European Heart Journal Advance Access originally published online on June 16, 2005
European Heart Journal 2005 26(20):2099-2105; doi:10.1093/eurheartj/ehi356
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Elevated C-reactive protein levels and coronary microvascular dysfunction in patients with coronary artery disease
1Division of Cardiology and Cardiac Surgery, Università di Roma Tor Vergata, European Hospital, via Portuense 700, 00149 Rome, Italy
2Division of Cardiology, Università del Piemonte Orientale, Novara, Italy
3Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy
Received 12 January 2005; revised 4 April 2005; accepted 10 May 2005; online publish-ahead-of-print 16 June 2005.
* Corresponding author. Tel: +39 06 65975725; fax: +39 06 65975724. E-mail address: f.tomai{at}tiscali.it
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.
Key Words: Adenosine • Coronary disease • Endothelium • Inflammation • Microcirculation
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