Neutrophil–Lymphocyte Ratio May Predict Left Atrial Thrombus in Patients With Nonvalvular Atrial Fibrillation

Objective:

Neutrophil–lymphocyte ratio (NLR) has been associated with poor outcomes in patients with cardiovascular diseases. We aimed to compare NLRs among patients with nonvalvular atrial fibrillation (AF) with or without left atrial (LA) thrombus.

Methods:

A total of 309 (70.1 ± 9.8 years, 49% male) patients with nonvalvular AF have undergone transoesophageal echocardiography (TEE) to assess the presence of LA thrombus. Baseline NLR was measured by dividing neutrophil count to lymphocyte count.

Results:

Left atrial thrombus was detected in 32 (10.3%) of 309 patients. Mean NLR (2.2 ± 1.0 vs 2.7 ± 1.1, P = .026) was significantly higher among patients with LA thrombus compared to patients without LA thrombus. On multivariate analysis, NLR (odds ratio 1.59, 95% confidence interval 0.87-4.18; P < .02) was an independent risk factor for the presence of LA thrombus in patients with nonvalvular AF.

Conclusion:

Neutrophil–lymphocyte ratio, an emerging marker of inflammation, was independently associated with the presence of LA thrombus in patients with nonvalvular AF.

The association between plasma uric acid level and cardiovascular events in patients with stable coronary artery disease: a short-term follow-up study

Aim The association of uric acid (UA) level with major cardiovascular risk factors has been well-known. However, whether UA is a risk factor for coronary artery disease (CAD) still remains controversial. We aimed to examine the short term effect of plasma UA level on cardiovascular events (CVEs) in patients with stable CAD. Methods The study included 147 consecutive patients with CAD. The patients were evaluated in two groups. Group 1: 101(68.7%) patients with UA level higher than 6.5 mg/dL for females and 7 mg/dL for males (n= 38 and 63, respectively); Group 2: 46 (31.3%) patients with UA level lower than those values (n= 15 and 31, respectively). The patients were followed for 15.3 ± 5.5 months. Death, acute coronary syndrome, stroke and other cardiovascular hospitalizations were defined as CVE. The relationship between CVEs and plasma UA level was examined using the Cox-regression analysis. Results The mean age was 63 ± 11 years [94 (63.9%) males, 53 (36.1%) females]. Forty-five (30.6%) had diabetes mellitus and 106 (72.1%) had hypertension. The mean UA level was 6.0 ± 1.5 mg/dL. In the follow-up, 23 (15.6%) had any defined CVEs. Only two patients died. No statistical significance was found in terms of the association between plasma UA level and CVEs (p = 0.61). Conclusion In patients with stable CAD no relation between plasma UA level and CVEs in the short-term was found. However, this subject still needs further studies with longer follow-up period.

Enlargement of the aorta: An occupational disease?

BACKGROUND

Aortic dilation may critically precede progression to thoracic aortic aneurysm (TAA). Prolonged or repetitive isometric-type heavier strenuous activities resulting from the nature of some professions may be an important causative factor for TAA.

METHOD

The echocardiographic measurement data of middle-age subjects who were isometric-type daily strenuous activity trainers or ordinary activity trainers were retrospectively analyzed. Clinical features and echocardiographic parameters of the left ventricle and left atrium (LA), aortic root (AR) and ascending aorta (AA) were compared between the groups.

RESULTS

AR (35.6±3.0 mm versus 33.5±1.9 mm), AA (36.8±3.0 mm versus 34.4±1.9 mm) and LA (37.4±2.2 mm versus 36.2±2.2 mm) diameters were significantly enlarged in the strenuous activity trainer group versus the ordinary activity group. Diastolic blood pressure was significantly lower (73.8±5.9 mmHg versus 78.3±6.0 mmHg) in this group. AR diameter was correlated with height (β=0.460; P=0.004) and LA diameter (β=0.280; P=0.008) while AA diameter was correlated with type of profession (β=0.309; P=0.003), left ventricular systolic diameter (β=0.500; P=0.001) and LA diameter (β=0.272; P=0.005) in regression analysis.

CONCLUSION

Aortic dilation and, subsequently, TAA may be an occupational disease due to nature of some professions (eg, the military, security, weight lifters, athletes, heavy workers, etc). Echocardiography is a convenient method of imaging that could be easily applied either during preparticipation screening or during periodical examination of these subjects. Earlier detection of TAA and limitation of such strenuous activities in these individuals may be initial lifesaving measures for the prevention of future cases of aortic aneurysm and dissection.

Cardiovascular risk scores for coronary atherosclerosis

OBJECTIVE

The objective of this study was to compare frequently used cardiovascular risk scores in predicting the presence of coronary artery disease (CAD) and 3-vessel disease.

METHODS AND RESULTS

In 350 consecutive patients (218 men and 132 women) who underwent coronary angiography, the cardiovascular risk level was determined using the Framingham Risk Score (FRS), the Modified Framingham Risk Score (MFRS), the Prospective Cardiovascular Münster (PROCAM) score, and the Systematic Coronary Risk Evaluation (SCORE). The area under the curve for receiver operating characteristic curves showed that FRS had more predictive value than the other scores for CAD (area under curve, 0.76, P < or = 0.001), but all scores had good specificity and positive predictive value. For 3-vessel disease, the FRS had better predictive value than the other scores (area under curve, 0.74, P < or = 0.001), but all scores had good specificity and negative predictive value.

CONCLUSION

The risk scores (FRS, MFRS, PROCAM, and SCORE) may predict the presence and severity of coronary atherosclerosis.The FRS had better predictive value than the other scores.

Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio are prolonged in patients with moderate and severe obstructive sleep apnea

BACKGROUND

Prolongation of the peak and the end of T wave (Tp-e) has been reported to be associated with ventricular arrhythmias. Tp-e/QT ratio and Tp-e/QTc ratio are used as an index of ventricular arrhythmogenesis. An increased incidence of ventricular arrhythmias has been reported in patients with obstructive sleep apnea (OSA). The aim of this study was to assess ventricular repolarization in patients with OSA by using Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio.

METHODS

We have studied 72 patients who underwent overnight polysomnography (PSG) between the years 2010-2011 at our institution. Patients with moderate and severe OSA (23 patients; mean age: 45±10), according to the apnea-hypopnea index, constituted the study group. Patients with normal PSG (23 patients; mean age: 42±11) were used as the control group. In all patients, Tp-e interval, Tp-e/QT ratio, Tp-e/QTc ratio, as well as some other electrocardiogram intervals were measured. Independent samples t-tests were used for comparison of continuous and categorical variables and correlations were calculated by Spearman rank correlation.

RESULTS

Although QT and QTc intervals were not different between the groups, mean Tp-e interval (81.6±11.1 msn; 63.9±7.3 msn; respectively; P < 0.001), Tp-e/QT ratio (0.21±0.03; 0.17±0.02; respectively; P < 0.001), and Tp-e/QTc ratio (0.20±0.03; 0.16±0.02; respectively; P < 0.001) were prolonged in the study group compared to the control group. Correlation analysis showed a significant positive correlation between the presence of moderate and severe OSA and Tp-e interval (r = 0.72; P < 0.001), Tpe/QT ratio (r = 0.70; P < 0.001), and Tp-e/QTc ratio (r = 0.70; P < 0.001).

CONCLUSIONS

Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio are prolonged in patients with moderate and severe OSA patients. There is a positive correlation between the presence of OSA and Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio.