부산대학교 도서관

Background-Aims: Early post-infarction pericardial injury is a common finding but its diagnosis remains elusive. Though C-reactive protein (CRP) is considered a marker of myocardial damage, reflecting myocardial inflammation at the infarcted area, we sought to assess the relationship between CRP and pericardial injury depicted by cardiovascular magnetic resonance (CMR) imaging in patients with ST elevation myocardial infarction (MI). Methods and results: 181 MI patients (84% male) were studied with CMR in the first week and at 4 months post-infarction to assess infarct characteristics, left ventricular volumes/function and pericardial injury. The latter was defined as pericardial fluid >4mm and/or enhancement on late gadolinium enhancement CMR. The CRP-value at day 2 (according to previous literature) was used for correlation with CMR and clinical parameters. Pericardial injury was noted in 87 patients, i.e. effusion (n = 30), inflammation (n = 46), both (n = 11). Patients with pericardial injury had significantly higher peak values of cardiac biomarkers (p<0.001) and higher peak CRP-values than patients with normal pericardium (median 13 vs 43 mg/dl, p<0.001). A strong correlation was found between peak CRP-values and a) left venticular ejection fraction and infarct size both at 1 week and 4 months, b) myocardial hemorrhage, microvascular obstruction (MVO) and pericardial injury at 1 week, c) cardiac biomarkers values and time to PCI. However in a multiple regression model only pericardial injury (p = 0.003) and less importantly time to PCI (p = 0.022) were the independent predictors of CRP values. Conclusion: Pericardial damage described by cardiac MRI occurs often after acute ST elevation MI. CRP-values at the acute phase of MI reflect not only inflammation at the infarcted area but even more the inflammation of the surrounding pericardial tissue. Table 1 Comparison of baseline clinical and biochemical parameters of patients with or without evidence of early post-infarct pericardial damage on CMR Normal Group (n = 94)Pericardial injury group (n = 87)p-valueAgem, years59±1160±120.48Male, n(%)83 (88)69 (79)0.10Diabets, n(%)12 (13)9 (10)0.61Smoker, n(%)52 (55)44 (51)0.52Hyperlipidemia, n(%)56 (60)55 (63)0.62BSA m22.0 ± 0.22.0 ± 0.20.20Time to PCI, min195 (155 − 274)223 (160 − 335)0.20Troponin I, μ/l44 (19 − 92)90 (44 − 149)>0.001CK-MB, U/L128 (77 − 216)250 (143 − 443)>0.001CRP, mg/dL13 (7 − 28)43 (16 − 96)>0.001Day of peak CRP2 (1 − 3)2 (1 − 3)0.39 Table 2 Significant correlations between CRP Values and corresponding CMR measurements, cardic biomarkers and clinical related parameters VariblesSpearmanscorrelations rp-valueCMR parameters 1 weekLV EF−0.28>0,001Infractsize(%ofLV)0.40>0,001Microvasular obstruction0.27>0,001Hemorrhage0.33>0,001Size of area atrisk0.31>0,001Transmurality0.30>0,001Pericaldial damage0.43>0,001CMR parameters 4 monthsLVEF−0.43>0,001Infarctsize(%ofLV)0.46>0,001Cardiac BiomarkersPeak TnI0.34>0,001Peak CK-MB0.32>0,001OtherTime to PCI0,1820,007