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Fabrizio Tomai, Flavio Ribichini, Anna S. Ghini, Valeria Ferrero, Giuseppe Andò, Corrado Vassanelli, Francesco Romeo, Filippo Crea, Luigi Chiariello, Elevated C-reactive protein levels and coronary microvascular dysfunction in patients with coronary artery disease, European Heart Journal, Volume 26, Issue 20, October 2005, Pages 2099–2105, https://doi.org/10.1093/eurheartj/ehi356
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Abstract
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.
