Inflammation’s Shifting Role in Heart and Liver Disease: How C-Reactive Protein’s Predictive Power Differs
New research indicates that the way key inflammatory markers, such as C-reactive protein (CRP), predict health risks differs significantly depending on whether a patient has cirrhosis or coronary artery disease. The study, led by Dr. Niya Emilova at the University Emergency Medicine Hospital Pirogov in Sofia, Bulgaria, highlights the importance of considering the underlying disease when interpreting inflammation levels.
Ventricular Repolarization: A Key Indicator of Heart Health
Ventricular repolarization – the time it takes for the heart muscle to electrically reset after each beat – is a crucial measure of heart health stability. This process is governed by the pumping ability of the left ventricle and the activity of the autonomic nervous system. Systemic diseases like liver failure or coronary blockage can disrupt these factors, leading to inflammation 1.
The Study’s Focus: Contrasting Inflammation Across Diseases
The research aimed to understand how the relationship between inflammation and heart rhythm instability varies between different disease systems. Dr. Emilova explains, “Most of the knowledge about markers of inflammation such as white blood cell count and C-reactive protein in the field of internal medicine comes from studies in patients with cardiovascular diseases, namely coronary artery disease.” 2 This study represents “the first contemporary exploration of the differences in inflammation regarding arrhythmia risk and clinical outcome of patients with cirrhosis, stable coronary artery disease and acute myocardial infarction.” 2
Key Inflammation Markers Investigated
Researchers measured three primary inflammation markers: white blood cell count, C-reactive protein, and procalcitonin. C-reactive protein is a protein produced in response to systemic inflammation.
Findings: CRP’s Role Varies by Disease
The study, published in the Bulgarian Society of Medical Sciences Journal, revealed that C-reactive protein is associated with the risk of ventricular arrhythmias in stable coronary disease. In cases of acute myocardial infarction (heart attack), both C-reactive protein and white blood cell count correlated with indices of repolarization. However, in patients with cirrhosis, only a high white blood cell count showed a trend toward linking to unstable heart rhythms. C-reactive protein did not correlate with heart rhythms in this group 3, 4.
Cirrhosis and Inflammation: White Blood Cell Count as a Marker
The researchers found that both white blood cell count and procalcitonin are associated with the risk of complications in alcoholic cirrhosis. Specifically, a high white blood cell count was a marker of increased dispersion of repolarization in cirrhotic patients undergoing therapy 4.
Potential Preventive Strategies
The study suggests that certain medications used to treat heart failure and coronary disease, such as beta-blockers, may have preventive value in reducing the risk of life-threatening cardiac arrhythmias in patients with cirrhosis.
Journal Reference
Emilova N, Dineva D, Moneva-Sakelarieva M, Kobakova Y, Chaneva M, Ionchev I, Slaveva D, Popova M, Tododrov R, Kostov K, Sarakostova S (2026) C-reactive protein and cardiac repolarization in cirrhosis. Bulgarian Society of Medical Sciences Journal 8: e154296.