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Delcea C, Adrian Buzea C, Dobrev D, Andrei Dan G. Prognostic roles of neutrophil-lymphocyte, monocyte-lymphocyte and platelet-lymphocyte ratios for long-term all-cause mortality in heart failure. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VASCULATURE 2024; 54:101502. [PMID: 39280696 PMCID: PMC11402304 DOI: 10.1016/j.ijcha.2024.101502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/25/2024] [Accepted: 08/07/2024] [Indexed: 09/18/2024]
Abstract
Background Heart failure (HF) and inflammation have a bidirectional relation leading to activation and adaptation of multiple cellular lines, including leucocyte subtypes and platelets. We aimed to assess and compare the predictive value of the neutrophil-lymphocyte (NLR), monocyte-lymphocyte (MLR) and platelet-lymphocyte (PLR) ratios for all-cause long-term mortality in HF. Methods This is an observational retrospective cohort study that included patients from the HI-HF cohort that survived the initial hospitalization. Vital status and survival time were assessed in June 2020. Results We analyzed 1018 HF patients with a mean age of 72.32 ± 10.29 years and 53.54 % women. All-cause long-term mortality was 38.21 % after a median follow-up time of 68 [38 - 82] months. NLR (AUC 0.667, 95 %CI 0.637 - 0.697), MLR (AUC 0.670, 95 %CI 0.640 - 0.700) and PLR (AUC 0.606, 95 %CI 0.574 - 0.636) were predictors of all-cause mortality. In multivariable Cox proportional hazards analysis, NLR≥3.56 was the only hematological index independent predictor of fatality (HR 1.36, 95 %CI 1.05 - 1.76). Conclusions Of the three hematological indices, NLR was the only independent predictor of all-cause long-term mortality of HF patients. We suggest NLR≥3.56 as an auxiliary prognostic biomarker for the evaluation of HF patients.
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Affiliation(s)
- Caterina Delcea
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Cardiology Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Catalin Adrian Buzea
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Cardiology Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
- Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada
- Department of Integrative Physiology, Baylor College of Medicine, Houston, TX, USA
| | - Gheorghe Andrei Dan
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Cardiology Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
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Che J, Song J, Long Y, Wang C, Zheng C, Zhou R, Liu Z. Association Between the Neutrophil-Lymphocyte Ratio and Prognosis of Patients Admitted to the Intensive Care Unit With Chronic Heart Failure: A Retrospective Cohort Study. Angiology 2024; 75:786-795. [PMID: 37586709 DOI: 10.1177/00033197231196174] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
The present study aimed to explore the association between the neutrophil-to-lymphocyte ratio (NLR) and prognosis of critically ill chronic heart failure patients. The records of 5298 patients who met the inclusion criteria were extracted from the Medical Information Mart for Intensive Care IV database. The primary outcome was 30-days all-cause mortality and the secondary outcome was 90-days all-cause mortality. Multivariable logistic regression analysis was performed to examine the relationship between NLR and 30-days mortality. Subgroup analysis was carried out to identify whether the association between NLR and 30-days mortality differed across various subgroups. For 30-days mortality, after adjusting for multiple confounders, the odds ratio (OR) (95% confidence interval [CI]) for the second (NLR 4.0-8.4) and the third (NLR ≥8.4) tertiles were 1.52 (1.13-2.03) and 2.53 (1.92-3.34), respectively, compared with the first tertile (NLR <4.0). As for 90-days mortality, the OR for the second (NLR 4.0-8.4) was 1.34 (1.07-1.67) and 2.23 (1.81-2.76) for the third (NLR ≥8.4) tertiles compared with the reference (NLR<4.0). The interactions between the sepsis subgroup and 30-days mortality were significant. Our study concluded that the NLR was an independent predictor of 30- and 90-days mortality for critically ill patients with chronic heart failure.
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Affiliation(s)
- Jinhang Che
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiaqi Song
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuxiang Long
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chunping Wang
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Caiyin Zheng
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ruoyu Zhou
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zengzhang Liu
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Cirelli C, Limonta R, Carioli G, D'Elia E, Ameri P, Inciardi RM, Ghirardi A, Fazzini L, Perra F, Rizzola G, Chiesa E, Tomasoni L, Montisci R, Gavazzi A, Senni M, Gori M. Prognostic role of gait speed in worsening heart failure. Eur J Intern Med 2024:S0953-6205(24)00311-X. [PMID: 39117554 DOI: 10.1016/j.ejim.2024.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 07/03/2024] [Accepted: 07/12/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Worsening Heart Failure (WHF) is associated with adverse prognosis. Identifying novel prognostic markers in WHF is crucial. Gait speed (GS), a validated frailty index, is an easily obtainable parameter that may aid in reclassifying the risk of HF patients. We assessed the independent prognostic role of GS in WHF patients. METHODS We studied 171 patients with chronic HF with worsening congestion symptoms and inadequate response to standard therapies, requiring intravenous diuretic treatment. The primary outcome was a composite of all-cause mortality or HF hospitalization. We assessed the association and the incremental value of GS, as compared to other clinical confounders, with the primary outcome. RESULTS The mean age was 76±11 years, 66 % were male, median BNP was 481 pg/ml, and median ejection fraction was 40 %. Over a median follow-up of 11.3 months, 71 events occurred. Lower GS was significantly associated with a higher risk of events (HR of 4.03, 95 % CI 2.25-7.21), along with neutrophil to lymphocyte ratio, BNP, QRS duration, natremia, and previous myocardial infarction. When added to the MAGGIC risk score and the other significant confounders identified, GS significantly enhanced the model risk prediction (Harrell's C-index 0.75 vs 0.71, p < 0.001). At Classification And Regression Tree analysis, GS≤0.8 m/s was the first parameter to be considered to risk stratify the population. CONCLUSIONS GS, an easily obtainable marker of frailty, may contribute to improve the risk stratification of patients with WHF.
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Affiliation(s)
- Camilla Cirelli
- Department of Medicine and Surgery, University of Milano Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, Italy
| | - Raul Limonta
- Department of Medicine and Surgery, University of Milano Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, Italy
| | - Greta Carioli
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Emilia D'Elia
- Department of Medicine and Surgery, University of Milano Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, Italy; Cardiovascular Department, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Pietro Ameri
- Department of Internal Medicine, University of Genova, Viale Benedetto XV 6, 16132, Genova, Italy
| | - Riccardo Maria Inciardi
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Arianna Ghirardi
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Luca Fazzini
- Clinical Cardiology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Cittadella Universitaria di Monserrato, Strada Provinciale 8, 09042, Monserrato, Cagliari, Italy
| | - Ferdinando Perra
- Clinical Cardiology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Cittadella Universitaria di Monserrato, Strada Provinciale 8, 09042, Monserrato, Cagliari, Italy
| | - Ginevra Rizzola
- Department of Internal Medicine, University of Genova, Viale Benedetto XV 6, 16132, Genova, Italy; Cardiology Unit, Medical Sciences Department, ASST Bergamo Est, Via Paderno 21, 24068, Seriate, Italy
| | - Erika Chiesa
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Laura Tomasoni
- In charge of Surgical, Cardiovascular & Neuroscience Nursing Department, Department of Health and Social Professions, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
| | - Roberta Montisci
- Clinical Cardiology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Cittadella Universitaria di Monserrato, Strada Provinciale 8, 09042, Monserrato, Cagliari, Italy
| | - Antonello Gavazzi
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Michele Senni
- Department of Medicine and Surgery, University of Milano Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, Italy; Cardiovascular Department, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Mauro Gori
- Department of Medicine and Surgery, University of Milano Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, Italy; Cardiovascular Department, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy.
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Gosav EM, Tanase DM, Buliga-Finis ON, Rezuș II, Morariu PC, Floria M, Rezus C. The Prognostic Role of the Neutrophil-to-Lymphocytes Ratio in the Most Frequent Cardiovascular Diseases: An Update. Life (Basel) 2024; 14:985. [PMID: 39202727 PMCID: PMC11355618 DOI: 10.3390/life14080985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 08/03/2024] [Accepted: 08/05/2024] [Indexed: 09/03/2024] Open
Abstract
Given the continuous changes in the world, with an increasing trend of unhealthy lifestyles, metabolic comorbidities, and increased susceptibility to cardiovascular diseases (CVDs), researchers change their attention to improve not only the therapeutic platform but also current CVD predictive and prognostic tools to improve disease outcomes. As CVD is characterized by an inflammatory paradigm involving, to some degree, the innate and adaptative immune systems, the neutrophil-to-lymphocyte ratio (NLR) emerged as a potential low-cost, rapidly available, and reliable inflammatory marker, with substantial recent evidence showing its potential utility in clinical practice. Thus, in this literature review, we will present an up-to-date discussion of the prognostic role of NLR in the most frequent CVDs, such as acute and chronic coronary disease, atherosclerotic disease, heart failure, cardiac valvopathies, and cardiac arrhythmias with predilection to atrial fibrillation.
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Affiliation(s)
- Evelina Maria Gosav
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (E.M.G.); (O.N.B.-F.); (P.C.M.); (C.R.)
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Daniela Maria Tanase
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (E.M.G.); (O.N.B.-F.); (P.C.M.); (C.R.)
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Oana Nicoleta Buliga-Finis
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (E.M.G.); (O.N.B.-F.); (P.C.M.); (C.R.)
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Ioana-Irina Rezuș
- Department of Radiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- Radiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania
| | - Paula Cristina Morariu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (E.M.G.); (O.N.B.-F.); (P.C.M.); (C.R.)
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Mariana Floria
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (E.M.G.); (O.N.B.-F.); (P.C.M.); (C.R.)
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Ciprian Rezus
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (E.M.G.); (O.N.B.-F.); (P.C.M.); (C.R.)
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania
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Dihoum A, Brown AJ, McCrimmon RJ, Lang CC, Mordi IR. Dapagliflozin, inflammation and left ventricular remodelling in patients with type 2 diabetes and left ventricular hypertrophy. BMC Cardiovasc Disord 2024; 24:356. [PMID: 38997620 PMCID: PMC11241903 DOI: 10.1186/s12872-024-04022-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/28/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND AND AIMS Sodium-glucose co-transporter 2 (SGLT2) inhibitors have beneficial effects in heart failure (HF), including reverse remodelling, but the mechanisms by which these benefits are conferred are unclear. Inflammation is implicated in the pathophysiology of heart failure (HF) and there are some pre-clinical data suggesting that SGLT2 inhibitors may reduce inflammation. There is however a lack of clinical data. The aim of our study was to investigate whether improvements in cardiac remodelling caused by dapagliflozin in individuals with type 2 diabetes (T2D) and left ventricular hypertrophy (LVH) were associated with its effects on inflammation. METHODS We measured C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), interleukin-1β (IL-1β), interleukin 6 (IL-6), and interleukin 10 (IL-10) and neutrophil-to-lymphocyte ratio (NLR) in plasma samples of 60 patients with T2D and left ventricular hypertrophy (LVH) but without symptomatic HF from the DAPA-LVH trial in which participants were randomised dapagliflozin 10 mg daily or placebo for 12 months and underwent cardiac magnetic resonance imaging (CMR) at baseline and end of treatment. The primary analysis was to investigate the effect of dapagliflozin on inflammation and to assess the relationships between changes in inflammatory markers and LV mass and global longitudinal strain (GLS) and whether the effect of dapagliflozin on LV mass and GLS was modulated by baseline levels of inflammation. RESULTS Following 12 months of treatment dapagliflozin significantly reduced CRP compared to placebo (mean difference of -1.96; 95% CI -3.68 to -0.24, p = 0.026). There were no significant statistical changes in other inflammatory markers. There were modest correlations between improvements in GLS and reduced inflammation (NLR (r = 0.311), IL-1β (r = 0.246), TNF-α (r = 0.230)) at 12 months. CONCLUSIONS Dapagliflozin caused a significant reduction in CRP compared to placebo. There were correlations between reductions in inflammatory markers including IL-1β and improvements in global longitudinal strain (but not reduced LV mass). Reductions in systemic inflammation might play a contributory role in the cardiovascular benefits of dapagliflozin. TRIAL REGISTRATION Clinicaltrials.gov NCT02956811 (06/11/2016).
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MESH Headings
- Humans
- Glucosides/therapeutic use
- Benzhydryl Compounds/therapeutic use
- Hypertrophy, Left Ventricular/physiopathology
- Hypertrophy, Left Ventricular/drug therapy
- Hypertrophy, Left Ventricular/diagnostic imaging
- Hypertrophy, Left Ventricular/etiology
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/physiopathology
- Ventricular Remodeling/drug effects
- Male
- Female
- Sodium-Glucose Transporter 2 Inhibitors/therapeutic use
- Middle Aged
- Ventricular Function, Left/drug effects
- Treatment Outcome
- Inflammation Mediators/blood
- Biomarkers/blood
- Aged
- Time Factors
- Inflammation/drug therapy
- Inflammation/blood
- Inflammation/physiopathology
- Inflammation/diagnosis
- Double-Blind Method
- Anti-Inflammatory Agents/therapeutic use
- Cytokines/blood
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Affiliation(s)
- Adel Dihoum
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Alexander Jm Brown
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | | | - Chim C Lang
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Ify R Mordi
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, UK.
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Alzaabi MA, Abdelsalam A, Alhammadi M, Bani Hani H, Almheiri A, Al Matrooshi N, Al Zaman K. Evaluating Biomarkers as Tools for Early Detection and Prognosis of Heart Failure: A Comprehensive Review. Card Fail Rev 2024; 10:e06. [PMID: 38915376 PMCID: PMC11194781 DOI: 10.15420/cfr.2023.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/19/2024] [Indexed: 06/26/2024] Open
Abstract
There is a high prevalence of heart failure (HF) worldwide, which has significant consequences for healthcare costs, patient death and quality of life. Therefore, there has been much focus on finding and using biomarkers for early diagnosis, prognostication and therapy of HF. This overview of the research presents a thorough examination of the current state of HF biomarkers and their many uses. Their function in diagnosing HF, gauging its severity and monitoring its response to therapy are all discussed. Particularly promising in HF diagnosis and risk stratification are the cardiac-specific biomarkers, B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide. Markers of oxidative stress, extracellular matrix, renal function, inflammation and cardiac peptides have shown promise in evaluating HF severity and prognosis. MicroRNAs and insulin-like growth factor are two emerging biomarkers that have shown potential in helping with HF diagnosis and prognosis.
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Affiliation(s)
- Moza A Alzaabi
- Cardiothoracic Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic Abu DhabiAbu Dhabi, United Arab Emirates
| | - Amin Abdelsalam
- Department of Cardiology, Al Qassemi HospitalSharjah, United Arab Emirates
| | - Majid Alhammadi
- College of Medicine, University of SharjahSharjah, United Arab Emirates
| | - Hasan Bani Hani
- College of Medicine, University of SharjahSharjah, United Arab Emirates
| | - Ali Almheiri
- College of Medicine, University of SharjahSharjah, United Arab Emirates
| | - Nadya Al Matrooshi
- Cardiothoracic Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic Abu DhabiAbu Dhabi, United Arab Emirates
| | - Khaled Al Zaman
- Cardiothoracic Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic Abu DhabiAbu Dhabi, United Arab Emirates
- College of Medicine, University of SharjahSharjah, United Arab Emirates
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7
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Nikhil KG, Jayakumar KT, Shiny PJ, Ramya NK, Kumar JS. Neutrophil lymphocyte ratio and heart type fatty acid binding protein as a prognostic marker in Myocardial infarction within 48 h of admission. Egypt Heart J 2024; 76:59. [PMID: 38771512 PMCID: PMC11109033 DOI: 10.1186/s43044-024-00489-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/09/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND The neutrophil to lymphocyte ratio (NLR) is a measure of systemic inflammation, whereas Heart type fatty acid protein (HFABP) is a cytosolic protein released early after acute coronary syndrome (ACS). The aim of this research study is to determine whether NLR and H-FAB are useful in predicting the prognosis in patients with ST segment elevation myocardial infarction (STEMI) 48 h after admission. This is a prospective observational study conducted on 97 patients who had been admitted to emergency room with ST-elevation myocardial infarction in their ECG in a tertiary care centre of south India. The neutrophil-lymphocyte ratio was measured at the time of admission, 24th hour and 48th hour, and then compared with the outcome. To determine their significance in the MI episode, troponin-I and H-FABP were also measured. RESULTS A significant correlation was found in the final outcomes of patients and the NLR at the time of admission and at 48 h (p = 0.01). Additionally, a substantial correlation between NLR and various degrees of LV dysfunction was also observed (p = 0.01). H-FABP was found to be positive in all 97 of the patients examined, whereas Troponin-I was only found to be positive in 56.7%. CONCLUSION The study's findings, indicated strong correlations between NLR and LVEF, indicated that NLR might serve as an early predictor of cardiac events which could be either poor prognosis or higher mortality. This research found that H-FABP may serve as an early MI diagnostic marker.
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Affiliation(s)
- K G Nikhil
- Department of General Medicine, SRM Medical College Hospital and Research Centre, SRMIST, Kattankulathur, Kancheepuram District, Tamil Nadu, 603209, India
| | - K T Jayakumar
- Department of General Medicine, SRM Medical College Hospital and Research Centre, SRMIST, Kattankulathur, Kancheepuram District, Tamil Nadu, 603209, India
| | - P J Shiny
- Department of Medical Research, SRM Medical College Hospital and Research Centre, SRMIST, Kattankulathur, Tamil Nadu, 603209, India
| | - N K Ramya
- Department of General Medicine, SRM Medical College Hospital and Research Centre, SRMIST, Kattankulathur, Kancheepuram District, Tamil Nadu, 603209, India
| | - J S Kumar
- Department of General Medicine, SRM Medical College Hospital and Research Centre, SRMIST, Kattankulathur, Kancheepuram District, Tamil Nadu, 603209, India.
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Boulet J, Sridhar VS, Bouabdallaoui N, Tardif JC, White M. Inflammation in heart failure: pathophysiology and therapeutic strategies. Inflamm Res 2024; 73:709-723. [PMID: 38546848 PMCID: PMC11058911 DOI: 10.1007/s00011-023-01845-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/09/2023] [Accepted: 12/19/2023] [Indexed: 04/30/2024] Open
Abstract
A role for inflammation in the development and progression of heart failure (HF) has been proposed for decades. Multiple studies have demonstrated the potential involvement of several groups of cytokines and chemokines in acute and chronic HF, though targeting these pathways in early therapeutic trials have produced mixed results. These studies served to highlight the complexity and nuances of how pro-inflammatory pathways contribute to the pathogenesis of HF. More recent investigations have highlighted how inflammation may play distinct roles based on HF syndrome phenotypes, findings that may guide the development of novel therapies. In this review, we propose a contemporary update on the role of inflammation mediated by the innate and adaptive immune systems with HF, highlighting differences that exist across the ejection fraction spectrum. This will specifically be looked at through the lens of established and novel biomarkers of inflammation. Subsequently, we review how improvements in inflammatory pathways may mediate clinical benefits of existing guideline-directed medical therapies for HF, as well as future therapies in the pipeline targeting HF and inflammation.
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Affiliation(s)
- Jacinthe Boulet
- Department of Medicine, Division of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Vikas S Sridhar
- Department of Medicine, Division of Nephrology, University Health Network, Toronto, ON, Canada
| | - Nadia Bouabdallaoui
- Department of Medicine, Division of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Jean-Claude Tardif
- Department of Medicine, Division of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Michel White
- Department of Medicine, Division of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada.
- Department of Medicine, Division of Cardiology, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, QC, H1C 1C8, Montreal, Canada.
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9
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Zhou P, Tian PC, Zhai M, Huang Y, Zhou Q, Zhuang XF, Liu HH, Wang JX, Zhang YH, Zhang J. Association between red blood cell distribution width-to-albumin ratio and prognosis in non-ischaemic heart failure. ESC Heart Fail 2024; 11:1110-1120. [PMID: 38266632 DOI: 10.1002/ehf2.14628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/07/2023] [Accepted: 11/21/2023] [Indexed: 01/26/2024] Open
Abstract
AIMS Red blood cell distribution width-to-albumin ratio (RAR), an innovate biomarker of inflammation, can independently predict adverse cardiovascular outcomes. However, the association between RAR and prognosis in patients with non-ischaemic heart failure (NIHF) remains unclear. METHODS AND RESULTS A total of 2077 NIHF patients admitted to the Heart Failure Care Unit, Fuwai Hospital, were consecutively enrolled from December 2006 to October 2017 in this retrospective study. The primary endpoint was a composite outcome of all-cause mortality and heart transplantation. The correlation between RAR and the composite outcome was assessed by the Kaplan-Meier survival analysis and the Cox regression analysis. Incremental predictive values and the clinical performance of RAR for all-cause mortality or heart transplantation were also assessed based on a 12-variable traditional risk model. The median follow-up time in this study was 1433 (1341, 1525) days. As the gender no longer satisfied the Cox proportional risk assumption after 1150 days, we set 1095 days as the follow-up time for analysis. A total of 500 patients reached the composite outcome. Multivariable Cox regression showed that per log2 increase of RAR was significantly associated with a 132.9% [hazard ratio 2.329, 95% confidence interval (CI) 1.677-3.237, P < 0.001] increased risk of all-cause mortality or heart transplantation. Better model discrimination [concordance index: 0.766 (95% CI 0.754-0.778) vs. 0.758 (95% CI 0.746-0.770), P < 0.001], calibration (Akaike information criterion: 1487.3 vs. 1495.74; Bayesian information criterion: 1566.25 vs. 1569.43; Brier score: 1569.43 vs. 1569.43; likelihood ratio test P < 0.001), and reclassification (integrated discrimination improvement: 1.35%, 95% CI 0.63-2.07%, P < 0.001; net reclassification improvement: 13.73%, 95% CI 2.05-27.18%, P = 0.034) were improved after adding RAR to the traditional model (P < 0.001 for all). A higher overall net benefit was also obtained in the threshold risk probability of 20-55%. CONCLUSIONS High level of RAR was an independent risk factor of poor outcome in NIHF.
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Affiliation(s)
- Ping Zhou
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing, 100037, China
| | - Peng-Chao Tian
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing, 100037, China
- Surgical Intensive Care Unit, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Mei Zhai
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing, 100037, China
| | - Yan Huang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing, 100037, China
| | - Qiong Zhou
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing, 100037, China
| | - Xiao-Feng Zhuang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing, 100037, China
| | - Hui-Hui Liu
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing, 100037, China
| | - Jin-Xi Wang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing, 100037, China
| | - Yu-Hui Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing, 100037, China
| | - Jian Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing, 100037, China
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10
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Pitt B, Iyer SPN, Humes HD. New opportunity for targeting systemic inflammation in patients with heart failure through leucocyte immunomodulation. Eur J Heart Fail 2024; 26:534-536. [PMID: 38390738 DOI: 10.1002/ejhf.3177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/03/2024] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Affiliation(s)
- Bertram Pitt
- Division of Internal Medicine (Emeritus), University of Michigan School of Medicine, Ann Arbor, MI, USA
| | | | - H David Humes
- Division of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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11
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Ang SP, Chia JE, Jaiswal V, Hanif M, Iglesias J. Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Patients with Acute Decompensated Heart Failure: A Meta-Analysis. J Clin Med 2024; 13:1212. [PMID: 38592030 PMCID: PMC10931846 DOI: 10.3390/jcm13051212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/07/2024] [Accepted: 02/14/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Inflammation plays a pivotal role in the pathogenesis of both acute and chronic heart failure. Recent studies showed that the neutrophil-to-lymphocyte ratio (NLR) could be related to adverse outcomes in patients with cardiovascular diseases. We sought to evaluate whether NLR could predict mortality in patients with acute heart failure by means of a meta-analysis. Methods: A comprehensive literature search was performed in PubMed, Embase, and Cochrane databases through January 2023 for studies evaluating the association of NLR with mortality in patients with acute heart failure. Primary outcomes were in-hospital mortality and long-term all-cause mortality. Endpoints were pooled using a random-effects DerSimonian-and-Laird model and were expressed as a hazard ratio (HR) or mean difference (MD) with their corresponding 95% confidence intervals. Results: A total of 15 studies with 15,995 patients with acute heart failure were included in the final study. Stratifying patients based on a cut-off NLR, we found that high NLR was associated with a significantly higher in-hospital mortality [HR 1.54, 95% CI (1.18-2.00), p < 0.001] and long-term all-cause mortality [HR 1.61, 95% CI (1.40-1.86), p < 0.001] compared to the low-NLR group. Comparing the highest against the lowest NLR quartile, it was shown that patients in the highest NLR quartile has a significantly heightened risk of long-term all-cause mortality [HR 1.77, 95% CI (1.38-2.26), p < 0.001] compared to that of lowest NLR quartile. However, the risks of in-hospital mortality were compared between both quartiles of patients [HR 1.78, 95% CI (0.91-3.47), p = 0.09]. Lastly, NLR values were significantly elevated among non-survivors compared to survivors during index hospitalization [MD 5.07, 95% CI (3.34-6.80), p < 0.001] and during the follow-up period [MD 1.06, 95% CI (0.54-1.57), p < 0.001]. Conclusions: Elevated NLR was associated with an increased risk of short- and long-term mortality and could be a useful tool or incorporated in the risk stratification in patients with acute heart failure.
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Affiliation(s)
- Song Peng Ang
- Department of Internal Medicine, Rutgers Health/Community Medical Center, Toms River, NJ 08755, USA;
| | - Jia Ee Chia
- Department of Internal Medicine, Texas Tech University Health Science Center, El Paso, TX 79905, USA;
| | - Vikash Jaiswal
- Department of Internal Medicine, Larkin Community Hospital, South Miami, FL 33143, USA;
| | - Muhammad Hanif
- Department of Internal Medicine, Suny Upstate Medical University, Syracuse, NY 13210, USA;
| | - Jose Iglesias
- Department of Internal Medicine, Rutgers Health/Community Medical Center, Toms River, NJ 08755, USA;
- Department of Internal Medicine, Hackensack Meridian School of Medicine, Nutley, NJ 07110, USA
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12
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Korepanov VA, Atabekov TA, Rebrova TY, Batalov RE, Afanasiev SA. Relationship between mitochondrial respiratory dysfunction of blood mononuclear cells and heart failure severity. J Geriatr Cardiol 2024; 21:130-134. [PMID: 38440343 PMCID: PMC10908581 DOI: 10.26599/1671-5411.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Affiliation(s)
- Viacheslav A. Korepanov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Tariel A. Atabekov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Tatiana Yu. Rebrova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Roman E. Batalov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Sergey A. Afanasiev
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
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13
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Bergamaschi G, Barteselli C, Calabretta F, Lenti MV, Merli S, Rossi CM, Di Sabatino A. Haematological sequelae in the post-acute phase of symptomatic SARS-CoV-2 infection. Intern Emerg Med 2024; 19:125-133. [PMID: 38001354 DOI: 10.1007/s11739-023-03459-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 10/10/2023] [Indexed: 11/26/2023]
Abstract
Many patients surviving SARS-CoV-2 infection suffer from long-term symptoms (long COVID or post COVID) such as shortness of breath, fatigue, loss of taste or smell and cognitive deterioration. However, few data are available concerning blood cell counts and haematological parameters during the post-COVID period. We analysed haematological data from 83 patients previously admitted to the internal medicine unit of our institution because of symptomatic SARS-CoV-2 infection; all data were obtained within 1-12 months from disease onset. A control group of 70 apparently healthy, age- and sex-matched COVID-19 negative individuals was assessed for comparison. Blood cell counts improved in the post-COVID period, but 81% of patients had persistent abnormalities, compared with 50% in the control group, p < 0.001. Most common haematological findings included anaemia (40%), reduced lymphocyte (43%) or eosinophil counts (38%) and low IgM memory B cells and correlated with advanced age, number of chronic comorbidities, female gender, altered renal function, reduced baseline Hb and procalcitonin concentrations and increased RDW. Data on lymphocytes and IgM memory B cells show that impaired immune responses may persist for up to one year in the post-COVID period, possibly contributing to long-term symptoms, especially in female patients.
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Affiliation(s)
- Gaetano Bergamaschi
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, Pavia, Italy.
| | - Chiara Barteselli
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, Pavia, Italy
| | - Francesca Calabretta
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, Pavia, Italy
| | - Marco Vincenzo Lenti
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, Pavia, Italy
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - Stefania Merli
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, Pavia, Italy
| | - Carlo Maria Rossi
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, Pavia, Italy
| | - Antonio Di Sabatino
- Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, Pavia, Italy
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
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14
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Vakhshoori M, Nemati S, Sabouhi S, Yavari B, Shakarami M, Bondariyan N, Emami SA, Shafie D. Neutrophil to lymphocyte ratio (NLR) prognostic effects on heart failure; a systematic review and meta-analysis. BMC Cardiovasc Disord 2023; 23:555. [PMID: 37957565 PMCID: PMC10644447 DOI: 10.1186/s12872-023-03572-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 10/21/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Neutrophil to lymphocyte ratio (NLR), as a recent inflammatory index, has been reported to be a prognostic tool in different diseases. However, implication of this ratio in heart failure (HF) is less investigated. In this systematic review and meta-analysis, we aimed to assess the potential impact of NLR on HF clinical outcomes. METHODS Relevant English published records in PubMed, Scopus, Embase, and Web of Science were screened up to July 2023. Articles reporting clinical outcomes (follow-up or in-hospital mortality, readmission, HF prediction, extended hospital stay length, pulmonary vascular resistance, atrial fibrillation, renal disease and functional capacity) in HF sufferers were collected for further analysis with addition of NLR difference stratified by death/survived and HF status. RESULTS Thirty-six articles (n = 18231) were finally selected which reported NLR in HF sufferers (mean: 4.38, 95% confidence interval (CI): 4.02-4.73). We found 25 articles reported NLR and total mortality (either follow-up death (N = 19): 4.52 (95% CI: 4.03-5.01) or in-hospital death (N = 10): 5.33 (95% CI: 4.08-6.57)) with mean NLR of 4.74 (95% CI: 4.28-5.20). NLR was higher among deceased patients compared to survived ones (standard mean difference: 0.67 (95% CI: 0.48-0.87), P < 0.001)). NLR was found to be related with higher mortality risk (continuous variable: hazard ratio (HR): 1.12, 95% CI: 1.02-1.23, P = 0.013), categorical variable: HR: 1.77, 95% CI: 1.27-2.46, P = 0.001, T2 vs. T1: HR:1.56, 95%CI: 1.21-2.00, P = 0.001, T3 vs. T1: HR:2.49, 95%CI: 1.85-3.35, P < 0.001). Other aforementioned variables were not feasible to analyze due to presence of few studies. CONCLUSIONS NLR is a simple and acceptable prognostic tool for risk stratification and prioritizing high risk patients in clinical settings, especially in resource limited nations.
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Affiliation(s)
- Mehrbod Vakhshoori
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Sepehr Nemati
- School of Medicine, Tehran Azad University of Medical Sciences, Tehran, Iran
| | - Sadeq Sabouhi
- Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behzad Yavari
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrnaz Shakarami
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Niloofar Bondariyan
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sayed Ali Emami
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Davood Shafie
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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15
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Tang XL, Nasr M, Zheng S, Zoubul T, Stephan JK, Uchida S, Singhal R, Khan A, Gumpert A, Bolli R, Wysoczynski M. Bone Marrow and Wharton's Jelly Mesenchymal Stromal Cells are Ineffective for Myocardial Repair in an Immunodeficient Rat Model of Chronic Ischemic Cardiomyopathy. Stem Cell Rev Rep 2023; 19:2429-2446. [PMID: 37500831 PMCID: PMC10579184 DOI: 10.1007/s12015-023-10590-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Although cell therapy provides benefits for outcomes of heart failure, the most optimal cell type to be used clinically remains unknown. Most of the cell products used for therapy in humans require in vitro expansion to obtain a suitable number of cells for treatment; however, the clinical background of the donor and limited starting material may result in the impaired proliferative and reparative capacity of the cells expanded in vitro. Wharton's jelly mesenchymal cells (WJ MSCs) provide a multitude of advantages over adult tissue-derived cell products for therapy. These include large starting tissue material, superior proliferative capacity, and disease-free donors. Thus, WJ MSC if effective would be the most optimal cell source for clinical use. OBJECTIVES This study evaluated the therapeutic efficacy of Wharton's jelly (WJ) and bone marrow (BM) mesenchymal stromal cells (MSCs) in chronic ischemic cardiomyopathy in rats. METHODS Human WJ MSCs and BM MSCs were expanded in vitro, characterized, and evaluated for therapeutic efficacy in a immunodeficient rat model of ischemic cardiomyopathy. Cardiac function was evaluated with hemodynamics and echocardiography. The extent of cardiac fibrosis, hypertrophy, and inflammation was assessed with histological analysis. RESULTS In vitro analysis revealed that WJ MSCs and BM MSCs are morphologically and immunophenotypically indistinguishable. Nevertheless, the functional analysis showed that WJ MSCs have a superior proliferative capacity, less senescent phenotype, and distinct transcriptomic profile compared to BM MSC. WJ MSCs and BM MSC injected in rat hearts chronically after MI produced a small, but not significant improvement in heart structure and function. Histological analysis showed no difference in the scar size, collagen content, cardiomyocyte cross-sectional area, and immune cell count. CONCLUSIONS Human WJ and BM MSC have a small but not significant effect on cardiac structure and function when injected intramyocardially in immunodeficient rats chronically after MI.
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Affiliation(s)
- Xian-Liang Tang
- Institute of Molecular Cardiology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Marjan Nasr
- Center for Cardiometabolic Science, University of Louisville School of Medicine, 580 South Preston St. - Rm 204B, Louisville, KY, 40202, USA
| | - Shirong Zheng
- Center for Cardiometabolic Science, University of Louisville School of Medicine, 580 South Preston St. - Rm 204B, Louisville, KY, 40202, USA
| | - Taylor Zoubul
- Center for Cardiometabolic Science, University of Louisville School of Medicine, 580 South Preston St. - Rm 204B, Louisville, KY, 40202, USA
| | - Jonah K Stephan
- Center for Cardiometabolic Science, University of Louisville School of Medicine, 580 South Preston St. - Rm 204B, Louisville, KY, 40202, USA
| | - Shizuka Uchida
- Center for RNA Medicine, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
| | - Richa Singhal
- Center for Cardiometabolic Science, University of Louisville School of Medicine, 580 South Preston St. - Rm 204B, Louisville, KY, 40202, USA
| | - Aisha Khan
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Anna Gumpert
- Institute of Molecular Cardiology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Roberto Bolli
- Institute of Molecular Cardiology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Marcin Wysoczynski
- Center for Cardiometabolic Science, University of Louisville School of Medicine, 580 South Preston St. - Rm 204B, Louisville, KY, 40202, USA.
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16
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Ferreira AI, Silva JE, Melo N, Oliveira D, Silva C, Lume M, Pereira J, Almeida J, Araújo JP, Lourenço P. Prognostic impact of red blood cell distribution width in chronic heart failure patients with left ventricular dysfunction. J Cardiovasc Med (Hagerstown) 2023; 24:746-751. [PMID: 37642949 DOI: 10.2459/jcm.0000000000001543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
AIMS Red blood cell (RBC) distribution width (RDW) measures RBC variations in size. Higher RDW values have been associated with poor outcome in acute heart failure (HF). We aimed to assess the prognostic impact of the RDW in chronic HF. METHODS We retrospectively analysed a cohort of chronic HF patients with left ventricular systolic dysfunction followed in our HF clinic between January 2012 and May 2018. Patients with missing data concerning RDW were excluded. Patients were categorized according to RDW tertiles: ≤13.5%; between 13.5 and 14.7%; and >14.7%. Patients were followed until January 2021; all-cause mortality was the end point analysed. The association of RDW with all-cause mortality was assessed with a Cox-regression analysis. Two multivariate models were built. RESULTS We studied 860 chronic HF patients, 66.4% males, mean age 70 (standard deviation, SD 13) years. Patients were followed for a median of 49 (29-82) months. During this period, 423 (49.2%) patients died. Mortality increased with increasing RDW tertiles. Patients with RDW >14.7% had a HR of mortality of 1.95 (1.47-2.58), p < 0.001 (model 1) and of 1.81 (1.35-2.41), p < 0.001 (model 2) when compared with those with RDW ≤13.5. Patients in the second RDW tertile had an all-cause death HR of 1.47 (1.12-1.93) and of 1.44 (1.09-1.90) in models 1 and 2, respectively. CONCLUSIONS Chronic HF patients with RDW values >14.7% presented an almost 2-fold higher risk of dying in the long term than those with RDW <13.5%. RDW is a widely available and easily measured parameter that can help clinicians in the risk stratification of chronic HF patients.
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Affiliation(s)
| | - João Enes Silva
- Internal Medicine Department, Centro Hospitalar Universitário de São João
| | - Nuno Melo
- Internal Medicine Department, Centro Hospitalar Universitário de São João
| | - Diana Oliveira
- Internal Medicine Department, Centro Hospitalar Universitário de São João
| | - Clara Silva
- Internal Medicine Department, Centro Hospitalar Universitário de São João
| | - Maria Lume
- Internal Medicine Department, Centro Hospitalar Universitário de São João
| | - Joana Pereira
- Internal Medicine Department, Centro Hospitalar Universitário de São João
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Jorge Almeida
- Internal Medicine Department, Centro Hospitalar Universitário de São João
| | - José Paulo Araújo
- Internal Medicine Department, Centro Hospitalar Universitário de São João
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Patrícia Lourenço
- Internal Medicine Department, Centro Hospitalar Universitário de São João
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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17
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Çakır MO. The Prognostic Significance of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio for Long-Term Survival in Patients With Severe Left Ventricular Dysfunction and Implantable Cardioverter Defibrillator. Cureus 2023; 15:e47441. [PMID: 37899896 PMCID: PMC10602596 DOI: 10.7759/cureus.47441] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 10/31/2023] Open
Abstract
İntroduction: Systemic inflammation resulting from comorbidities such as arterial hypertension, diabetes, and obesity is responsible for the pathogenesis of myocardial structural and functional changes in heart failure. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are novel biomarkers of inflammation. The aim of this study was to evaluate the relationship between blood NLR and PLR levels and one-year cardiac mortality in primary prevention patients with left ventricular ejection fraction (LVEF) ≤35%, using an intracardiac defibrillator. METHODS A total of 180 compensated heart failure patients with LVEF<35% (ischemic or nonischemic) and implantable cardioverter-defibrillator (ICD) therapy for primary prevention who applied to the cardiology outpatient clinic of Zonguldak Bülent Ecevit Üniversitesi Hospital, Zonguldak, Türkiye, between March 2018 and June 2019 were consecutively included. The patients were followed for one year after the application. RESULTS In the multivariate logistic regression analysis model, only NLR (OR: 1.328; 95%CI: 1.129-1.563; p <0.01) was found independently associated with the risk of one-year cardiovascular mortality. Based on the NLR, levels were 2.69 ng/ml, and the area under the curve was found to be 0.795 (95%CI: 0.729-0.862) in the evaluation made with the receiver operating characteristic curve. CONCLUSION High NLR ratio levels independently predicted one-year cardiac mortality in patients with LVEF<35% and ICD for secondary protection. Large-scale randomized studies are needed to fully demonstrate the relationship between NLR levels and cardiovascular mortality in patients with severe left ventricular dysfunction and ICD.
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Affiliation(s)
- Mustafa Ozan Çakır
- Cardiology, Zonguldak Bülent Ecevit Üniversitesi Faculty of Medicine, Zonguldak, TUR
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18
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Alshuweishi Y, Alfaifi M, Almoghrabi Y, Al-Sheikh YA, Alfhili MA. A Retrospective Analysis of the Association of Neutrophil-Lymphocyte Ratio (NLR) with Anemia in the Saudi Population. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1592. [PMID: 37763711 PMCID: PMC10536447 DOI: 10.3390/medicina59091592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/23/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023]
Abstract
Background: The link between inflammation and anemia is well established but fluctuations in the emerging inflammatory index, neutrophil-lymphocyte ratio (NLR), in anemic subjects remain ambiguous. The purpose of this study is to address the prevailing knowledge gaps regarding the association of NLR with anemia in the Saudi population. Methods: Laboratory results of NLR, C-reactive protein (CRP), and hemoglobin for 14,261 subjects were obtained from Al Borg Diagnostics and retrospectively analyzed. Means, risk measures, and the diagnostic performance of NLR for anemia were examined in age- and gender-wise comparisons. Results: NLR was significantly elevated in anemic individuals and those with high NLR had a significantly lower Hb concentration. Moreover, elevated NLR was more prevalent in anemic subjects (PR: 1.87, 95% CI: 1.46-2.40, p < 0.0001) and carried a greater risk for the condition (OR: 1.91, 95% CI: 1.47-2.48, p < 0.0001) as did CRP. These observations demonstrated distinct age- and gender-specific patterns. However, both parameters were of no value in the diagnosis of anemia as seen from receiver operating characteristic curves. Conclusions: Altogether, these findings indicate that elevated NLR is associated with anemia, which suggests its usefulness for monitoring rather than diagnosing anemia associated with inflammation in Saudi subjects. Further examination of this association in longitudinal studies is needed.
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Affiliation(s)
- Yazeed Alshuweishi
- Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia; (Y.A.); (Y.A.A.-S.)
| | - Mohammed Alfaifi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia;
| | - Yousef Almoghrabi
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- Department of Clinical Pathology, Al Borg Diagnostics, Jeddah 23226, Saudi Arabia
| | - Yazeed A. Al-Sheikh
- Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia; (Y.A.); (Y.A.A.-S.)
| | - Mohammad A. Alfhili
- Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia; (Y.A.); (Y.A.A.-S.)
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19
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Colluoglu T, Akın Y. The Value of Neutrophil-to-Lymphocyte Ratio and Epicardial Adipose Tissue Thickness in Heart Failure With Preserved Ejection Fraction. Cureus 2023; 15:e42846. [PMID: 37538972 PMCID: PMC10395397 DOI: 10.7759/cureus.42846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2023] [Indexed: 08/05/2023] Open
Abstract
Background Using epicardial adipose tissue thickness (EATt) and neutrophil-to-lymphocyte ratio (NLR) as individual indicators provides beneficial insight into the prognosis of patients suffering from heart failure with preserved ejection fraction (HFpEF). Aim In our study, we aimed to evaluate whether the combined evaluation of NLR and EATt would provide an advantage for identifying high-risk HFpEF patients according to hospitalization for heart failure (HHF) and left ventricular diastolic dysfunction (LVDD). Method A total of 168 outpatients with HFpEF were retrospectively analyzed. The predictive performance of two inflammatory variables was assessed by the receiver operating characteristic curve and a one-way analysis of variance (ANOVA) test. The patients were stratified into three distinct risk categories based on the established cut-off values for EATt and NLR as follows: Group I, high risk; Group II, middle risk; and Group III, low risk. Results Patients in Group I had the highest risk for HHF and the presence of LVDD (p=0.001 for HHF, p=0.011 for LVDD). Patients in Group I also exhibited more symptomatic and a greater number of comorbidities. In Group I, more structural remodeling (enlarged left ventricular end-systolic volume index (LVESVI) and left atrial volume index (LAVI)) and associated signs of increased intracardiac pressure (elevated E/A ratio, medial E/e') were observed. Conclusion The results of our study indicate that the use of both EATt and NLR among patients with HFpEF may provide better accuracy in predicting HHF and LVDD compared to the use of either EATt or NLR alone.
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Affiliation(s)
| | - Yeşim Akın
- Cardiology, Karabuk University, Faculty of Medicine, Karabuk, TUR
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Wang X, Chen X, Wang Y, Peng S, Pi J, Yue J, Meng Q, Liu J, Zheng L, Chan P, Tomlinson B, Liu Z, Zhang Y. The Association of Lipoprotein(a) and Neutrophil-to-Lymphocyte Ratio Combination with Atherosclerotic Cardiovascular Disease in Chinese Patients. Int J Gen Med 2023; 16:2805-2817. [PMID: 37426518 PMCID: PMC10328105 DOI: 10.2147/ijgm.s410840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/15/2023] [Indexed: 07/11/2023] Open
Abstract
Objective The association of lipoprotein(a) [Lp(a)] with atherosclerotic cardiovascular disease (ASCVD) risk can be modified by chronic systemic inflammation. The neutrophil-to-lymphocyte ratio (NLR) is a reliable and easily available marker of immune response to various infectious and non-infectious stimuli. The purpose of this study was to assess the combined effects of Lp(a) and NLR in predicting the ASCVD risk and coronary artery plaque traits. Methods This study included 1618 patients who had coronary computed tomography angiography (CTA) with risk assessment of ASCVD. CTA was used to evaluate the traits of coronary atherosclerotic plaques, and the association of ASCVD with Lp(a) and NLR was assessed by multivariate logistic regression models. Results Plasma Lp(a) and NLR were significantly increased in patients having plaques. High Lp(a) was defined as the plasma Lp(a) level > 75 nmol/L and high NLR as NLR > 1.686. The patients were grouped into four categories according to normal or high NLR and plasma Lp(a) as nLp(a)/NLR-, hLp(a)/NLR-, nLp(a)/NLR+ and hLp(a)/NLR+. The patients in the latter three groups had higher risk of ASCVD compared to the reference group nLp(a)/NLR-, with the highest ASCVD risk in the hLp(a)/NLR+ group (OR = 2.39, 95% CI = 1.49-3.83, P = 0.000). The occurrence of unstable plaques was 29.94% in the hLp(a)/NLR+ group, which was significantly higher than groups nLp(a)/NLR+, hLp(a)/NLR- and nLp(a)/NLR- with 20.83%, 26.54% and 22.58%, respectively, and there was a significantly increased risk of unstable plaque in the hLp(a)/NLR+ group compared to the nLp(a)/NLR- group (OR = 1.67, 95% CI = 1.04-2.68, P = 0.035). The risk of stable plaque was not significantly increased in the hLp(a)/NLR+ group compared to the nLp(a)/NLR- group (OR = 1.73, 95% CI = 0.96-3.10, P = 0.066). Conclusion The concomitant presence of elevated Lp(a) and higher NLR is associated with increased unstable coronary artery plaques in patients with ASCVD.
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Affiliation(s)
- Xiaoyu Wang
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Shanghai Heart Failure Research Center, Research Center for Translational Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China
| | - Xiaoli Chen
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Shanghai Heart Failure Research Center, Research Center for Translational Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China
| | - Yanfang Wang
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Shanghai Heart Failure Research Center, Research Center for Translational Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China
| | - Sheng Peng
- Department of Trauma, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, People’s Republic of China
| | - Jingjiang Pi
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Jinnan Yue
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Shanghai Heart Failure Research Center, Research Center for Translational Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China
| | - Qingshu Meng
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Shanghai Heart Failure Research Center, Research Center for Translational Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China
| | - Jie Liu
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Shanghai Heart Failure Research Center, Research Center for Translational Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China
| | - Liang Zheng
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Shanghai Heart Failure Research Center, Research Center for Translational Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China
- Jian hospital, Shanghai East Hospital, Tongji University School of Medicine, Jian, 343006, People’s Republic of China
| | - Paul Chan
- Division of Cardiology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Brian Tomlinson
- Faculty of Medicine, Macau University of Science and Technology, Macau, People’s Republic of China
| | - Zhongmin Liu
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Shanghai Heart Failure Research Center, Research Center for Translational Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China
| | - Yuzhen Zhang
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Shanghai Heart Failure Research Center, Research Center for Translational Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China
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21
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Peh ZH, Dihoum A, Hutton D, Arthur JSC, Rena G, Khan F, Lang CC, Mordi IR. Inflammation as a therapeutic target in heart failure with preserved ejection fraction. Front Cardiovasc Med 2023; 10:1125687. [PMID: 37456816 PMCID: PMC10339321 DOI: 10.3389/fcvm.2023.1125687] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 06/15/2023] [Indexed: 07/18/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) accounts for around half of all cases of heart failure and may become the dominant type of heart failure in the near future. Unlike HF with reduced ejection fraction there are few evidence-based treatment strategies available. There is a significant unmet need for new strategies to improve clinical outcomes in HFpEF patients. Inflammation is widely thought to play a key role in HFpEF pathophysiology and may represent a viable treatment target. In this review focusing predominantly on clinical studies, we will summarise the role of inflammation in HFpEF and discuss potential therapeutic strategies targeting inflammation.
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Affiliation(s)
- Zhen Hui Peh
- School of Medicine, University of Dundee, Ninewells Hospital, Dundee, United Kingdom
| | - Adel Dihoum
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Dana Hutton
- School of Medicine, University of Dundee, Ninewells Hospital, Dundee, United Kingdom
| | - J. Simon C. Arthur
- Division of Cell Signalling and Immunology, School of Life Sciences, University of Dundee, Dundee, United Kingdom
| | - Graham Rena
- Division of Cellular Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Faisel Khan
- Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Chim C. Lang
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Ify R. Mordi
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
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22
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Chou OHI, Zhou J, Li L, Chan JSK, Satti DI, Chou VHC, Wong WT, Lee S, Cheung BMY, Tse G, Chang C, Liu T. The Association Between Neutrophil-Lymphocyte Ratio and Variability with New-Onset Dementia: A Population-Based Cohort Study. J Alzheimers Dis 2023:JAD220111. [PMID: 37302029 DOI: 10.3233/jad-220111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Previous studies identified that neutrophil-to-lymphocyte ratio (NLR) may be a predictor of dementia. However, the associations between NLR and dementia at the population level were less explored. OBJECTIVE This retrospective population-based cohort study was designed to identify the associations between NLR and dementia among patients visiting for family medicine consultation in Hong Kong. METHODS The patients were recruited from January 1, 2000, to December 31, 2003, and followed up until December 31, 2019. The demographics, prior comorbidities, medications, and laboratory results were collected. The primary outcomes were Alzheimer's disease and related dementia and non-Alzheimer's dementia. Cox regression and restricted cubic spline were applied to identify associations between NLR and dementia. RESULTS A cohort of 9,760 patients (male: 41.08% ; baseline age median: 70.2; median follow-up duration: 4756.5 days) with complete NLR were included. Multivariable Cox regression identified that patients with NLR >5.44 had higher risks of developing Alzheimer's disease and related dementia (hazard ratio [HR]: 1.50, 95% Confidence interval [CI]: 1.17-1.93) but not non-Alzheimer's dementia (HR: 1.33; 95% CI: 0.60-2.95). The restricted cubic splines demonstrated that higher NLR was associated with Alzheimer's disease and related dementia. The relationship between the NLR variability and dementia was also explored; of all the NLR variability measures, only the coefficient of variation was predictive of non-Alzheimer's dementia (HR: 4.93; 95% CI: 1.03-23.61). CONCLUSION In this population-based cohort, the baseline NLR predicts the risks of developing dementia. Utilizing the baseline NLR during family medicine consultation may help predict the risks of dementia.
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Affiliation(s)
- Oscar Hou In Chou
- Family Medicine Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
- Department of Medicine, Queen Mary Hospital, Hong Kong, China
| | - Jiandong Zhou
- Family Medicine Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Lifang Li
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Jeffrey Shi Kai Chan
- Family Medicine Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
| | - Danish Iltaf Satti
- Family Medicine Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
| | - Vanessa Hou Cheng Chou
- Family Medicine Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
| | - Wing Tak Wong
- School of Life Sciences, Chinese University of Hong Kong, Hong Kong, China
| | - Sharen Lee
- Family Medicine Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
| | | | - Gary Tse
- Family Medicine Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
- Kent and Medway Medical School, Canterbury, Kent, UK
| | - Carlin Chang
- Department of Medicine, Queen Mary Hospital, Hong Kong, China
| | - Tong Liu
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
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23
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Michaëlsson E, Lund LH, Hage C, Shah SJ, Voors AA, Saraste A, Redfors B, Grove EL, Barasa A, Richards AM, Svedlund S, Lagerström-Fermér M, Gabrielsen A, Garkaviy P, Gan LM, Lam CSP. Myeloperoxidase Inhibition Reverses Biomarker Profiles Associated With Clinical Outcomes in HFpEF. JACC. HEART FAILURE 2023:S2213-1779(23)00125-7. [PMID: 37140510 DOI: 10.1016/j.jchf.2023.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/21/2023] [Accepted: 03/01/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Systemic microvascular dysfunction and inflammation are postulated to play a pathophysiologic role in heart failure with preserved ejection fraction (HFpEF). OBJECTIVES This study aimed to identify biomarker profiles associated with clinical outcomes in HFpEF and investigate how inhibition of the neutrophil-derived reactive oxygen species-producing enzyme, myeloperoxidase, affects these biomarkers. METHODS Using supervised principal component analyses, the investigators assessed the associations between baseline plasma proteomic Olink biomarkers and clinical outcomes in 3 independent observational HFpEF cohorts (n = 86, n = 216, and n = 242). These profiles were then compared with the biomarker profiles discriminating patients treated with active drug vs placebo in SATELLITE (Safety and Tolerability Study of AZD4831 in Patients With Heart Failure), a double-blind randomized 3-month trial evaluating safety and tolerability of the myeloperoxidase inhibitor AZD4831 in HFpEF (n = 41). Pathophysiological pathways were inferred from the biomarker profiles by interrogation of the Ingenuity Knowledge database. RESULTS TNF-R1, TRAIL-R2, GDF15, U-PAR, and ADM were the top individual biomarkers associated with heart failure hospitalization or death, and FABP4, HGF, RARRES2, CSTB, and FGF23 were associated with lower functional capacity and poorer quality of life. AZD4831 downregulated many markers (most significantly CDCP1, PRELP, CX3CL1, LIFR, VSIG2). There was remarkable consistency among pathways associated with clinical outcomes in the observational HFpEF cohorts, the top canonical pathways being associated with tumor microenvironments, wound healing signaling, and cardiac hypertrophy signaling. These pathways were predicted to be downregulated in AZD4831 relative to placebo-treated patients. CONCLUSIONS Biomarker pathways that were most strongly associated with clinical outcomes were also the ones reduced by AZD4831. These results support the further investigation of myeloperoxidase inhibition in HFpEF.
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Affiliation(s)
- Erik Michaëlsson
- Early Clinical Development, Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Lars H Lund
- Department of Medicine, Cardiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Camilla Hage
- Department of Medicine, Cardiology Unit, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Antti Saraste
- Heart Center, Turku University Hospital, University of Turku, Turku, Finland
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Erik L Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Anders Barasa
- Department of Medicine, Glostrup Hospital, Copenhagen, Denmark
| | - A Mark Richards
- Department of Medicine, University of Otago, Christchurch, New Zealand; National University Heart Centre Singapore (NUHCS), National University of Singapore, Singapore
| | - Sara Svedlund
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Maria Lagerström-Fermér
- Early Clinical Development, Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Anders Gabrielsen
- Early Clinical Development, Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Pavlo Garkaviy
- Early Clinical Development, Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Li-Ming Gan
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Carolyn S P Lam
- University of Groningen, Groningen, the Netherlands; National Heart Centre Singapore, Duke-National University of Singapore, Singapore.
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24
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Shafie D, Abhari AP, Fakhrolmobasheri M. Relative Values of Hematological Indices for Prognosis of Heart Failure: A Mini-Review. Cardiol Rev 2023:00045415-990000000-00088. [PMID: 36946981 DOI: 10.1097/crd.0000000000000546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Owing to the augmented perception of heart failure (HF) pathophysiology, management of the affected patients has been improved dramatically; as with the identification of the inflammatory background of HF, new avenues of HF prognosis research have been opened up. In this regard, relative values of hematologic indices were demonstrated by a growing body of evidence to successfully predict HF outcomes. Cost-effectiveness, accessibility, and easy obtainability of these relative values make them a precious option for the determination of HF prognosis; particularly in low-income developing countries. In this short review, we aimed to present the current literature on the predictability of these hematologic parameters for HF outcomes.
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Affiliation(s)
- Davood Shafie
- From the Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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25
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Tamaki S, Nagai Y, Shutta R, Masuda D, Yamashita S, Seo M, Yamada T, Nakagawa A, Yasumura Y, Nakagawa Y, Yano M, Hayashi T, Hikoso S, Nakatani D, Sotomi Y, Sakata Y. Combination of Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios as a Novel Predictor of Cardiac Death in Patients With Acute Decompensated Heart Failure With Preserved Left Ventricular Ejection Fraction: A Multicenter Study. J Am Heart Assoc 2022; 12:e026326. [PMID: 36565197 PMCID: PMC9973595 DOI: 10.1161/jaha.122.026326] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are novel inflammation markers. Their combined usefulness for estimating the prognosis of patients with heart failure with preserved ejection fraction (HFpEF) admitted for acute decompensated heart failure remains elusive. Methods and Results We investigated 1026 patients registered in the Prospective Multicenter Observational Study of Patients with Heart Failure with Preserved Ejection Fraction. Both NLR and PLR values were measured at the time of admission. Comorbidity burden was defined as the number of occurrences of 8 common comorbidities of HFpEF. The primary end point was cardiac death. The patients were stratified into 3 groups based on the optimal cut-off values of NLR and PLR on the receiver operating characteristic curve analysis for predicting cardiac death (low NLR and PLR, either high NLR or PLR, and both high NLR and PLR). After a median follow-up of 429 days, 195 patients died, with 85 of these deaths attributed to cardiac causes. An increased comorbidity burden was significantly associated with a higher proportion of patients with high NLR (>4.5) or PLR (>193), or both. High NLR and PLR values were independently associated with cardiac death, and a combination of both values was the strongest predictor (hazard ratio, 2.66 [95% CI, 1.51%-4.70%], P=0.0008). A significant difference was found in the rate of cardiac death among the 3 groups stratified by NLR and PLR values. Conclusions The combination of NLR and PLR is useful for the prediction of postdischarge cardiac death in patients with acute HFpEF. Registration URL: ClinicalTrials.gov; Unique identifier: UMIN000021831.
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Affiliation(s)
- Shunsuke Tamaki
- Department of CardiologyRinku General Medical CenterOsakaJapan
| | - Yoshiyuki Nagai
- Department of CardiologyRinku General Medical CenterOsakaJapan
| | - Ryu Shutta
- Department of CardiologyRinku General Medical CenterOsakaJapan
| | - Daisaku Masuda
- Department of CardiologyRinku General Medical CenterOsakaJapan
| | | | - Masahiro Seo
- Division of CardiologyOsaka General Medical CenterOsakaJapan
| | - Takahisa Yamada
- Division of CardiologyOsaka General Medical CenterOsakaJapan
| | - Akito Nakagawa
- Division of CardiologyAmagasaki Chuo HospitalAmagasakiJapan,Department of Medical InformaticsOsaka University Graduate School of MedicineOsakaJapan
| | | | | | | | | | - Shungo Hikoso
- Department of Cardiovascular MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Daisaku Nakatani
- Department of Cardiovascular MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Yohei Sotomi
- Department of Cardiovascular MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Yasushi Sakata
- Department of Cardiovascular MedicineOsaka University Graduate School of MedicineOsakaJapan
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26
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Liu L, Chen Y, Xie J. Association of GNRI, NLR, and FT3 with the Clinical Prognosis of Older Patients with Heart Failure. Int Heart J 2022; 63:1048-1054. [DOI: 10.1536/ihj.22-306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Luqiong Liu
- Department of General Medicine, Shanghai Fifth People's Hospital, Fudan University
| | - Yangqin Chen
- Department of General Medicine, Shanghai Fifth People's Hospital, Fudan University
| | - Juan Xie
- Department of General Medicine, Shanghai Fifth People's Hospital, Fudan University
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27
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Yuan X, Huang B, Wang R, Tie H, Luo S. The prognostic value of advanced lung cancer inflammation index (ALI) in elderly patients with heart failure. Front Cardiovasc Med 2022; 9:934551. [PMID: 36440019 PMCID: PMC9697177 DOI: 10.3389/fcvm.2022.934551] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 10/13/2022] [Indexed: 11/12/2022] Open
Abstract
Purpose The advanced lung cancer inflammation index (ALI) is a novel inflammatory and nutritional index that exerts prognostic value in various types of cancer. A previous study demonstrated that ALI at discharge could predict the prognosis in patients with acute decompensated heart failure (ADHF). However, the long-term prognostic value of ALI on admission in elderly heart failure (HF) inpatients remains unclear. Materials and methods We retrospectively collected HF inpatients over 65-year-old who were hospitalized in our cardiology center during the whole year of 2015. ALI was calculated as body mass index (BMI) × serum albumin (Alb)/neutrophil-to-lymphocyte ratio (NLR). Patients were divided into two groups by the optimal cutoff value of ALI for predicting all-cause mortality using time-dependent receiver operating characteristic (ROC) curves. The Spearman rank correlation coefficient was computed to evaluate the correlation between ALI and the geriatric nutritional risk index (GNRI). Kaplan–Meier curves, Cox survival analyses, time-dependent ROC analyses, and net reclassification improvement (NRI) analyses were used to assess the prognostic effect of ALI on all-cause mortality and cardiovascular mortality. Results Over a 28-month median follow-up, all-cause and cardiovascular mortality occurred in 192 (35.4%) and 132 (24.3%) out of 543 patients, respectively. The optimal cutoff value of ALI for predicting all-cause mortality at 2 years was 25.8. Spearman’s correlation coefficient showed a moderate positive linear correlation between ALI and GNRI (r = 0.44, p < 0.001). The Kaplan–Meier analysis revealed that the cumulative incidences of both all-cause and cardiovascular mortalities were significantly higher in patients with lower ALI (log-rank test, all-cause mortality: p < 0.0001; cardiovascular mortality: p < 0.0001). The multivariate Cox proportional hazard analyses indicated that ALI was an independent predictor for both all-cause mortality (HR 0.550, 95% CI 0.349–0.867, p = 0.01) and cardiovascular mortality (HR 0.536, 95% CI 0.302–0.953, p = 0.034). Time-dependent ROC analyses showed that ALI was comparable to GNRI in predicting long-term all-cause mortality (AUC: ALI 0.625, GNRI 0.641, p = 0.976) and cardiovascular mortality (AUC: ALI 0.632, GNRI 0.626, p = 0.999) at 2 years. However, the estimated NRI indicated that the addition of ALI could not significantly improve risk stratification of base models for all-cause mortality (categorical NRI 4.9%, p = 0.433, continuous NRI 25%, p = 0.022) or cardiovascular mortality (categorical NRI 6.5%, p = 0.223, continuous NRI 27.5%, p = 0.029). Conclusion Higher ALI was significantly associated with lower all-cause and cardiovascular mortalities in elderly HF patients. ALI on admission could be a competent nutrition-inflammation marker with independent predictive value for evaluating the long-term mortality of HF in elder population.
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Affiliation(s)
- Xiao Yuan
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bi Huang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ruiyu Wang
- Institute of Life Science, Chongqing Medical University, Chongqing, China
| | - Hongtao Tie
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Suxin Luo
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Suxin Luo,
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28
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Vural A, Aydın E. The Predictive Value of Eosinophil Indices for Major Cardiovascular Events in Patients with Acute Decompensated HFrEF. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1455. [PMID: 36295615 PMCID: PMC9611138 DOI: 10.3390/medicina58101455] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/04/2022] [Accepted: 10/12/2022] [Indexed: 11/09/2022]
Abstract
Background and Objectives: Heart failure is a chronic disease with a high risk of mortality and morbidity. In these patients, inflammatory markers have been shown to be associated with cardiovascular adverse outcomes and disease progression. To investigate the relationships between eosinophil indices and major cardiovascular events (MACE) in patients with acute decompensated heart failure (ADHF) with reduced ejection fraction. Materials and Methods: A total of 395 consecutive patients admitted to the intensive care unit (ICU) with ADHF and reduced ejection fraction between January 2017 and December 2021 were enrolled in this retrospective study. MACE was defined as the composite of death and re-hospitalization for ADHF within 6 months of index hospitalization. All-cause mortality and MACE were assessed with respect to relationships with eosinophil indices, including neutrophil-to-eosinophil ratio (NER), leukocyte-to-eosinophil ratio (LER), eosinophil-to-lymphocyte ratio (ELR), and eosinophil-to-monocyte ratio (EMR). Results: NER and LER were significantly higher in subjects with MACE. Absolute eosinophil, lymphocyte and basophil count, hemoglobin, serum Na+, albumin, and CRP, and EMR and ELR were significantly lower in subjects with MACE compared to those without. NT-proBNP (OR: 1.682, 95% CI: 1.106−2.312, p = 0.001), Na+ (OR: 0.932, 95% CI: 0.897−0.969, p < 0.001), NER (OR: 2.740, 95 % CI: 1.797−4.177, p < 0.001), LER (OR: 2.705, 95% CI: 1.752−4.176, p < 0.001), EMR (OR:1.654, 95% CI 1.123−2.436, p = 0.011), ELR (OR: 2.112, 95% CI 1.424−3.134, p < 0.001), and eosinophil count (OR: 1.833, 95% CI 1.276−2.635) were independent predictors for development of MACE. Conclusions: Patients with ADHF and reduced ejection fraction who developed MACE within the first six months of index hospitalization had lower levels of absolute eosinophil and lymphocyte counts, and EMR and ELR values, whereas NER and LER were higher compared to those without MACE. The eosinophil indices were independently associated with mortality and MACE development. The eosinophil indices may be used to estimate MACE likelihood with acceptable sensitivity and specificity.
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Affiliation(s)
- Aslı Vural
- Clinic of Cardiology, Faculty of Medicine, Giresun University, Giresun 28200, Turkey
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29
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Li Z, Rong H, Wu W, Huang T, Xu J. Application Value of NT-proBNP Combined with NLR in Evaluation of Major Adverse Cardiac Events in Elderly Patients with Chronic Heart Failure. Emerg Med Int 2022; 2022:3689445. [PMID: 36275040 PMCID: PMC9586813 DOI: 10.1155/2022/3689445] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022] Open
Abstract
Objective To explore the application value of N-terminal pro-B type natriuretic peptide (NT-proBNP) combined with neutrophil-to-lymphocyte ratio (NLR) in evaluation of major adverse cardiac events (MACEs) in elderly patients with chronic heart failure (CHF). Methods 50 CHF patients admitted to the Department of Cardiovascular Medicine of our hospital from January 2021 to December 2021 were selected as the observation group. Another 50 non-CHF patients of our hospital were selected as the control group. Clinical data were collected from subjects who met the inclusion criteria, including general information, personal disease history, and laboratory test indicators. Patients with CHF were followed up for 6 months. Patients with CHF were divided into two groups, MACE group and non-MACE group. Results The levels of WBC, NEU, NLR, and NT-proBNP in observation group were higher than those in control group, but the level of LYM was the opposite (P < 0.05). The age, WBC, NEU, LYM, PLT, blood glucose, NLR, and NT-proBNP of MACE group and non-MACE group were significantly different (P < 0.05). The increased levels of NEU, NLR, NT-proBNP and the decreased levels of LYM and PLT are all independent risk factors for MACE in elderly patients with CHF (P < 0.05). The AUC of NLR in evaluating the occurrence of MACE in elderly CHF patients was 0.841. When the Youden index was 0.7692, the sensitivity was 76.92% and the specificity was 100.00%. The AUC of NT-proBNP in evaluating the occurrence of MACE in elderly CHF patients was 0.705. When the Youden index was 0.5260, the sensitivity was 76.92% and the specificity was 75.68%. The AUC of NT-proBNP combined with NLR in evaluating the occurrence of MACE in elderly CHF patients was 0.954. When the Youden index was 0.8420, the sensitivity was 92.31% and the specificity was 91.89%. Conclusion NT-proBNP combined with NLR has high value in the evaluation of MACE in elderly CHF patients and can be used as an auxiliary predictive index in clinic.
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Affiliation(s)
- Zhiyong Li
- Department of Geriatrics, General Hospital of Pingxiang Mining Group Company with Limited Liability, Pingxiang 337035, Jiangxi, China
| | - Hui Rong
- Department of Internal Medicine-Cardiovascular, General Hospital of Pingxiang Mining Group Company with Limited Liability, Pingxiang 337035, Jiangxi, China
| | - Wenxun Wu
- Clinical Laboratory, General Hospital of Pingxiang Mining Group Company with Limited Liability, Pingxiang 337035, Jiangxi, China
| | - Ting Huang
- Department of Hematology, General Hospital of Pingxiang Mining Group Company with Limited Liability, Pingxiang 337035, Jiangxi, China
| | - Jun Xu
- Department of Geriatrics, General Hospital of Pingxiang Mining Group Company with Limited Liability, Pingxiang 337035, Jiangxi, China
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Mordi IR, Lang CC. Glucose-Lowering and Metabolic Effects of SGLT2 Inhibitors. Heart Fail Clin 2022; 18:529-538. [PMID: 36216483 DOI: 10.1016/j.hfc.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Sodium-glucose cotransporter 2 (SGLT2) inhibitors have consistently demonstrated improved outcomes in patients with heart failure with or without type 2 diabetes; however, the mechanisms contributing to these benefits remain poorly understood. Although SGLT2 inhibitors do have glucose-lowering effects, it is unlikely that their cardiovascular benefits are solely due to improved glycemic control. This improved glycemia leads to consequent metabolic effects that could provide further explanation for their action. This review discusses the glucose-lowering and metabolic effects of SGLT2 inhibitors and how these might lead to improved cardiovascular outcomes in patients with heart failure.
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Affiliation(s)
- Ify R Mordi
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee DD1 9SY, United Kingdom
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee DD1 9SY, United Kingdom.
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Zhu X, Cheang I, Xu F, Gao R, Liao S, Yao W, Zhou Y, Zhang H, Li X. Long-term prognostic value of inflammatory biomarkers for patients with acute heart failure: Construction of an inflammatory prognostic scoring system. Front Immunol 2022; 13:1005697. [PMID: 36189198 PMCID: PMC9520349 DOI: 10.3389/fimmu.2022.1005697] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/01/2022] [Indexed: 02/05/2023] Open
Abstract
Objective Systemic inflammation is associated with a poor prognosis in acute heart failure (AHF). This study was to assess the long-term prognostic value of combining the accessible inflammatory markers in relation to all-cause mortality in patients with AHF. Methods Consecutive patients with AHF who were hospitalized between March 2012 and April 2016 at the Department of Cardiology of the First Affiliated Hospital of Nanjing Medical University were enrolled in this prospective study. The LASSO regression model was used to select the most valuable inflammatory biomarkers to develop an inflammatory prognostic scoring (IPS) system. Kaplan-Meier method, multivariate COX regression and time-dependent ROC analysis were used to assess the relationship between inflammatory markers and AHF prognosis. A randomized survival forest model was used to estimate the relative importance of each inflammatory marker in the prognostic risks of AHF. Results A total of 538 patients with AHF were included in the analysis (mean age, 61.1 ± 16.0 years; 357 [66.4%] men). During a median follow-up of 34 months, there were 227 all-cause deaths (42.2%). C-reactive protein (CRP), red blood cell distribution width (RDW) and neutrophil-to-lymphocyte ratio (NLR) were incorporated into the IPS system (IPS = 0.301×CRP + 0.263×RDW + 0.091×NLR). A higher IPS meant a significantly worse long-term prognosis in Kaplan-Meier analysis, with 0.301 points as the optimal cut-off value (P log-rank <0.001). IPS remained an independent prognostic factor associated with an increased risk of all-cause mortality among patients with AHF in multivariate Cox regression models with a full adjustment of the other significant covariables. Random forest variable importance and minimal depth analysis further validated that the IPS system was the most predictive for all-cause mortality in patients with AHF. Conclusions Inflammatory biomarkers were associated with the risk of all-cause mortality in patients with AHF, while IPS significantly improved the predictive power of the model and could be used as a practical tool for individualized risk stratification of patients with AHF.
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Affiliation(s)
- Xu Zhu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Iokfai Cheang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Fang Xu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Rongrong Gao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Shengen Liao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Wenming Yao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Yanli Zhou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Haifeng Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
- Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Xinli Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
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Davison BA, Takagi K, Edwards C, Adams KF, Butler J, Collins SP, Dorobantu MI, Ezekowitz JA, Filippatos G, Greenberg BH, Levy PD, Masip J, Metra M, Pang PS, Ponikowski P, Severin TM, Teerlink JR, Teichman SL, Voors AA, Werdan K, Cotter G. Neutrophil-to-Lymphocyte Ratio and Outcomes in Patients Admitted for Acute Heart Failure (As Seen in the BLAST-AHF, Pre-RELAX-AHF, and RELAX-AHF Studies). Am J Cardiol 2022; 180:72-80. [PMID: 35933224 DOI: 10.1016/j.amjcard.2022.06.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/13/2022] [Accepted: 06/22/2022] [Indexed: 11/01/2022]
Abstract
Previous studies have suggested that the neutrophil-to-lymphocyte ratio (NLR) is a novel yet readily evaluable inflammatory biomarker that may be useful for determining cardiovascular prognosis during acute episodes. The study investigated the role of NLR in predicting cardiovascular (CV) outcomes in patients with acute heart failure (HF). Individual patient data from the BLAST-AHF (phase 2b study of the biased ligand of the angiotensin 2 type 1 receptor, TRV027), Pre-RELAX-AHF (phase 2b study of recombinant human relaxin-2, serelaxin), and RELAX-AHF (phase 3 study of serelaxin) randomized, placebo-controlled studies for patients with acute HF were pooled for analysis. Dyspnea visual analog scale area under the curve through day 5, worsening HF through day 5, 30-day all-cause mortality, 60-day HF/renal failure rehospitalizations or CV death, 180-day all-cause mortality, and 180-day CV death were assessed. There were several differences in the baseline characteristics of the patients divided by NLR tertile, with patients in the higher NLR having worse clinical characteristics. NLR was an independent predictor of 30-day all-cause mortality (adjusted hazard ratio [HR] per log2 NLR increment: 1.66 [1.22 to 2.25], p = 0.001), 60-day HF/renal failure rehospitalizations or CV death: 1.33 [1.12 to 1.57], p = 0.001), 180-day all-cause mortality (adjusted HR 1.27 [1.08 to 1.50], p = 0.003), and 180-day CV death (adjusted HR 1.24 [1.04 to 1.49], p = 0.018). NLR, a readily available inflammatory biomarker, was associated with independent risk for short- and long-term adverse outcomes in acute HF, surpassing traditional markers, such as natriuretic peptides.
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Affiliation(s)
- Beth A Davison
- Momentum Research, Inc., Chapel Hill, North Carolina; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France
| | - Koji Takagi
- Momentum Research, Inc., Chapel Hill, North Carolina
| | | | - Kirkwood F Adams
- Department of Medicine and Radiology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | - Javed Butler
- Department of Medicine, University of Mississippi School of Medicine, Jackson, Mississippi
| | - Sean P Collins
- Vanderbilt University Medical Center Department of Emergency Medicine, Nashville, Tennessee; Geriatric Research, Education, and Clinical Center, Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Maria I Dorobantu
- Department 4-Cardiothoracic Pathology, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania; Department of Cardiology, Clinical Emergency Hospital of Bucharest, Bucharest, Romania
| | - Justin A Ezekowitz
- Canadian VIGOUR Centre, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - Barry H Greenberg
- Department of Cardiology, University of California, San Diego Medical Center, San Diego, California; Sulpizio Family Cardiovascular Center, University of California, San Diego Medical Center, San Diego, California
| | - Phillip D Levy
- Integrative Biosciences Center, Department of Emergency Medicine, Wayne State University, Detroit, Michigan
| | - Josep Masip
- Research direction, Consorci Sanitari Integral, University of Barcelona, Spain
| | - Marco Metra
- Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Peter S Pang
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Piotr Ponikowski
- Department of Heart Diseases, Wrocław Medical University, Wroclaw, Poland; Center for Heart Diseases, University Hospital in Wrocław, Wroclaw, Poland
| | | | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, California
| | - Sam L Teichman
- Teichman Drug Development Consulting, Lafayette, California
| | - Adriaan A Voors
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Karl Werdan
- Clinic for Internal Medicine III, University Hospital Halle (Saale), Martin-Luther University, Halle-Wittenberg, Germany
| | - Gad Cotter
- Momentum Research, Inc., Chapel Hill, North Carolina; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France.
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Zhao HL, Gao XL, Liu YH, Li SL, Zhang Q, Shan WC, Zheng Q, Zhou J, Liu YZ, Liu L, Guo N, Tian HS, Wei QM, Hu XT, Cui YK, Geng X, Wang Q, Cui W. Validation and derivation of short-term prognostic risk score in acute decompensated heart failure in China. BMC Cardiovasc Disord 2022; 22:307. [PMID: 35799104 PMCID: PMC9264535 DOI: 10.1186/s12872-022-02743-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/01/2022] [Indexed: 12/02/2022] Open
Abstract
Background Few prognostic risk scores (PRSs) have been routinely used in acute decompensated heart failure (ADHF). We, therefore, externally validated three published PRSs (3A3B, AHEAD, and OPTIME-CHF) and derived a new PRS to predict the short-term prognosis in ADHF. Methods A total of 4550 patients from the Heb-ADHF registry in China were randomly divided into the derivation and validation cohorts (3:2). Discrimination of each PRS was assessed by the area under the receiver operating characteristic curve (AUROC). Logistic regression was exploited to select the predictors and create the new PRS. The Hosmer–Lemeshow goodness-of-fit test was used to assess the calibration of the new PRS. Results The AUROCs of the 3A3B, AHEAD, and OPTIME-CHF score in the derivation cohort were 0.55 (95% CI 0.53–0.57), 0.54 (95% CI 0.53–0.56), and 0.56 (95% CI 0.54–0.57), respectively. After logistic regression analysis, the new PRS computed as 1 × (diastolic blood pressure < 80 mmHg) + 2 × (lymphocyte > 1.11 × 109/L) + 1 × (creatinine > 80 μmol/L) + 2 × (blood urea nitrogen > 21 mg/dL) + 1 × [BNP 500 to < 1500 pg/mL (NT-proBNP 2500 to < 7500 pg/mL)] or 3 × [BNP ≥ 1500 (NT-proBNP ≥ 7500) pg/mL] + 3 × (QRS fraction of electrocardiogram < 55%) + 4 × (ACEI/ARB not used) + 1 × (rhBNP used), with a better AUROC of 0.67 (95% CI 0.64–0.70) and a good calibration (Hosmer–Lemeshow χ2 = 3.366, P = 0.186). The results in validation cohort verified these findings. Conclusions The short-term prognostic values of 3A3B, AHEAD, and OPTIME-CHF score in ADHF patients were all poor, while the new PRS exhibited potential predictive ability. We demonstrated the QRS fraction of electrocardiogram as a novel predictor for the short-term outcomes of ADHF for the first time. Our findings might help to recognize high-risk ADHF patients.
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Affiliation(s)
- Hong-Liang Zhao
- First Division, Department of Cardiology, The Second Hospital of Hebei Medical University, Heping West Road No. 215, Shijiazhuang, 050000, Hebei province, China.,Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang, 050031, Hebei province, China
| | - Xiao-Li Gao
- Department of Cardiology, Huabei Petroleum Administration Bureau General Hospital, Renqiu, 062552, Hebei Province, China
| | - Ying-Hua Liu
- Department of Cardiology, Huabei Petroleum Administration Bureau General Hospital, Renqiu, 062552, Hebei Province, China
| | - Sen-Lin Li
- Department of Cardiology, Zhangjiakou First Hospital, Zhangjiakou, 075000, Hebei Province, China
| | - Qi Zhang
- Department of Cardiology, Baoding First Central Hospital, Baoding, 071000, Hebei Province, China
| | - Wei-Chao Shan
- Department of Cardiology, Affiliated Hospital of Chengde Medical University, Chengde, 067000, Hebei Province, China
| | - Qun Zheng
- Department of Cardiology, Hengshui People's Hospital, Hengshui, 053000, Hebei Province, China
| | - Jiang Zhou
- Department of Cardiology, Chengde Central Hospital, Chengde, 067024, Hebei Province, China
| | - Yong-Zheng Liu
- Department of Cardiology, Qinhuangdao First Hospital, Qinhuangdao, 066099, Hebei Province, China
| | - Li Liu
- Department of Cardiology, Qinhuangdao First Hospital, Qinhuangdao, 066099, Hebei Province, China
| | - Nan Guo
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou, 061011, Hebei Province, China
| | - Hong-Sen Tian
- Department of Cardiology, Handan Central Hospital, Handan, 056000, Hebei Province, China
| | - Qing-Min Wei
- Department of Cardiology, Xingtai People's Hospital, Xingtai, 054001, Hebei Province, China
| | - Xi-Tian Hu
- Department of Cardiology, Shijiazhuang People's Hospital, Shijiazhuang, 050011, Hebei Province, China
| | - Ying-Kai Cui
- Department of Cardiology, The 252nd Hospital of People's Liberation Army, Baoding, 071000, Hebei Province, China
| | - Xue Geng
- First Division, Department of Cardiology, The Second Hospital of Hebei Medical University, Heping West Road No. 215, Shijiazhuang, 050000, Hebei province, China
| | - Qian Wang
- First Division, Department of Cardiology, The Second Hospital of Hebei Medical University, Heping West Road No. 215, Shijiazhuang, 050000, Hebei province, China
| | - Wei Cui
- First Division, Department of Cardiology, The Second Hospital of Hebei Medical University, Heping West Road No. 215, Shijiazhuang, 050000, Hebei province, China.
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Zhang X, Wang T, Chen Z, Wang H, Yin Y, Wang L, Wang Y, Xu B, Xu W. HMGB1‐Promoted Neutrophil Extracellular Traps Contribute to Cardiac Diastolic Dysfunction in Mice. J Am Heart Assoc 2022; 11:e023800. [PMID: 35156391 PMCID: PMC9245819 DOI: 10.1161/jaha.121.023800] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Heart failure with preserved ejection fraction (HFpEF) remains an increasing public health problem with substantial morbidity and mortality but with few effective treatments. A novel inflammatory mechanism has been proposed, but the inflammatory signals promoting the development of HFpEF remain greatly unknown. Methods and Results Serum of patients with HFpEF was collected for measurement of circulating neutrophils and markers of neutrophil extracellular traps (NETs). To induce HFpEF phenotype, male C57BL/6 mice underwent uninephrectomy, received a continuous infusion of d‐aldosterone for 4 weeks, and maintained on 1.0% sodium chloride drinking water. Heart tissues were harvested, immune cell types determined by flow cytometry, NETs formation by immunofluorescence, and western blotting. Differentiated neutrophils were cultured to investigate the effect of HMGB1 (high mobility group protein B1) and SGLT2 (sodium‐glucose cotransporter‐2) inhibitor on NETs formation in vitro. Circulating neutrophils and NETs markers are elevated in patients with HFpEF, as are cardiac neutrophils and NETs formation in HFpEF mice. NETs inhibition with deoxyribonuclease 1 in experimental HFpEF mice reduces heart macrophages infiltration and inflammation and ameliorates cardiac fibrosis and diastolic function. Damage‐associated molecular pattern HMGB1 expression is elevated in cardiac tissue of HFpEF mice, and HMGB1 inhibition reduces heart neutrophil infiltration and NETs formation and ameliorates diastolic function. Lastly, SGLT2 inhibitor empagliflozin down‐regulates heart HMGB1 expression, attenuates NETs formation and cardiac fibrosis, and improves diastolic function in HFpEF mice. Conclusions NETs contribute to the pathogenesis of HFpEF, which can be ameliorated by HMGB1 inhibition and SGLT2 inhibitors. Thus, HMGB1 and NETs may represent novel therapeutic targets for the treatment of HFpEF.
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Affiliation(s)
- Xin‐Lin Zhang
- Department of Cardiology Affiliated Drum Tower Hospital Nanjing University School of Medicine Nanjing China
| | - Ting‐Yu Wang
- Central for Translational Medicine Nanjing University School of Medicine Nanjing China
- State Key Laboratory of Analytical Chemistry for Life Science & Jiangsu Key Laboratory of Molecular Medicine Nanjing University School of Medicine Nanjing China
| | - Zheng Chen
- Department of Cardiology Affiliated Drum Tower Hospital Nanjing University School of Medicine Nanjing China
| | - Hong‐Wei Wang
- Central for Translational Medicine Nanjing University School of Medicine Nanjing China
- State Key Laboratory of Analytical Chemistry for Life Science & Jiangsu Key Laboratory of Molecular Medicine Nanjing University School of Medicine Nanjing China
| | - Yong Yin
- Department of Cardiology Affiliated Drum Tower Hospital Nanjing University School of Medicine Nanjing China
| | - Lian Wang
- Department of Cardiology Affiliated Drum Tower Hospital Nanjing University School of Medicine Nanjing China
| | - Yong Wang
- Central for Translational Medicine Nanjing University School of Medicine Nanjing China
- State Key Laboratory of Analytical Chemistry for Life Science & Jiangsu Key Laboratory of Molecular Medicine Nanjing University School of Medicine Nanjing China
| | - Biao Xu
- Department of Cardiology Affiliated Drum Tower Hospital Nanjing University School of Medicine Nanjing China
| | - Wei Xu
- Department of Cardiology Affiliated Drum Tower Hospital Nanjing University School of Medicine Nanjing China
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Sauer F, Riou M, Charles AL, Meyer A, Andres E, Geny B, Talha S. Pathophysiology of Heart Failure: A Role for Peripheral Blood Mononuclear Cells Mitochondrial Dysfunction? J Clin Med 2022; 11:jcm11030741. [PMID: 35160190 PMCID: PMC8836880 DOI: 10.3390/jcm11030741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 02/06/2023] Open
Abstract
Heart failure (HF) is a leading cause of hospitalization in patients aged more than 65 years and is associated with high mortality rates. A better comprehension of its physiopathology is still needed, and, in addition to neurohormonal systems and sodium glucose co-transporter 2 modulations, recent studies focus on the mitochondrial respiration of peripheral blood circulating cells (PBMCs). Thus, cardiovascular metabolic risk factors and cellular switch with an increased neutrophil/lymphocytes ratio might favor the decreased PBMC mitochondrial respiration observed in relation with HF severity. PBMCs are implicated in the immune system function and mitochondrial dysfunction of PBMC, potentially induced by their passage through a damaged heart and by circulating mitoDAMPs, which can lead to a vicious circle, thus sustaining negative cardiac remodeling during HF. This new approach of HF complex pathophysiology appears to be a promising field of research, and further studies on acute and chronic HF with reduced or preserved LVEF are warranted to better understand whether circulating PBMC mitochondrial function and mitoDAMPs follow-ups in HF patients might show diagnosis, prognosis or therapeutic usefulness.
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Affiliation(s)
- François Sauer
- University of Strasbourg, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France; (F.S.); (M.R.); (A.-L.C.); (A.M.); (E.A.); (S.T.)
- University Hospital of Strasbourg, Physiology and Functional Exploration Service, 1 Place de l’Hôpital, 67091 Strasbourg, France
| | - Marianne Riou
- University of Strasbourg, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France; (F.S.); (M.R.); (A.-L.C.); (A.M.); (E.A.); (S.T.)
- University Hospital of Strasbourg, Physiology and Functional Exploration Service, 1 Place de l’Hôpital, 67091 Strasbourg, France
| | - Anne-Laure Charles
- University of Strasbourg, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France; (F.S.); (M.R.); (A.-L.C.); (A.M.); (E.A.); (S.T.)
- University Hospital of Strasbourg, Physiology and Functional Exploration Service, 1 Place de l’Hôpital, 67091 Strasbourg, France
| | - Alain Meyer
- University of Strasbourg, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France; (F.S.); (M.R.); (A.-L.C.); (A.M.); (E.A.); (S.T.)
- University Hospital of Strasbourg, Physiology and Functional Exploration Service, 1 Place de l’Hôpital, 67091 Strasbourg, France
| | - Emmanuel Andres
- University of Strasbourg, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France; (F.S.); (M.R.); (A.-L.C.); (A.M.); (E.A.); (S.T.)
- Internal Medicine, Diabete and Metabolic Diseases Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, France
| | - Bernard Geny
- University of Strasbourg, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France; (F.S.); (M.R.); (A.-L.C.); (A.M.); (E.A.); (S.T.)
- University Hospital of Strasbourg, Physiology and Functional Exploration Service, 1 Place de l’Hôpital, 67091 Strasbourg, France
- Correspondence:
| | - Samy Talha
- University of Strasbourg, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France; (F.S.); (M.R.); (A.-L.C.); (A.M.); (E.A.); (S.T.)
- University Hospital of Strasbourg, Physiology and Functional Exploration Service, 1 Place de l’Hôpital, 67091 Strasbourg, France
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Hayıroğlu Mİ, Çınar T, Çinier G, Pay L, Yumurtaş AÇ, Tezen O, Eren S, Kolak Z, Çetin T, Çiçek V, Tekkeşin Aİ. Evaluating systemic immune-inflammation index in patients with implantable cardioverter defibrillator for heart failure with reduced ejection fraction. Pacing Clin Electrophysiol 2022; 45:188-195. [PMID: 34978742 DOI: 10.1111/pace.14436] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/23/2021] [Accepted: 12/19/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pro-inflammatory pathways play an important role in the follow-ups of patients with intracardiac defibrillators (ICDs) for heart failure (HF) reduced with ejection fraction (HFrEF). A newly defined index - the systemic immune-inflammation index (SII)-has recently been reported to have prognostic value in patients with cardiovascular disease. This study's aim is to evaluate the SII value regarding its association with long-term mortality and appropriate ICD therapy during a 10-year follow-up. METHODS This retrospective study included 1011 patients with ICD for HFrEF. The SII was calculated as the neutrophil-to-lymphocyte ratio × total platelet count in the peripheral blood. The study population was divided into two groups according to the SII's optimal cut-off value to predict long-term mortality. The long-term prognostic impact of SII on these patients was evaluated regarding mortality and appropriate ICD therapy. RESULTS The patients with a higher SII (≥1119) had significantly higher long-term mortality and appropriate ICD therapy rates. After adjustment for all confounding factors, the long-term mortality rate was 5.1 for a higher SII. (95% CI: 2.9-8.1). The long-term appropriate ICD therapy rate was 2.0 for a higher SII (95% CI: 1.4-3.0). CONCLUSION SII may be an independent predictive marker for both long-term mortality and appropriate ICD therapy in patients with HFrEF.
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Affiliation(s)
- Mert İlker Hayıroğlu
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Tufan Çınar
- Department of Cardiology, Haydarpasa Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Göksel Çinier
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Levent Pay
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Çağdaş Yumurtaş
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ozan Tezen
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Semih Eren
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Zeynep Kolak
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Tuğba Çetin
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Vedat Çiçek
- Department of Cardiology, Haydarpasa Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Ahmet İlker Tekkeşin
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Curran FM, Bhalraam U, Mohan M, Singh JS, Anker SD, Dickstein K, Doney AS, Filippatos G, George J, Metra M, Ng LL, Palmer CN, Samani NJ, van Veldhuisen DJ, Voors AA, Lang CC, Mordi IR. Neutrophil-to-lymphocyte ratio and outcomes in patients with new-onset or worsening heart failure with reduced and preserved ejection fraction. ESC Heart Fail 2021; 8:3168-3179. [PMID: 33998162 PMCID: PMC8318449 DOI: 10.1002/ehf2.13424] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 04/16/2021] [Accepted: 05/02/2021] [Indexed: 12/11/2022] Open
Abstract
AIMS Inflammation is thought to play a role in heart failure (HF) pathophysiology. Neutrophil-to-lymphocyte ratio (NLR) is a simple, routinely available measure of inflammation. Its relationship with other inflammatory biomarkers and its association with clinical outcomes in addition to other risk markers have not been comprehensively evaluated in HF patients. METHODS We evaluated patients with worsening or new-onset HF from the BIOlogy Study to Tailored Treatment in Chronic Heart Failure (BIOSTAT-CHF) study who had available NLR at baseline. The primary outcome was time to all-cause mortality or HF hospitalization. Outcomes were validated in a separate HF population. RESULTS 1622 patients were evaluated (including 523 ventricular ejection fraction [LVEF] < 40% and 662 LVEF ≥ 40%). NLR was significantly correlated with biomarkers related to inflammation as well as NT-proBNP. NLR was significantly associated with the primary outcome in patients irrespective of LVEF (hazard ratio [HR] 1.18 per standard deviation increase; 95% confidence interval [CI] 1.11-1.26, P < 0.001). Patients with NLR in the highest tertile had significantly worse outcome than those in the lowest independent of LVEF (<40%: HR 2.75; 95% CI 1.84-4.09, P < 0.001; LVEF ≥ 40%: HR 1.51; 95% CI 1.05-2.16, P = 0.026). When NLR was added to the BIOSTAT-CHF risk score, there were improvements in integrated discrimination index (IDI) and net reclassification index (NRI) for occurrence of the primary outcome (IDI + 0.009; 95% CI 0.00-0.019, P = 0.030; continuous NRI + 0.112, 95% CI 0.012-0.176, P = 0.040). Elevated NLR was similarly associated with adverse outcome in the validation cohort. Decrease in NLR at 6 months was associated with reduced incidence of the primary outcome (HR 0.75; 95% CI 0.57-0.98, P = 0.036). CONCLUSIONS Elevated NLR is significantly associated with elevated markers of inflammation in HF patients and is associated with worse outcome. Elevated NLR might potentially be useful in identifying high-risk HF patients and may represent a treatment target.
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Affiliation(s)
| | - U Bhalraam
- School of MedicineUniversity of DundeeDundeeUK
| | - Mohapradeep Mohan
- Division of Molecular and Clinical MedicineUniversity of DundeeDundeeUK
| | - Jagdeep S. Singh
- Division of Molecular and Clinical MedicineUniversity of DundeeDundeeUK
| | - Stefan D. Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site BerlinCharité Universitätsmedizin BerlinBerlinGermany
| | | | | | - Gerasimos Filippatos
- Heart Failure Unit, Department of Cardiology, School of MedicineNational and Kopodistrian University of Athens, Athens University Hospital AttikonAthensGreece
| | - Jacob George
- Division of Molecular and Clinical MedicineUniversity of DundeeDundeeUK
| | - Marco Metra
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | - Leong L. Ng
- Department of Cardiovascular SciencesUniversity of Leicester and NIHR Leicester Biomedical Research CentreLeicesterUK
| | - Colin N. Palmer
- Division of Population Health and GenomicsUniversity of DundeeDundeeUK
| | - Nilesh J. Samani
- Department of Cardiovascular SciencesUniversity of Leicester and NIHR Leicester Biomedical Research CentreLeicesterUK
| | - Dirk J. van Veldhuisen
- Department of Cardiology, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Adriaan A. Voors
- Department of Cardiology, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Chim C. Lang
- Division of Molecular and Clinical MedicineUniversity of DundeeDundeeUK
| | - Ify R. Mordi
- Division of Molecular and Clinical MedicineUniversity of DundeeDundeeUK
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