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CLINICAL RESEARCH: CARDIAC IMAGING

Relationship Between C-Reactive Protein Levels and Regional Left Ventricular Function in Asymptomatic Individuals

The Multi-Ethnic Study of Atherosclerosis

Boaz D. Rosen, MD^_*, Mary Cushman, MD, Khurram Nasir, MD, MPH^_*, David A. Bluemke, MD, PhD, Thor Edvardsen, MD, PhD^_*, Verônica Fernandes, MD, PhD^_*, Shenghan Lai, MD, PhD, Russell P. Tracy, PhD and João A.C. Lima, MD, FACC^_*,,_*

^_* Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, Maryland
Departments of Medicine and Pathology, University of Vermont, Burlington, Vermont
Radiology Department, Johns Hopkins Medical Institutions, Baltimore, Maryland
Department of Epidemiology, Bloomberg School of Public Health and Hygiene, Johns Hopkins University, Baltimore, Maryland

Manuscript received May 16, 2006; revised manuscript received September 8, 2006, accepted September 28, 2006.

^_* Reprint requests and correspondence: Dr. João A. C. Lima, Cardiology Division, Blalock 524, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, Maryland 21287-0409. (Email: jlima{at}jhmi.edu).

OBJECTIVES: This study sought to investigate the relationship between C-reactive protein (CRP) and regional left ventricular (LV) function in asymptomatic individuals without a history of cardiovascular disease.

BACKGROUND: C-reactive protein is associated with an increased risk for developing cardiovascular disease. However, the relationship between CRP and subclinical LV dysfunction has not been evaluated in asymptomatic individuals.

METHODS: Regional myocardial function was analyzed as peak systolic circumferential shortening strain (Ecc) using the harmonic-phase method by tagged magnetic resonance imaging in 1,164 individuals without symptomatic cardiovascular disease from the MESA (Multi-Ethnic Study of Atherosclerosis) trial (age 66.4 ± 9.6 years old). Regions were defined by coronary territories: left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA). The relationship between log-CRP concentration and Ecc was studied by multivariable linear regression after adjustment for demographic characteristics, risk factors, and therapy (including hormone replacement therapy).

RESULTS: For each region, associations differed by gender with no association of CRP and regional LV function among women. In men, after adjustment, higher log-CRP was significantly associated with lower (absolute) Ecc in the LAD and RCA regions (regression coefficient 0.37 per unit higher log-CRP [95% confidence interval [CI] 0.08 to 0.65] and 0.31 [95% CI 0.02 to 0.59], respectively) and peak systolic Ecc overall (regression coefficient 0.32 [95% CI 0.05 to 0.58]). In the LCX region, the association was weaker (p = 0.06).

CONCLUSIONS: Among individuals without evident heart failure or other cardiovascular disorders, higher CRP was associated with lower systolic myocardial function in all regions in men but not in women. These findings support the role of inflammation and atherosclerosis in incipient myocardial dysfunction. (Multi-Ethnic Study of Atherosclerosis; http://clinicaltrials.gov/ct/show/NCT00005487 [ClinicalTrials.gov] ).

Abbreviations and Acronyms   CAD = coronary artery disease   CHF = congestive heart failure   CI = confidence interval   CRP = C-reactive protein   Ecc = circumferential strain   IQR = interquartile range   LAD = left anterior descending artery   LCX = left circumflex artery   LV = left ventricular   MESA = Multi-Ethnic Study of Atherosclerosis   RCA = right coronary artery

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