery, Università di Roma Tor Vergata, European Hospital, via Portuense 700, 00149 Rome, Italy. f.tomai@tiscali.it, Ribichini F, Ghini AS, Ferrero V, Andò G, Vassanelli C, Romeo F, Crea F, Chiariello L
Jazyk:	angličtina
Zdroj:	European heart journal [Eur Heart J] 2005 Oct; Vol. 26 (20), pp. 2099-105. Date of Electronic Publication: 2005 Jun 16.
DOI:	10.1093/eurheartj/ehi356
Abstrakt:	Aims: It is still unknown whether elevated C-reactive protein levels are responsible for coronary microcirculatory dysfunction in patients with coronary artery disease (CAD). This study was aimed at evaluating the association between C-reactive protein levels and endothelium-dependent and endothelium-independent coronary blood flow (CBF) responses in non-culprit arteries of patients with CAD. Methods and Results: We studied 28 patients (14 with normal and 14 with elevated C-reactive protein levels, >5 mg/L) with single-vessel disease and otherwise angiographically normal coronary arteries undergoing percutaneous transluminal coronary angioplasty (PTCA). CBF was measured in the non-PTCA vessel using an intracoronary Doppler guide wire and quantitative coronary angiography at baseline, after intracoronary infusion of substance P and of adenosine, and expressed as per cent change from baseline. The increases in CBF during infusion of substance P and of adenosine were lesser in patients with elevated than in those with normal C-reactive protein levels (34+/-22 vs. 61+/-34%, P=0.04 and 131+/-53 vs. 189+/-89%, P=0.03, respectively). Multivariable analysis identified elevated C-reactive protein level as the only independent predictor of reduced response to substance P (P=0.01) and adenosine (P=0.02). Conclusion: In patients with CAD, evidence of systemic inflammation is independently associated with endothelium-dependent and endothelium-independent coronary microvascular dysfunction, which, in turn, may be critical to precipitate myocardial ischaemia, in particular, in unstable patients.
Databáze:	MEDLINE
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