CRP and LVEF values useful for predicting improvement in LV function after aortic valve replacement

Japan: A combination of C-reactive protein (CRP) and LV ejection fraction (LVEF) values may be useful in the prediction of left ventricular (LV) functional improvement after aortic valve replacement (AVR), states an article published in The American Heart Journal Plus: Cardiology Research and Practice. High CRP level was independently and significantly associated with LV dysfunction after AVR.

Chronic severe aortic regurgitation (AR) imposes significant volume and pressure overload on the left ventricle which eventually leads to detrimental myocardial changes, with patients remaining asymptomatic for a long time. Aortic valve surgery is recommended in symptomatic or asymptomatic patients with depressed left ventricular (LV) systolic function or a dilated left ventricle. LV dysfunction in the preoperative period is widely known to be a useful prognostic marker for patients after AVR. Therefore, preoperative LV function is an important issue for patients with AR. It is previously reported that C-reactive protein (CRP), a representative biomarker of inflammatory factors, is important for LV dysfunction in patients with AR and concomitant collagen disease. However, there have been no reports about the association between CRP and LV dysfunction after AVR in all AR patients.

HirokiUsuku, Kumamoto University Hospital, Kumamoto, Japan, and colleagues performed a study to clarify the predictive factors for improving LV function after AVR in AR patients.

Researchers enrolled 44 patients for whom only AVR (or AVR + aortic replacement) was performed. They defined LV dysfunction under any of the following criteria: LV ejection fraction (LVEF) <50 %, LV diastolic dimension >65 mm, LV systolic dimension (LVDs) >50 mm, or LVDs/body surface area > 25 mm/m2. Multivariable logistic regression analysis and receiver-operating characteristic analysis were performed.

Key findings of the study,

• High C-reactive protein (CRP) and low LVEF in the pre-AVR period were significantly associated with LV dysfunction after AVR.

• An area under the curve of CRP and LVEF in the pre-AVR period for LV dysfunction after AVR of 0.84 and 0.83, respectively was observed.

• In the low CRP (<0.13 mg/dL) and high LVEF (≥50 %) group, no patients had LV dysfunction.

• All patients in the high CRP (≥0.13 mg/dL) and low LVEF (<50 %) group had LV dysfunction after AVR.

The authors conclude that a high CRP level was significantly associated with LV dysfunction after AVR, even after adjusting for LVEF.In the present study, decreased LVEF (<50 %) in the pre-AVR period was significantly associated with LV dysfunction after AVR, indicating the importance of pre-AVR LV function. A combination of CRP and LVEF values might be very helpful to predict  LV functional improvement after AVR.

Reference:

Hiroki Usuku, Fumi Oike, Eiichiro Yamamoto, Naoko Kai, Koichi Egashira et al. The usefulness of C-reactive protein to predict improving left ventricular function after aortic valve replacement in patients with aortic regurgitation, American Heart Journal Plus: Cardiology Research and Practice,2022,100169, ISSN 2666-6022,

https://doi.org/10.1016/j.ahjo.2022.100169