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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
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Key stages in the development of Acute Coronary Syndrome
1. Ischemic cascade2. Plaque formation and
rupture 3. Coronary occlusion
and MI4. Ventricular
remodeling
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REMODELING PREVENTION
Pharmacological intervention:
-ACE-inhibitors
-Beta-blockers-Diuretics-Ca-blockers and other
PTCA
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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.
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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.
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MATERIALS AND METHODS
Patients underwent through several steps:
Clinical examination Laboratory examination ECG Echocardiography Coronarography
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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)
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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
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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.
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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.
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RESULTS
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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
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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.
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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