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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 17  |  Issue : 1  |  Page : 78-83

Comparison between biomarkers high-sensitivity C-Reactive protein and N-Terminal probrain natriuretic peptide in patients with myocardial infarction


1 Department of Biochemistry, Government Medical College, Shivpuri, Madhya Pradesh, India
2 Department of Pathology, Government Medical College, Shivpuri, Madhya Pradesh, India
3 Department of Biochemistry, GSVM Medical College, Kanpur, Uttar Pradesh, India

Date of Submission17-Oct-2021
Date of Decision21-Dec-2021
Date of Acceptance17-Jan-2022
Date of Web Publication25-Jul-2022

Correspondence Address:
Dr. Vidyanand Pandit
Department of Pathology, Government Medical College, Shivpuri, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_382_21

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  Abstract 


Background: Elevated inflammatory markers have been associated with an increased risk of future cardiovascular events, acute myocardial infarction (MI), and illness in patients with stable or unstable coronary artery disease. Aim: The present study was comparison between high-sensitivity C-reactive protein (hsCRP), NTproBNP, TnT, and creatine kinase MB (CK-MB) in patient groups and control group. Materials and Methods: The diagnostic test blood glucose and lipid profile biochemical parameter were assessed using endpoint method. hsCRP kits for human were assessed using turbidimetric immunoassay method. Serum N-terminal probrain natriuretic peptide (NT-proBNP) levels were measured by automated immunoassay. Both cardiac TnT and CK-MB mass were measured with highly specific monoclonal antibodies in a sensitive chemiluminescence assay. Results: Comparing marker levels of the two groups, Mann–Whitney U test and independent sample t-test were used. The mean NT-proBNP (pg/ml) and hsCRP (mg/L) were found significantly different and almost 24- and 8-fold higher in cases as compared to controls (610.69 ± 25.28 vs. 25.28 ± 11.76, and 4.47 ± 1.62 vs 0.52 ± 0.23; all P < 0.01). Further, the CK-MB (IU/L) and TnT (pg/ml) (mean ± standard deviation) were also high in the case group than control (166.83 ± 27.8 vs. 98.03 ± 3.05; P < 0.01 and 135.44 ± 8.79 vs 96.46 ± 2.91; P < 0.01). Conclusion: Elevated level of NT-proBNP is a strong independent prognostic predictor in patients with myocardial infarction and positive correlation between NTproBNP with TnT and CK-MB with TnT and consumption of alcohol, smoking, and tobacco may be also a risk factor for myocardial infarction.

Keywords: Biomarker, creatine kinase MB, coronary heart disease, high-sensitivity C-reactive protein, myocardial infarction, NTproBNP, TnT


How to cite this article:
Sharma D, Jain VK, Pandit V, Verma MK. Comparison between biomarkers high-sensitivity C-Reactive protein and N-Terminal probrain natriuretic peptide in patients with myocardial infarction. J Datta Meghe Inst Med Sci Univ 2022;17:78-83

How to cite this URL:
Sharma D, Jain VK, Pandit V, Verma MK. Comparison between biomarkers high-sensitivity C-Reactive protein and N-Terminal probrain natriuretic peptide in patients with myocardial infarction. J Datta Meghe Inst Med Sci Univ [serial online] 2022 [cited 2022 Aug 16];17:78-83. Available from: http://www.journaldmims.com/text.asp?2022/17/1/78/352237




  Introduction Top


In affluent countries, coronary heart disease (CHD) is leading cause of illness and mortality and its prevalence is rising in developing countries.[1] Myocardial infarction (MI) is the most dangerous form of CHD, and it can cause immediate death. Although MI is more common in people over the age of 45 years, it can also affect young men and women.[2] Biomarker clusters linked to CHD have been discovered in several investigations. When compared to traditional risk markers, the assessment of these biomarkers, alone or in combination, may enhance the long-term prediction of death or the first major cardiovascular event.[3],[4] The biomarker N-terminal probrain natriuretic peptide (NT-proBNP) is released from the myocardial stress and is utilized to diagnose heart failure.[5] NT-pro BNP was found to be released by ischemic myocardium,[6] and high level of NT-proBNP has been linked to a poor prognosis in patients who have a MI[7],[8] or who have had percutaneous coronary procedures[9] Its highly significant and correlate with coronary artery disease NT-proBNP but also high sensitivity C- reactive protein (hsCRP) and high sensitivity troponin were among the biomarker with the highest predictive value for adverse cardiovascular in the general population.[10] The WHO agreement serves as the foundation for the traditional diagnosis of acute MI.[11] A clinical description of chest pain, an electrocardiographic portrayal, and serial change in cardiac enzymes are all included. The American Heart Association published a scientific statement in 1996 that expanded on this assertion. The use of creatine kinase MB (CK-MB) as the preferable cardiac marker for AMI diagnosis was discussed.[12] MI is still defined by the presence of CK and, more specifically, the isoenzyme CK-MB. The present definition, however, is not especially useful because studies have indicated that individuals with MI and unstable angina have similar outcomes as currently characterized.[13],[14] Troponin I and T (TnI and TnT) are troponin regulatory complex proteins that have a role in cardiac contractility. Both non enzymatic parameter TnI and TnT high specificity for myocardial tissue damage and not detectable in raised level in healthy peoples's in blood circulations, and have better sensitivity and specificity marker for detection of acute myocardial infarction than a combination of electrocardiogram and standard biochemical markers because cardiac troponin are very sensitive and specific markers of myocardial injury,[15] cardiac troponins are the preferred markers for diagnosis[16] Inflammation play a role in the development of atherosclerosis and CAD.[17] Elevated inflammatory markers have been associated with an increased risk of future cardiovascular events, acute MI, and illness in patients with stable or unstable coronary artery disease.[18],[19]


  Materials and Methods Top


This case–control study was conducted from July 2020 to June 2021; one hundreds seventy-eight participants were enrolled (89 MI cases and 89 healthy control) during the study period. Samples were collected after the informed consent form and proforma; TnT, CK-MB, NTproBNP, and hsCRP were used as biomarkers. All the information were collected from the all participants such as gender, age, smoking, hypertension, history of diabetes, physical activity, previous history of MI, and family history etc. Peripheral venous blood samples were collected within 24 hours of admission for measuring lipid profiles. Blood pressure measurement for systolic and diastolic blood pressure was measured in a sitting position, after a 5-min rest, using a mercurial sphygmomanometer instrument.

The fasting blood samples were collected from the study and control participants for the estimation of blood glucose, lipid profile (total cholesterol, triglyceride, high- and low-density lipoprotein cholesterol), hsCRP TnT, CK-Mb, NTproBNP, collected venous blood samples were centrifuged on 4000 ×g for 5 minutes and stored at -80°C in a deep freeze until being analyzed. The diagnostic test blood glucose and lipid profile biochemical parameter assessed using endpoint method. hsCRP kits for human were assessed using turbidimetric immunoassay method. Serum NT-proBNP levels were measured by automated immunoassay. Both cardiac TnT and CK-MB mass were measured with highly specific monoclonal antibodies in a sensitive chemiluminescence assay.

Ethics approval and consent to participate

All procedures were performed in these studies involving human participants after the ethical clearance (Ref no. GMC/ Ethics/5812-2020 on July 5, 2020) of the Ethical Committee, Government Medical College, Shivpuri, M. P., India and informed consent was obtained from all individual participants involved in this study.

Statistical analysis

For continuous data, normality was tested using Kolmogorov–Smirnov test and represented as the mean ± standard deviation (SD) or as median and interquartile ranges. The baseline characteristics between case and control were compared by 2 × 2 contingency table calculator available online at (http://faculty.vassar.iedu/lowry/VassarStats.html). Categorical data were presented in frequency and percentage. The selected markers of case and control were compared using Mann– Whitney U test and independent t-test were used to compare the groups as appropriate. Statistical analysis was carried out using the SPSS (Statistical Package for the Social Sciences), version 22 (SPSS-22, IBM, Chicago, USA). All tests were two-sided and P value was set at <0.05 for significant level.


  Results Top


Baseline and principal characteristics of cases and controls

The baseline characteristics of the selected case and control groups are summarized in [Table 1]. The mean age (± SD) of cases and controls was 44 ± 5.03 years and 55.9 ± 12.2 years, respectively. Comparing the mean age of the two groups, independent samples t-test showed a significant reduction in age of case than control (P > 0.01). In other words, subjects of two groups were not age matched. Further, gender was found similar between the two groups, i.e., also not differed significantly (P > 0.05). Alcohol was found to be a predominant risk factor for case group compared to control groups (odds ratio [OR]: 82; 95% confidence interval [CI]: 23.7–285.7, P < 0.001). Further analysis showed that high level of smoking and use of tobacco were strongly associated with case risk (OR: 167; 95% CI: 46–610 and OR: 111; 95% CI: 25–285; all P < 0.001). On the other hand, odds ratio reveals that the physical activity was significantly associated with control (OR: 0.2; 95% CI: 0.1–0.5; P < 0.01).
Table 1: Baseline variables in this case–control study

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We also analyzed diabetes and dyslipidemia in case and control groups. In our study, we enrolled healthy voluntary persons who had not these types of symptoms (no heat diseases, diabetes, dyslipidaemia and hypertension). Therefore, statistical comparison of these parameters between case and control group was statistically restricted.

Distribution of selected markers in this study

The selected marker levels, i.e., NTproBNP, hsCRP, CK-MB, and TnT of the two groups, are summarized in [Table 2]. Comparing marker levels of the two groups, Mann–Whitney U test and independent samples t-test were used. The mean NTproBNP (pg/ml) and hsCRP (mg/L) were found significantly different and almost 24- and 8-fold higher in cases as compared to controls (610.69 ± 25.28 vs. 25.28 ± 11.76, and 4.47 ± 1.62 vs 0.52 ± 0.23; all P < 0.01) [Table 2]. Further, the CK-MB (IU/L) and TnT (pg/ml) (mean ± SD) were also high in the case group than the control (166.83 ± 27.8 vs. 98.03 ± 3.05; P < 0.01 and 135.44 ± 8.79 vs 96.46 ± 2.91; P < 0.01). The comparisons concluded that all the selected markers may have an influence on cases and this is also shown in [Figure 1].
Table 2: Comparative biochemical parameters of this case–control study

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Figure 1: Variation of selected markers (Comparison between Case & Control a. NTproBNP b. hsCRP c. cTnT d. CKMB) in case–control study. Significance was calculated by Mann–Whitney U test (Only for NTproBNP) and independent samples t test

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Biochemical parameters like lipid profile in case and control were categorized in total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL) and very LDL (VLDL) and hypertension. Hypertension was also categorized in two subgroups, viz. systolic and diastolic. All the descriptive characteristics of these parameters are shown in [Table 2]. The mean level of TC (mg/ml) was 155.61 ± 41.78 in the control group, and in the case group, it was almost 1.5-fold higher, 208 ± 65.11. The lipid profile TC, TG, LDL, and VLDL level increases in case group than control (All P < 0.01) and HDL level was inversely to other lipid parameter case was decrease and control was higher, diabetes, hypertension and dyslipidaemia was risk factor of lead to myocardial infarction [Figure 2].
Figure 2: Box plot indicating the distribution of lipid profile in this study. Line and asterisks indicate statistically significant was calculated by Mann–Whitney U test. (a) Comparison between case and control in TC, TG & LDL. (b) Comparison between case and control in HDL & VLDL TC- Total Cholesterol, TG- Triglyceride, LDL- Low density lipoprotein, HDL- High Density Lipoprotein, VLDL- Very low density lipoprotein

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Correlation between selected biochemical markers

Correlation between myocardial infarction and control found in strong association between case and control (case NTproBNP with TnT 0.23 P = 0.03*; control= 0.3 P = 0.006*); CK-MB with TnT (case= 0.25 P = 0.02* control= 0.352 P = 0.01*); Similarly, a positive but weak correlation was found in NTproBNP with hsCRP, NTproBNP with CK-MB. The relation of these selected markers is shown in [Table 3].
Table 3: Correlation between myocardial infarction markers of this case–control study

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  Discussion Top


In the present case–control study, a total of 178 participants were enrolled: 89 cases and 89 controls. In the present study, we found that majority of male participants were higher as compared to females. The mean age of the myocardial infarction and control group (44.4±5.03 vs 53.9±12.2 p=0.001*) age was significance. In this study, we found strong association of consumption of alcohol, smoking, and tobacco with MI and Physical activity were found significantly associated with control. Consumption of alcoholic beverages is being more recognized as a risk factor for cardiovascular disease (CVD).[20] Even consumed in moderation, alcohol is linked to changes in various biomarkers are involved in blood biochemistry, for the risk of cardiometabolic disease,[21] being drinking has been linked to alcoholic cardiomyopathy, high blood pressure and a higher risk of heart disease MI, arrhythmias and fatal cardiac arrest are all possible outcomes as well as stroke.[22] In previous study, no any significant differences could be identified with regard to sex, age, body mass index, obesity, family history, smoking habit, physical activity, dietary habit and family history in patients with AMI.[23]

Dyslipidemia was observed imbalance of lipid levels and a major risk factor of excessive burden of coronary artery diseases.[24],[25] In the present study, TG, LDL, and VLDL were increased in MI case than control. Contrary to this, Mal et al., 2019, found that HDL was significantly lower in patients with acute MI as compared to without acute MI.[25] Another study found an inverse relationship between HDL and CVD,[26] while Holmes et al., 2015, argued against the causal relation between HDL and CVD.[27] Previous study was conducted in young Acute Mi showed that derange levels of lipid profile TG level was elevated and HDL level was decreased.[28] In the present study, hypertension was also higher in MI cases as compared to healthy controls.

The present study was shows that NTproBNP, hsCRP, CK-MB, and cTnT were statistically significance, and higher than control group after that we concluded (NTproBNP, hsCRP, CK-MB, and cTnT) may have an influence on MI. Previously, Kasap et al., 2007, also found same result in acute MI i.e., NTproBNP, hsCRP, CK-MB and cTnT were higher in case than nondiseases group.[23]

Furthermore, correlation between the selected markers was found to be null, except NTproBNP with cTnT and CK-MB with cTnT. We concluded that a strong correlation between NTproBNP with TnT and weak correlation between NTproBNP with CK-MB was found. In a previous study, Kasap et al., 2007, found that serum TnT values in cadiovascular patients show positive correlation with NTproBNP.[23]


  Conclusion Top


Increased serum NT-proBNP was found to be a stronger prognostic for myocardial infarction patients and also positive correlation between NTproBNP with TnT and CK-MB consumption of alcohol, smoking, and tobacco may be also a risk factor for myocardial infarction. At present, we recommend only to use NT-proBNP in patients with stable CAD as a predictor of future cardiovascular events and death.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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