Usefulness of Non-Invasive Myocardial Work and Systemic Inflammation Assessment in Predicting Left Ventricular Dysfunction in Patients with Acute Coronary Syndrome.

Background: Left ventricular (LV) remodeling plays a pivotal role in the pathophysiology of heart failure (HF) following acute coronary syndrome (ACS). Left ventricular ejection fraction (LVEF), left ventricular (LV) volumes and, more recently, speckle tracking echocardiography (STE) are used to describe LV performance. Myocardial work (MW) is a new noninvasive imaging method that integrates loading conditions and can be used to detect early myocardial dysfunction before LVEF decreases.

Aim: This study aims to characterize the relationship between MW, high-sensitivity troponin (hs-cTn I) and C-reactive protein (CRP) as an inflammation biomarker. Their use as predictors for LV dysfunction in the acute phase of ACS is of particular interest but is still under debate.

Method: Complete clinical examination and two-dimensional echocardiography (2-DE), with speckle-tracking and myocardial work measurements, were performed in the first 24 hours after admission. Locally available biomarkers were assessed in the same timeframe, with special interest in hs-cTn I and CRP, as a marker for inflammation. A follow-up visit, including the same clinical, biological, and echocardiographic measurements, was performed six to eight weeks after the index event.

Results: We evaluated 56 patients (53 ± 10 years, 45 men) with ACS. Baseline hs-cTn I significantly correlated with baseline global longitudinal strain (GLS) (r=0.43, p=0.001) and baseline MW parameters (GWI: r=-0.44, p=0.001; GCW: r=-0.40, p=0.002). A correlation between hs-cTn I and LVEF was not statistically relevant. C-reactive protein, which was used to assess systemic inflammation, also failed to correlate with LVEF. However, CRP significantly correlated with relevant MW parameters (GWE: r=-0.53, p<0.001 and GWW: r=0.48, p<0.001). C-reactive protein levels above 28 mg/L correlated with a decrease in MW performance assessed by GWE, suggesting a possible tendency to adverse remodeling.

Conclusions: C-reactive protein level in the first 24 hours after ACS and its correlation with MW parameters may be a potential indicator of future LV dysfunction and heart failure.