Elevated hs-CRP independently predicted positive findings on Holter monitoring (OR 3.8; 95% CI 2.3-6.2) and exercise testing (OR 1.7; 95% CI 1.2-2.2) in patients with CPNCA.
Cross-Sectional (n=137)
Does hs-CRP correlate with symptoms and ECG markers of myocardial ischemia in patients with chest pain and normal coronary angiograms?
Elevated hs-CRP levels correlate with the frequency and duration of chest pain episodes as well as ECG markers of myocardial ischemia in patients with typical chest pain and normal coronary angiograms.
Effect estimate: OR 3.8 (95% CI 2.3 to 6.2)
OBJECTIVES: We sought to investigate the relationship among C-reactive protein (hs-CRP), clinical characteristics, exercise stress test responses, and ST-segment changes during daily life in patients with typical chest pain and normal coronary angiograms (CPNCA). BACKGROUND: Patients with CPNCA have coronary microvascular endothelial dysfunction and myocardial ischemia. Elevated hs-CRP levels have been related to atherogenesis and endothelial dysfunction. The relationship between hs-CRP and disease activity has not been previously investigated in CPNCA patients. METHODS: We studied 137 consecutive CPNCA patients (mean age, 57 +/- 9; 33 men). All completed standardized angina questionnaires, underwent exercise stress testing, 24-h ambulatory electrocardiogram (ECG) monitoring (Holter), and hs-CRP measurements at study entry. RESULTS: C-reactive protein levels (mg/l) were higher in patients with frequent (2.9 +/- 3.3) and prolonged (3.9 +/- 4.1) chest pain episodes, and in those with ST-segment depression on exercise testing (2.6 +/- 2.8) and Holter monitoring (3.4 +/- 3.1) compared with patients with occasional (1.3 +/- 1.2; p = 0.002) or shorter chest pain (1.5 +/- 1.3; p < 0.001) episodes, negative exercise stress testing (1.1 +/- 1.1; p < 0.001), and no ST-segment shifts on Holter monitoring (0.9 +/- 0.7; p < 0.001). Moreover, we found a correlation between hs-CRP concentration and number of ischemic episodes during Holter monitoring (r = 0.65; p < 0.001) and with the magnitude of ST-segment depression on exercise testing (r = -0.43; p < 0.001). The hs-CRP was the only independent variable (multivariate logistic regression) capable of predicting positive findings on Holter monitoring (odds ratio OR, 3.8; confidence interval CI, 2.3 to 6.2) and exercise testing (OR, 1.7; CI, 1.2 to 2.2). CONCLUSIONS: The hs-CRP correlates with symptoms and ECG markers of myocardial ischemia in CPNCA patients. Whether hs-CRP is related to the pathogenesis of angina in these patients deserves further investigation.
Cosı́n-Sales et al. (Thu,) conducted a cross-sectional in Typical chest pain and normal coronary angiograms (CPNCA) (n=137). hs-CRP was evaluated on Positive findings on Holter monitoring (OR 3.8, 95% CI 2.3 to 6.2). Elevated hs-CRP independently predicted positive findings on Holter monitoring (OR 3.8; 95% CI 2.3-6.2) and exercise testing (OR 1.7; 95% CI 1.2-2.2) in patients with CPNCA.