Relationship Between Inflammatory (Hs-CRP, Neutrophil-to-Lymphocyte Ratio) and Cardiac (Troponin) Biomarkers, and Cardiac Dysfunction in Acute Coronary Syndrome.

Acute Coronary Syndrome (ACS) remains a leading cause of morbidity and mortality worldwide, accounting for a significant proportion of cardiovascular-related deaths. Early diagnosis and accurate risk stratification are crucial for improving clinical outcomes and guiding therapeutic decisions. Cardiac troponins (I and T) are highly sensitive and specific biomarkers of myocardial injury and represent the gold standard for the diagnosis of ACS (1). In recent years, inflammation has been recognized as a key contributor to the pathophysiology of atherosclerosis and plaque instability. Inflammatory biomarkers such as high-sensitivity C-reactive protein (hs-CRP) and the neutrophil-to-lymphocyte ratio (NLR) have gained attention as predictors of adverse cardiovascular outcomes. Elevated hs-CRP levels are associated with increased risk of myocardial infarction and poor prognosis (2), while NLR reflects the balance between inflammatory activation and immune regulation and has been linked to severity of coronary artery disease and mortality in ACS patients (3). Echocardiography remains a cornerstone in the assessment of cardiac function, providing essential information about left ventricular ejection fraction (LVEF) and regional wall motion abnormalities (RWMA). More recently, speckle tracking echocardiography (STE) has emerged as a sensitive tool for detecting subclinical myocardial dysfunction through parameters such as global longitudinal strain (GLS), even before a reduction in LVEF becomes apparent (4,5). Despite the established individual roles of cardiac and inflammatory biomarkers, limited data are available regarding their combined effect on cardiac function, particularly when integrated with advanced echocardiographic techniques. Therefore, this study aims to evaluate the relationship between inflammatory biomarkers (hs-CRP, NLR), cardiac biomarker (troponin), and echocardiographic findings in patients with ACS to enhance early risk stratification and improve clin