The association between platelet/lymphocyte ratio and coronary artery disease severity

OBJECTIVE

In this study, we aimed to explore the association between platelet-to-lymphocyte ratio (PLR) and the severity of atherosclerosis in coronary artery disease (CAD).

METHODS

Clinical and laboratory data of 388 patients who underwent coronary angiography were evaluated retrospectively. Gensini score, which indicates the severity of atherosclerosis, was calculated for all of the patients. Patients with CAD were categorized as mild and severe atherosclerosis, according to their Gensini score. Eighty patients with normal coronary arteries formed the control group. Mean PLR values of the three study groups were compared. Also, PLR value was tested for whether it showed a positive correlation with Gensini score.

RESULTS

The mean PLR of the severe atherosclerosis group was significantly higher than that of the mild atherosclerosis and controls groups (p<0.001). Also, PLR was positively correlated with Gensini score in CAD patients. A cut-off value of 111 for PLR predicted severe atherosclerosis with 61% sensitivity and 59% specificity. Pre-procedural PLR level was found to be independently associated with Gensini score, together with WBC, age, and low HDL level, in the multivariate analysis.

CONCLUSION

Our study suggests that high PLR appears to be additive to conventional risk factors and commonly used biomarkers in predicting severe atherosclerosis.

Choroidal thickness in relation to sex, age, refractive error, and axial length in healthy Turkish subjects

The aim of this study was to investigate the association between choroidal thickness (CT) and sex, age, refractive error (RE), and axial length in healthy subjects. This is a study of 154 eyes in 154 healthy subjects. CT measurements were performed by the same experienced technician using a spectral domain optical coherence tomography device. CT was measured perpendicularly from the outer edge of the retinal pigment epithelium to the choroid-sclera boundary at the fovea and at six more points which are located at, respectively, 500 µm nasal to the fovea, 1,000 µm nasal to the fovea, and 1,500 μm nasal to the fovea, 500 μm temporal to the fovea, 1,000 μm temporal to the fovea, and 1,500 μm temporal to the fovea. The RE was measured by autorefractometry, and the axial length was measured by interferometry. Statistical analysis was performed to evaluate CT at each location, and to the correlations of CT with sex, age, RE, and axial length. The mean subfoveal CT was 265.86 ± 60.32 µm, the mean age was 49.01 ± 19.19 years, the mean RE was -0.17 ± 1.20 diopters (D), and the mean axial length was 23.39 ± 0.76 mm. CT profile indicated that the choroid was thicker at the fovea than at temporal and nasal locations. Univariable linear regression analysis showed that subfoveal CT decreased 3.14 µm for each year of age and decreased 79.33 µm for each mm of axial length (P = 0.000, R(2) = 0.249; P = 0.000, R(2) = 0.487, respectively). In a similar analysis, subfoveal CT was found to decrease by 50.24 µm/D myopia-shifted change in refraction (P = 0.000, R (2) = 0.201). The subfoveal choroid was 99.16 µm (39.22 %) thicker in men than women when adjusting for age and axial length (P = 0.000, R(2) = 0.249). CT decreases with increasing myopia, age, and axial length. Men had thicker choroid than women, and CT varies depending on location.

Visceral fat reflects disease activity in patients with ankylosing spondylitis

PURPOSE

Response to infliximab treatment diminishes as body mass index (BMI) increases in patients with ankylosing spondylitis (AS). The purpose of the study was to determine if diminished response to infliximab treatment in patients with AS could be associated with increased visceral adipose tissue rather than increased BMI.

METHODS

Twenty six AS patients (21 males and five females) who fulfilled the modified New York criteria and who were currently receiving infliximab treatment were enrolled in the study. Pain was measured by the visual analogue scale (VAS). The disease activity and functional status were assessed by the Bath AS Disease Activity Index (BASDAI) and the Bath AS Functional Index (BASFI). The Bath AS Metrology Index (BASMI) was used to evaluate mobility restrictions. Weight and visceral body composition were measured without shoes in light indoor clothes using a bio-impedance meter.

RESULTS

There was a significant correlation between visceral adipose tissue amount and disease activity under infliximab treatment. In correlation analysis, visceral fat showed significant correlations between BASDAI (r=0.545, p=0.004) and VAS (r=0.458, p=0.019). Total body fat also showed a significant correlation with BASDAI (r=0.463, p=0.017).

CONCLUSION

A significant correlation was found between visceral adipose tissue amount and disease activity in patients with AS.

Relationship Between Hematologic Indices and Global Registry of Acute Coronary Events Risk Score in Patients With ST-Segment Elevation Myocardial Infarction

The aim of this study was to evaluate the relationship between hematologic indices and the Global Registry of Acute Coronary Events (GRACE) score in patients with ST-segment elevation myocardial infarction (STEMI). A total of 800 patients who consecutively and retrospectively presented with STEMI within 12 hours of symptom onset. After accounting for exclusion criteria, a total of 379 patients remained in the study. We enrolled 379 patients with STEMI (mean age 61.7 ± 13.6 years; men 73%). Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), red cell distribution width (RDW), and monocyte count were associated with increased worse GRACE risk score (P = .008, P = .012, P = .005, P = .022, respectively). In multivariate linear regression analysis, NLR, PLR, RDW, and monocyte count were found to be independent predictors of GRACE risk score. We demonstrate for the first time that PLR, RDW, and monocyte were associated with the GRACE score in patients with STEMI.

Platelet-to-lymphocyte ratio is a predictor of in-hospital mortality patients with acute coronary syndrome

Objective:

Platelets and inflammatory cells are vital elements of acute coronary syndromes (ACS). Recent studies have shown that the plateletto-lymphocyte ratio (PLR) is associated with several malignancies; however, there are not enough data in cardiovascular diseases. Therefore, the aim of this study was to explore the association between PLR and in-hospital mortality in patients with ACS.

Methods:

We retrospectively collected patients with ACS undergoing coronary angiography. Total and differential leukocyte counts were measured by an automated hematology analyzer.

Results:

This study is single-centered and observational. In total, 587 patients with a mean age of 61.8±13.1 years (68.4% male) were enrolled in the study. Patients were divided into 3 tertiles based on PLR levels. In-hospital mortality was significantly higher among patients in the upper PLR tertile when compared with the middle and lower PLR tertile groups [29 (14.8%) vs. 17 (8.7%) and 2 (1.0%); p<0.001]. In the multiple logistic regression analysis, a high level of PLR was an independent predictor of in-hospital mortality, together with age, total leukocyte count, and creatinine. Using a cutoff point of 142, the PLR predicted in-hospital mortality with a sensitivity of 69% and specificity of 63%.

Conclusion:

Different from other inflammatory markers and assays, PLR is an inexpensive and readily available biomarker that may be useful for cardiac risk stratification in patients with ACS.

Percutaneous coronary intervention increases microvascular resistance in patients with non-ST-elevation acute coronary syndrome

AIMS

In the acute coronary syndrome setting, the interaction between epicardial coronary artery stenosis and microcirculation subtended by the culprit vessel is poorly understood. The purpose of the present study was to assess the immediate impact of percutaneous coronary intervention (PCI) on microvascular resistance (MR) in patients with non-ST-elevation myocardial infarction (NSTEMI).

METHODS AND RESULTS

Thirty-eight patients undergoing PCI for NSTEMI were recruited consecutively. Culprit lesions were stented over a Doppler and pressure-sensor-equipped guidewire. In the presence of epicardial stenosis, MR was calculated by taking collateral flow, as measured by the coronary wedge pressure, into consideration. After removal of epicardial stenosis, MR was calculated simply as distal coronary pressure divided by average peak velocity. When collateral flow was incorporated into the calculation, MR increased significantly from 1.70 ± 0.76 to 2.05 ± 0.72 (p=0.001) after PCI in the whole population. Periprocedural changes (Δ) in absolute values of MR and troponin T correlated significantly (r=0.629, p=0.0001). In patients who developed periprocedural myocardial infarction, MR increased significantly after PCI (1.48 ± 0.73 versus 2.28 ± 0.71, p<0.001). Nevertheless, removal of the epicardial lesion did not change MR in patients without periprocedural MI (1.91±0.73 versus 1.81±0.67, p=0.1).

CONCLUSIONS

When collateral flow is accounted for, removal of epicardial stenosis increases MR in patients with NSTEMI undergoing PCI.

The association between the neutrophil/lymphocyte ratio and functional capacity in patients with idiopathic dilated cardiomyopathy

Objective:

The neutrophil/lymphocyte ratio (NLR) is an inexpensive, readily available and reliable inflammatory marker, which has a predictor value in different cardiovascular disorders. Functional capacity is one of the most important prognostic factors in patients with heart failure, which is usually stated as metabolic equivalents (MET). The goal of the study was to investigate the relationship between the NLR and functional capacity (FC) in patients with idiopathic dilated cardiomyopathy (IDC).

Methods:

Treadmill test according to modified-Bruce protocol was performed in 37 patients with IDC (mean age 46.7±11.7 years, 81.1% male) to assess their functional capacity. Baseline clinical and echocardiographic variables were obtained. Hematological and biochemical parameters were measured using standard techniques.

Results:

The patients were divided into low (<5 MET, n=18) and high (>5 MET, n=19) FC groups according to their functional status in the exercise test. The 2 groups were similar regarding age, gender and the presence of hypertension and diabetes mellitus. There was no significant difference between groups regarding echocardiographic parameters such as left ventricular ejection fraction and diameters. However, the NLR was significantly higher in low FC group compared to high FC group (3.62±2.24 vs. 2.24±0.67, p=0.002; respectively). There were significant negative correlations between the NLR, MET and left ventricular ejection fraction (r=-0.405, p=0.013 and r=-0.028, p=0.028; respectively). Diastolic dysfunction was present in all the patients with low functional capacity. A cut-off point of 2.26 for the NLR had 83% sensitivity and 69% specificity in predicting poor FC. After multivariate analysis, only the NLR remained significant predictor of poor functional status.

Conclusion:

We detected a significant association between the NLR and low FC, both of which has predictive and prognostic value in patients with heart failure. Functional capacity may depend on diastolic function rather than left ventricular ejection fraction in patients with IDC.

The Utility of the Platelet–Lymphocyte Ratio for Predicting No Reflow in Patients With ST-Segment Elevation Myocardial Infarction

The aim of the study was to evaluate the utility of the preprocedural platelet–lymphocyte ratio (PLR) for predicting no reflow in patients undergoing primary percutaneous intervention (PCI) for the treatment of ST-segment elevation myocardial infarction. The thrombolysis in myocardial infarction (TIMI) flow grades of 287 patients treated with primary PCI were assessed retrospectively. Patients were divided into 3 tertiles based upon preprocedural PLR. Pre- and postprocedural TIMI flow grades were evaluated. No reflow developed in 6, 14, and 43 patients in the lower, middle, and higher tertiles, respectively ( P < .001). After multivariate analysis, PLR remained a significant predictor of no reflow together with neutrophil–lymphocyte ratio (NLR). A cutoff value of 160 for PLR and 5.9 for NLR predicted no reflow with sensitivities and specificities of 75% and 71% and 74% and 70%, respectively. In conclusion, high preprocedural PLR and NLR levels are significant and independent predictors of no reflow in patients undergoing primary PCI.

Association of Neutrophil–Lymphocyte Ratio With the Presence and Severity of Rheumatic Mitral Valve Stenosis

The aim of the study is to investigate the association between the severity of rheumatic mitral valvular disease (RMVD) and the neutrophil–lymphocyte ratio (NLR). A total of 227 patients were enrolled in the study and divided into 3 groups. Patients in group 1 had rheumatic mitral stenosis (RMS), those in group 2 had RMVD without stenosis, and those in group 3 served as the control group. Group 1 was further divided into 2 groups, severe mitral stenosis (MS) and mild to moderate MS. The NLR was significantly higher in patients with severe MS when compared to those with mild to moderate MS ( P = .002) while lymphocyte count was lower ( P = .034). Using a cutoff level of 2.56, the NLR predicted severe RMS with a sensitivity of 75% and specificity of 74%. In conclusion, as an inexpensive, simple, and accessible marker of inflammation, the NLR may be useful in predicting the presence and severity of MS in patients with RMVD.

Predictors of functional capacity in younger and elderly chronic heart failure patients: an observational study

OBJECTIVE

The prevalence of chronic heart failure (CHF) in the elderly population is growing. Identification of risk factors in patients with CHF is important. Recent studies suggest that red cell distribution width (RDW) has prognostic significance in these patients. We aimed to evaluate the relationship of RDW with clinical and laboratory parameters in patients with young and elderly CHF patients.

METHODS

We evaluated patients with CHF with an ejection fraction (EF) of <50% in this observational cross-sectional study. Exclusion criteria were decompensated CHF, malignancy and end-stage renal disease. Clinical information, functional capacity (FC), hemoglobin, RDW, EF, and pro-B type natriuretic peptide (proBNP) were recorded. The younger and elderly groups were compared and correlation of RDW with clinical and laboratory parameters were analyzed in each group. Ordinal regression analysis was performed to determine independent correlates of increased FC.

RESULTS

Seventy young and 47 elderly cases were enrolled. The groups were similar regarding EF, proBNP and FC. RDW showed stronger correlation with FC in the young group (r=0.627, p<0.001) compared to the elderly group (r=0.332, p=0.023). In the younger group, there was a negative correlation between RDW and EF (r=-0.278, p=0.021) and a positive correlation between RDW and proBNP (r=0.487, p<0.001). RDW (OR=16.36, 95% CI 0.33-0.96, p<0.001), EF [OR=7.75, 95% CI (-0.16)-(-0.03), p=0.005] and usage of RAS inhibitors (OR=6.7, 95% CI 0.57-3.36, p=0.007) were independent predictors of increased FC.

CONCLUSION

We found a stronger correlation between RDW and EF, proBNP and FC in the younger patients compared the elderly group. RDW is a simple, inexpensive and easily accessible parameter that may be considered risk predictor especially in younger patients with CHF.

Assessment of myocardial damage by cardiac MRI in patients with anorexia nervosa

OBJECTIVE

Cardiac damage is a major complication of anorexia nervosa (AN). The present study evaluated the prevalence of myocardial damage in patients with AN by cardiac magnetic resonance imaging (CMR).

METHOD

This study was cross-sectional and observational. Forty consecutive female patients with a diagnosis of AN and 28 healthy female subjects were evaluated from January 2007 to 2011 at the Department of Psychiatry (University of Istanbul, Istanbul, Turkey). Following enrollment in the study, participants underwent a cardiac evaluation, a physical examination, a standard electrocardiogram (ECG), an echocardiography and a CMR.

RESULTS

Body weight, body mass index and heart rate values were lower in patients with AN than in the control group. When compared with control groups, patients with AN showed reduced left ventricular mass with normal systolic function. Compared to control subjects, patients with AN had higher prevalence of pericardial effusion (30% in the AN group, 4% in the control group, p = .005) and mitral valve prolapses (23% in the AN group, 4% in the control group, p = .03). Myocardial fibrosis (detected as late gadolinium enhancement on CMR) was found in 23% of patients with AN. Myocardial fibrosis was not detected in any control subject (p = .007).

CONCLUSION

A strong association was found between myocardial fibrosis and AN. Cardiac damage of myocardial fibrosis in asymptomatic patients with AN can be found by CMR examination.

The Association Between the Neutrophil-to-Lymphocyte Ratio and the Presence of Ventricular Premature Contractions in Young Adults

Inflammation has recently emerged in the pathogenesis of several cardiovascular disorders, including arrhythmias. The neutrophil-lymphocyte ratio (NLR) is a simple marker for the assessment of inflammatory status. Therefore, we aimed to investigate the relationship between the NLR and the ventricular premature contraction (VPC) existence. Patients aged between 18 and 40 years who were referred to the cardiology clinic were enrolled in the study. All patients' complete blood counts and 24-hour Holter recordings were analyzed. The NLR was higher within the VPC group compared to the control group (P < .001). According to the NLR tertiles, VPCs were more common in the higher NLR tertile (P < .001). A cutoff point of 1.80 for the NLR had 71% sensitivity and 60% specificity in predicting VPC in apparently healthy individuals. After multivariate analysis, only the NLR remained significant predictor of presence of VPC. In conclusion, the NLR is independently and significantly associated with VPC existence.

New inflammatory predictors for non-valvular atrial fibrillation: echocardiographic epicardial fat thickness and neutrophil to lymphocyte ratio

The objective of this study was to investigate the relationship of echocardiographic epicardial fat thickness (EFT) and neutrophil to lymphocyte ratio (NLR) with different types of non-valvular atrial fibrillation (AF) in a clinical setting. A total of 197 consecutive patients were enrolled in the study. Seventy-one patients had paroxysmal non-valvular AF, 63 patients had persistent/permanent non-valvular AF, and 63 patients had sinus rhythm (control group). EFT was measured with echocardiography, while NLR was measured by dividing neutrophil count by lymphocyte count. EFT was significantly higher in patients with paroxysmal non-valvular AF compared with those in the sinus rhythm group (6.6 ± 0.7 vs. 5.0 ± 0.9 mm, p < 0.001). Persistent/permanent non-valvular AF patients had a significantly larger EFT compared with those with paroxysmal AF (8.3 ± 1.1 vs. 6.6 ± 0.7 mm, p < 0.001). EFT had a significant relationship with paroxysmal non-valvular AF (odds ratio 4.672, 95 % CI 2.329-9.371, p < 0.001) and persistent/permanent non-valvular AF (OR 24.276, 95% CI 9.285-63.474, p < 0.001). NLR was significantly higher in those with paroxysmal non-valvular AF compared with those in the sinus rhythm group (2.5 ± 0.6 vs. 1.8 ± 0.4, p < 0.001). Persistent/permanent non-valvular AF patients had a significantly larger NLR when compared with paroxysmal non-valvular AF patients (3.4 ± 0.6, vs. 2.5 ± 0.6, p < 0.001). NLR (>2.1) had a significant relationship with non-valvular AF (OR 11.313, 95% CI 3.025-42.306, b 2.426, p < 0.001). EFT and NLR are highly associated with types of non-valvular AF independent of traditional risk factors. EFT measured by echocardiography and NLR appears to be related to the duration and severity of AF.