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Oguz M, Torun A. Prognostic Value of Systemic Immune-Inflammation Index in Predicting Premature Saphenous Vein Graft Disease in Patients With Coronary Artery Bypass Grafting. Cureus 2023; 15:e42833. [PMID: 37664391 PMCID: PMC10472081 DOI: 10.7759/cureus.42833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Systemic inflammation is a risk factor for premature coronary artery disease (CAD), and systemic immune-inflammation index (SII), a new marker of systemic inflammation, is linked to the severity and prognosis of CAD. However, the prognosis of the SII in bypass patients' venous saphenous grafts has not been adequately evaluated. This study aimed to evaluate the prognostic value of SII in predicting premature saphenous vein graft disease (SVGD) in patients who underwent bypass surgery with venous saphenous grafts. METHODS We retrospectively included 422 patients who had saphenous vein grafts (SVG) at least one year after bypass surgery. Of these, 222 patients had SVGD, and 200 had patent SVG. RESULTS SII was higher in the SVGD group than in the control group (631.55 ± 397.84, 421.71 ± 351.07, P=0.001). A receiver operating characteristic (ROC) analysis was performed to identify the optimal cutoff point with the highest sensitivity and specificity. The optimal cutoff point for SII was defined as 430. Using a cutoff level of >430, SII predicted SVGD with a sensitivity of 73% and specificity of 56%. CONCLUSION Our study demonstrated that SII was substantially higher in patients with SVGD than in those with patent SVG. SII predicted SVGD in bypass surgery patients. SII may be a helpful parameter for identifying patients at high risk of SVGD and guiding preventive treatments.
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Affiliation(s)
- Mustafa Oguz
- Department of Cardiology, Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, TUR
| | - Akin Torun
- Department of Cardiology, Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, TUR
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2
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Li XW, Cui Z, Xiao JY, Gao MD, Zhang M, Zhang WJ, Tian FS, Song Y, Liu YW, Yao ZH, Ma J, Liu Y, Gao J. A five-parameter score for predicting saphenous vein graft degenerative and/or occlusive disease in recurring ischemic symptoms after one year post coronary artery bypass grafting. Perfusion 2022; 38:843-852. [PMID: 35583035 DOI: 10.1177/02676591221090588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The recurrence rate of ischemic symptoms after coronary artery bypass grafting (CABG) is increasing in recent years. How to prevent and treat saphenous vein graft disease (SVGD [symptomatic ⩾50% stenosis in at least one Saphenous vein graft]) has been a clinical challenge to date. Different pathogenesis may exist in SVGD of different periods. There are currently few available scores for estimating the risk of SVGD after one year post CABG. OBJECTIVE We sought to develop and validate a simple predictive clinical risk score for SVGD with recurring ischemia after one year post CABG. METHODS AND RESULTS This was a cross-sectional study and the results were validated using bootstrap resampling on a separate cohort. A nomogram and risk scoring system were developed based on retrospective data from a training cohort of 606 consecutive patients with recurring ischemia >1 year after CABG. Logistic regression model was used to find the predictive factors and to build a nomogram. To assess the generalization, models were validated using bootstrap resampling and an external cross-sectional study of 187 consecutive patients in four other hospitals. In multivariable analysis of the primary cohort, native lesion vessel number, SVG age, recurring ischemia type, very low-density lipoprotein level, and left ventricular end-diastolic diameter were independent predictors. A summary risk score was derived from nomogram, with a cut-off value of 15. In internal and external validation, the C-index was 0.86 and 0.82, indicating good discrimination. The calibration curve for probability of SVGD showed optimal agreement between actual observations and risk score prediction. CONCLUSION A simple-to-use risk scoring system based on five easily variables was developed and validated to predict the risk of SVGD among patients who recurring ischemia after one year post CABG. This score may be useful for providing patients with individualized estimates of SVGD risk.
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Affiliation(s)
- Xiao-Wei Li
- Tianjin Medical University, Tianjin, China.,Department of Cardiology, 499773Tianjin Chest Hospital, Tianjin, China.,Cardiovascular Institute, 499773Tianjin Chest Hospital, Tianjin, China
| | - Zhuang Cui
- Tianjin Medical University, Tianjin, China
| | - Jian-Yong Xiao
- Department of Cardiology, 499773Tianjin Chest Hospital, Tianjin, China
| | - Ming-Dong Gao
- Department of Cardiology, 499773Tianjin Chest Hospital, Tianjin, China
| | - Mei Zhang
- Tianjin Logistics University of Chinese People's Armed Police Forces, Tianjin, China
| | - Wen-Juan Zhang
- Tianjin Medical University General Hospital, Tianjin, China
| | | | - Yu Song
- TEDA International Cardiovascular Hospital, Tianjin, China
| | - Ying-Wu Liu
- Tian Jin Third Center Hospital, Tianjin, China
| | | | - Jun Ma
- Tianjin Medical University, Tianjin, China
| | - Yin Liu
- Department of Cardiology, 499773Tianjin Chest Hospital, Tianjin, China
| | - Jing Gao
- Tianjin Medical University, Tianjin, China.,Department of Cardiology, 499773Tianjin Chest Hospital, Tianjin, China.,Cardiovascular Institute, 499773Tianjin Chest Hospital, Tianjin, China
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3
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Yılmaz F, Yılmaz FK, Karagöz A, Yıldırım A, Gunes HM, Akbas RB, Efe SÇ, Barutçu İ. Usefulness of neutrophil-to-lymphocyte ratio for predicting acute pericarditis outcomes. Acta Cardiol 2021; 77:422-430. [PMID: 34275415 DOI: 10.1080/00015385.2021.1951998] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND In daily practice, C-reactive protein (CRP) may be used to predict recurrence and treatment response in patients with acute pericarditis; however, the predictive role of CRP might be insufficient for clinical prediction in some patients. In this study, we aimed to investigate the relationship between neutrophil-to-lymphocyte ratio (NLR) and the composite endpoint of pericarditis recurrence and/or tamponade within 1 year in patients with acute pericarditis. METHODS A total of 104 patients diagnosed with acute idiopathic pericarditis (mean age 42.8 ± 15.2 years, 55.8% male) were included in the study. Physical examination findings of these patients, electrocardiography, echocardiography, chest X-ray and laboratory findings were evaluated and analysed. During the 1-year follow-up, the composite of cardiac tamponade and/or pericarditis recurrence was investigated as the primary endpoint of the study. RESULTS Compared to the group without the composite outcome, the group with the composite outcome had significantly higher rates of moderate and severe pericardial effusion (p < 0.01) and higher white blood cell (WBC) count (p:0.001), platelet count (p = 0.003), NLR (2.14 (1.49-3.02) vs 6.60 (5.50-8.68); p < 0.001) and high-sensitivity C-reactive protein (hs-CRP) (8.01 (5.1-24.5 vs 69.5 (40.8-128); p:0.001). Higher hs-CRP (p < 0.001), WBC (p:0.001), NLR (p < 0.001) and platelets (p:0.02) were associated with pericarditis recurrence. NLR and hs-CRP were independently associated with the composite endpoint (p < 0.001 and p < 0.001, respectively). CONCLUSION NLR and hs-CRP were found to be independent predictors for the composite endpoint of tamponade and/or recurrence in acute pericarditis patients during the 1-year follow-up. Similar to hs-CRP, NLR may also be used for risk assessment in patients with idiopathic pericarditis.
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Affiliation(s)
- Fatih Yılmaz
- Kartal Kosuyolu Research and Education Hospital, Kartal, Turkey
| | | | - Ali Karagöz
- Kartal Kosuyolu Research and Education Hospital, Kartal, Turkey
| | - Arzu Yıldırım
- Faculty of Medicine, Cardiology Department, Medipol University, Istanbul, Turkey
| | - Haci Murat Gunes
- Faculty of Medicine, Cardiology Department, Medipol University, Istanbul, Turkey
| | | | | | - İrfan Barutçu
- Faculty of Medicine, Cardiology Department, Medipol University, Istanbul, Turkey
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Yayla C, Gayretli Yayla K. C-Reactive Protein to Albumin Ratio in Patients With Saphenous Vein Graft Disease. Angiology 2021; 72:770-775. [PMID: 33678042 DOI: 10.1177/0003319721998863] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Atherosclerosis plays an important role in saphenous vein graft disease (SVGD). Previous studies showed that inflammatory blood cells play an active role in this process. C-reactive protein to albumin ratio (CAR) is considered as a novel predictor for cardiovascular risk and an indicator of inflammation. We aimed to assess the relationship between SVGD and CAR. A total of 711 participants with saphenous vein graft (SVG) were included; 348 patients had SVGD and 363 patients had patent (no stenosis) SVG. C-reactive protein to albumin ratio was higher in patients with SVGD (P < .001). There was a significant positive correlation between CAR and the age of SVG (r = 0.123; P = .001) and SYNTAX score (r = 0.568; P < .001). Multivariate logistic regression analyses showed that lymphocyte count, CAR, and SYNTAX score were independent predictors of SVGD (P < .05). C-reactive protein to albumin ratio may be a useful marker after bypass surgery to predict SVGD.
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Affiliation(s)
- Cagri Yayla
- Department of Cardiology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Kadriye Gayretli Yayla
- Department of Cardiology, Dr. Abdurrahman Yurtaslan Ankara Onkoloji Education and Research Hospital, University of Health Sciences, Ankara, Turkey
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Cankurt T, Celik İE, Ozturk S, Maden O. Inflammatory Conditions in Acute Coronary Syndrome Patients Treated with Percutaneous Coronary Intervention of Saphenous Vein Graft. Int J Angiol 2020; 29:237-244. [PMID: 33268974 PMCID: PMC7690989 DOI: 10.1055/s-0040-1714751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The study aimed to evaluate the inflammatory blood parameters in acute coronary syndrome (ACS) patients with a history of coronary artery bypass graft (CABG) and treated with percutaneous coronary intervention (PCI) of saphenous vein graft (SVG). A total of 347 patients who underwent urgent SVG PCI with the diagnosis of ACS were included in the study. After the application of exclusion criteria, 79 patients were allocated into two groups, namely, successful PCI ( n = 59) and unsuccessful PCI ( n = 20), and included in the statistical analysis. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) levels were significantly higher in patients with unsuccessful SVG PCI. In the logistic regression analysis, PLR, C-reactive protein, and diabetes mellitus emerged as independent factors associated with unsuccessful SVG PCI. The area under the curve for PLR was 0.70 (95% confidence interval: 0.55-0.85, p = 0.006). The cut-off value of PLR (128.99) was associated with 70.0% sensitivity and 69.5% specificity. Elevated inflammatory status is associated with unsuccessful PCI of SVG in ACS patients. Increased PLR levels on admission is an independent predictor of this situation. This cheap and simple marker can help us to predict unsuccessful SVG PCI in ACS patients.
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Affiliation(s)
- Tayyar Cankurt
- Cardiology Clinic, Amasya University Sabuncuoglu Sereefeddin State Hospital, Ankara, Turkey
| | - İbrahim E. Celik
- Department of Cardiology, University of Health Sciences, Ankara Education and Research Hospital, Ankara, Turkey
| | - Selcuk Ozturk
- Department of Cardiology, University of Health Sciences, Ankara Education and Research Hospital, Ankara, Turkey
| | - Orhan Maden
- Department of Cardiology, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey
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Neutrophil-Lymphocyte Ratio (NLR) Reflects Myocardial Inhomogeneities in Hemodialyzed Patients. Mediators Inflamm 2020; 2020:6027405. [PMID: 32963494 PMCID: PMC7486637 DOI: 10.1155/2020/6027405] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/24/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Cardiovascular diseases (CVDs) are a leading cause of death in chronically hemodialyzed (HD) patients. In this group, inflammation exerts significant impact on the prevalence of CVD morbidity and mortality. Spatial QRS-T angle is an independent and strong predictor of CV events, including sudden cardiac death (SCD), both in general population and HD patients. Pathogenesis of widened QRS-T angle is complicated and is not well established. Objectives The study is aimed at evaluating whether inflammation process can contribute to the wide QRS-T angle. Patients and Methods. The retrospective study was performed on 183 HD patients. The control group consisted of 38 patients. Demographic, biochemical, vectorcardiographic, and echocardiographic data were evaluated in all patients. Inflammation process was expressed as neutrophil-lymphocyte ratio (NLR), as well as C-reactive protein (CRP). Results Both NLR (3.40 vs. 1.95 (p < 0.0001)) and spatial QRS-T angle (50.76 vs. 93.56 (p < 0.001)) were higher in the examined group, compared to the control group. Similarly, CRP was higher in the examined group than in the control group (8.35 vs. 4.06 (p < 0.001), respectively). The QRS-T angle correlated with NLR, CRP, some structural echocardiographic parameters, parathormone (PTH), and calcium (Ca) concentrations. Multiple regression analysis showed that NLR is an independent QRS-T angle predictor (r = 0.498, p = 0.0027). The ROC curve analysis indicated the cut-off point of NLR equaled 4.59, where the sensitivity and specificity were the highest for predicting myocardial inhomogeneities expressed as widened QRS-T angle. Conclusion The NLR, as an inflammation marker, may indicate myocardial inhomogeneities in HD patients.
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İyigün T, Kyaruzi MM, Timur B, Satılmışoğlu MH, İyigün M, Kaya M. The Predictive Effects of Clinical Hematological Changes on Saphenous Graft Patency after Coronary Artery Surgery. Braz J Cardiovasc Surg 2019; 34:297-304. [PMID: 31310468 PMCID: PMC6629236 DOI: 10.21470/1678-9741-2018-0211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives To investigate the association between clinical hematologic parameters and
saphenous vein graft failure after on-pump coronary artery bypass
surgery. Methods A total of 1950 consecutive patients underwent isolated on-pump coronary
artery surgery between November 2010 and February 2013. Of these, 284
patients met our inclusion criteria; their preoperative clinical
hematological parameters were retrospectively obtained for this cohort
study. And of them, 109 patients underwent conventional coronary angiography
after graft failure was revealed by coronary computed tomography
angiography. The primary endpoint was to catch at least one saphenous vein
graft stenosis or occlusion following the coronary angiogram. We then
analyzed risk factors for graft failure. In sequential or T grafts, each
segment was analyzed as a separate graft. Results In logistic regression analysis, older age, platelet distribution width, and
diabetes mellitus were identified as independent predictors of saphenous
vein graft failure (P<0.). In contrast, preserved
ejection fraction value favored graft patency
(P<0.001). Conclusion Increased platelet distribution width is easily measurable and can be used as
a simple and valuable marker in the prediction of saphenous vein graft
failure.
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Affiliation(s)
- Taner İyigün
- Cardiovascular Surgery Training and Research Hospital Department of Cardiovascular Surgery Istanbul Turkey Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mugisha Markior Kyaruzi
- Cardiovascular Surgery Training and Research Hospital Department of Cardiovascular Surgery Istanbul Turkey Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Barış Timur
- Cardiovascular Surgery Training and Research Hospital Department of Cardiovascular Surgery Istanbul Turkey Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Muhammed Hulusi Satılmışoğlu
- Cardiovascular Surgery Training and Research Hospital Department of Cardiology Istanbul Turkey Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Müzeyyen İyigün
- Acıbadem University Department of Anesthesiology and Reanimation Istanbul Turkey Department of Anesthesiology and Reanimation, Acıbadem University, Istanbul, Turkey
| | - Mehmet Kaya
- Cardiovascular Surgery Training and Research Hospital Department of Cardiovascular Surgery Istanbul Turkey Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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8
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Gao J, Liu Y, Li YM. Review of risk factors, treatment, and prevention of saphenous vein graft disease after coronary artery bypass grafting. J Int Med Res 2018; 46:4907-4919. [PMID: 30178686 PMCID: PMC6300967 DOI: 10.1177/0300060518792445] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Saphenous vein graft disease (SVGD) is a type of vascular disease that may develop after coronary artery bypass grafting (CABG). SVGD seriously affects the short-term and long-term effects of CABG and increases the incidence of major adverse cardiovascular events. It is very important to identify patients at greatest risk and carry out prevention and treatment measures to determine the risk factors for SVGD. Many factors contribute to SVGD when the vein is grafted into an arterial environment, such as surgery-related factors, smoking, diabetes mellitus, hyperlipidemia, and others. In this review, we discuss the risk factors for SVGD, current surgical and pharmacologic therapies with which to manage SVGD, and the prevention of SVGD.
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Affiliation(s)
- Jing Gao
- 1 Logistics University of Chinese People's Armed Police Forces, Dongli District, Tianjin, P. R. China.,2 Cardiovascular Institute, Tianjin Chest Hospital, Jinnan District, Tianjin, P. R. China
| | - Yin Liu
- 3 Department of Cardiology, Tianjin Chest Hospital, Jinnan District, Tianjin, P. R. China
| | - Yu-Ming Li
- 1 Logistics University of Chinese People's Armed Police Forces, Dongli District, Tianjin, P. R. China
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9
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Durmuş G, Belen E, Can MM. Increased neutrophil to lymphocyte ratio predicts myocardial injury in patients undergoing non-cardiac surgery. Heart Lung 2018; 47:243-247. [PMID: 29500104 DOI: 10.1016/j.hrtlng.2018.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 01/14/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND The neutrophil to lymphocyte ratio (NLR), has been proposed as potential indicator of cardiovascular events. Our aim was to determine the relationship between NLR and development of myocardial injury after non-cardiac surgery (MINS). METHODS This observational cohort study included 255 consecutive noncardiac surgery patients aged ≥45 years. Electrocardiography recordings and high sensitivity cardiac troponin T (hscTnT) levels of the patients were obtained for a period of 3 days postoperatively. RESULTS MINS was detected in 30 (11.8%) patients using the cut-off level of ≥14 ng/L for hscTnT. In the MINS group NLR (3.79 ± 0.7 vs. 2.69 ± 0.6, p < 0.000) values were higher than non-NLR group. The NLR to be independently associated with the development of MINS (OR: 11.690; CI: 4.619-29.585, p < 0.000). CONCLUSIONS NLR seems to be a simple, easy and cheap tool to predict the development of MINS in patient undergoing non-cardiac surgery.
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Affiliation(s)
- Gündüz Durmuş
- Department of Cardiology, Haseki Education And Research Hospital, Istanbul, Turkey.
| | - Erdal Belen
- Department of Cardiology, Haseki Education And Research Hospital, Istanbul, Turkey
| | - Mehmet Mustafa Can
- Department of Cardiology, Haseki Education And Research Hospital, Istanbul, Turkey
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THE CORRELATION BETWEEN THE PARAMETERS OF PERIPHERAL BLOOD AND OXYGEN ABSORPTION AFTER REVASCULARIZATION FOR CORONARY ARTERY DISEASE. КЛИНИЧЕСКАЯ ПРАКТИКА 2017. [DOI: 10.17816/clinpract8422-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Patients with coronary artery disease (CAD) are characterized by changes in the oxygen uptake and indices of peripheral blood. The aim of the study was to identify the relationship between the parameters of blood oxygen uptake and blood test in patients with CAD following coronary artery bypass graft surgery. We examined 8 patients with acute coronary syndrome (ACS) and 11 patients with chronic CAD (cCAD) at days of admission to hospital, discharge and 6 months after a CABG procedure. 10 healthy donors were included to the control group. We conducted a comparative analysis of the parameters of peripheral blood and blood oxygen uptake. We revealed a negative correlation between parameters of oxygen uptake and the platelets in patients with ACS and blood count of neutrophils in patients with cCAD on the admission to hospital. Also we established a strong relationship between blood oxygen uptake and white blood cells count in patients with cCAD at the discharge from hospital. We found a strong positive correlation between blood oxygen absorption and platelets and a negative correlation with count of lymphocytes in patients with cCAD 6 months after surgery.
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Oksuz F, Elcik D, Yarlioglues M, Duran M, Ozturk S, Celik IE, Kurtul A, Kilic A, Murat SN. The relationship between lymphocyte-to-monocyte ratio and saphenous vein graft patency in patients with coronary artery bypass graft. Biomark Med 2017; 11:867-876. [PMID: 28976779 DOI: 10.2217/bmm-2017-0079] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM A lower lymphocyte count and a high monocyte count give important clues about the prognosis of various cardiovascular diseases. We hypothesized that lymphocyte-to-monocyte ratio (LMR) was associated with the saphenous vein graft disease (SVGD) in patients with coronary artery bypass graft (CABG). PATIENTS & METHODS A total of 218 patients with previous history of CABG surgery, who underwent coronary angiography due to stable angina symptoms, were investigated, retrospectively. RESULTS LMR levels were significantly lower in the SVGD group. Multiple logistic regression analyses showed that LMR levels were independent predictors of SVGD (OR: 0.648; 95% CI: 0.469-0.894; p = 0.008). CONCLUSION Our results suggested that LMR levels may provide useful information for the relevant risk evaluation of SVGD in CABG patients.
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Affiliation(s)
- Fatih Oksuz
- Ankara Education & Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Deniz Elcik
- Ankara Education & Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Mikail Yarlioglues
- Ankara Education & Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Mustafa Duran
- Ankara Education & Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Selcuk Ozturk
- Ankara Education & Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Ibrahim Etem Celik
- Ankara Education & Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Alparslan Kurtul
- Ankara Education & Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Alparslan Kilic
- Ankara Education & Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Sani Namik Murat
- Ankara Education & Research Hospital, Department of Cardiology, Ankara, Turkey
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Paulos RG, Rudelli BA, Filippe RZ, dos Santos GB, Herrera AA, Ribeiro AA, de Rezende MR, Hsiang-Wei T, Mattar-Jr R. Experimental study of histological changes in vascular loops according to the duration of the postoperative period: Application in reconstructive microsurgery. Clinics (Sao Paulo) 2017; 72:538-542. [PMID: 29069256 PMCID: PMC5629734 DOI: 10.6061/clinics/2017(09)03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 05/10/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To analyze the histological changes observed in venous grafts subjected to arterial blood flow as a function of the duration of the postoperative period to optimize their use in free flap reconstructions. METHOD Twenty-five rats (7 females and 18 males) underwent surgery. Surgeries were performed on one animal per week. Five weeks after the first surgery, the same five animals were subjected to an additional surgery to assess the presence or absence of blood flow through the vascular loop, and samples were collected for histological analysis. This cycle was performed five times. RESULTS Of the rats euthanized four to five weeks after the first surgery, no blood flow was observed through the graft in 80% of the cases. In the group euthanized three weeks after the first surgery, no blood flow was observed in 20% of the cases. In the groups euthanized one to two weeks after the first surgery, blood flow through the vascular loop was observed in all animals. Moreover, intimal proliferation tended to increase with the duration of the postoperative period. Two weeks after surgery, intimal proliferation increased slightly, whereas strong intimal proliferation was observed in all rats evaluated five weeks after surgery. CONCLUSION Intimal proliferation was the most significant change noted in venous grafts as a function of the duration of the postoperative period and was directly correlated with graft occlusion. In cases in which vascular loops are required during free flap reconstruction, both procedures should preferably be performed during the same surgery.
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Affiliation(s)
- Renata Gregorio Paulos
- Departamento de Ortopedia e Traumatologia, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Bruno Alves Rudelli
- Departamento de Ortopedia e Traumatologia, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Renee Zon Filippe
- Departamento de Ortopedia e Traumatologia, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Gustavo Bispo dos Santos
- Departamento de Ortopedia e Traumatologia, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Ana Abarca Herrera
- Departamento de Ortopedia e Traumatologia, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Andre Araujo Ribeiro
- Departamento de Ortopedia e Traumatologia, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marcelo Rosa de Rezende
- Departamento de Ortopedia e Traumatologia, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Teng Hsiang-Wei
- Departamento de Ortopedia e Traumatologia, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Rames Mattar-Jr
- Departamento de Ortopedia e Traumatologia, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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13
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Seropian IM, Romeo FJ, Pizarro R, Vulcano NO, Posatini RA, Marenchino RG, Berrocal DH, Belziti CA. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as predictors of survival after heart transplantation. ESC Heart Fail 2017; 5:149-156. [PMID: 28758719 PMCID: PMC5793982 DOI: 10.1002/ehf2.12199] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/15/2017] [Accepted: 06/27/2017] [Indexed: 12/13/2022] Open
Abstract
Aims The aim of this study was to evaluate whether neutrophil‐to‐lymphocyte ratio (NLR) and platelet‐to‐lymphocyte ratio (PLR) predict outcome in heart failure (HF) patients undergoing heart transplantation (HTX). Methods and results Data from 111 HF patients undergoing HTX 2010–2015 were retrospectively reviewed. NLR and PLR were calculated before HTX, immediately after HTX, and at 6 and 24 hours. Primary endpoint was in‐hospital mortality, and secondary endpoints were 1 year mortality and renal replacement therapy (RRT). Prognostic factors were assessed by multivariate analysis, and the predictive values of NLR and PLR for mortality were compared. The discriminatory performance for predicting in‐hospital mortality was better for NLR [area under the receiver operating characteristic curve (AUC) = 0.644, 95% confidence interval 0.492–0.797] than for PLR (AUC = 0.599, 95% confidence interval 0.423–0.776). Best cut‐off value was 2.41 for NLR (sensitivity 86%, specificity 67%) and 92.5 for PLR (sensitivity 86%, specificity 68%). When divided according to best cut‐off value, in‐hospital mortality was significantly higher in the high NLR group (17.5% vs. 3.2%, P < 0.05), but not in the high PLR group (16.5% vs. 6.3%, P = ns). One year mortality was not significantly higher for either group (37.5% vs. 6.5% for NLR; 36.7% vs. 9.4% for PLR, P = ns for both), while RRT was significantly higher in both the NLR and PLR high groups (33.8% vs. 0%; 32.9% vs. 3.1%, respectively, P < 0.001). Multivariate analysis indicated that only high NLR (hazard ratio = 3.403, P < 0.05) and pre‐transplant diabetes (hazard ratio = 3.364, P < 0.05) were independent prognostic factors for 1 year mortality. Conclusions High NLR was a predictor for in‐hospital mortality, and an independent prognostic factor for 1 year mortality. Both high NLR and high PLR were predictors for RRT.
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Affiliation(s)
- Ignacio M Seropian
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Francisco J Romeo
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Rodolfo Pizarro
- Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Norberto O Vulcano
- Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ricardo A Posatini
- Cardiovascular Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ricardo G Marenchino
- Cardiovascular Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Daniel H Berrocal
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Cesar A Belziti
- Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Ertem AG, Ozcelik F, Kasapkara HA, Koseoglu C, Bastug S, Ayhan H, Sari C, Akar Bayram N, Bilen E, Durmaz T, Keles T, Bozkurt E. Neutrophil Lymphocyte Ratio as a Predictor of Left Ventricular Apical Thrombus in Patients with Myocardial Infarction. Korean Circ J 2016; 46:768-773. [PMID: 27826334 PMCID: PMC5099331 DOI: 10.4070/kcj.2016.46.6.768] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/02/2016] [Accepted: 02/23/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In this study, we examined the role of inflammatory parameters in an apical mural thrombus with a reduced ejection fraction due to large anterior myocardial infarction (MI). SUBJECTS AND METHODS A total of 103 patients who had suffered from heart failure, 45 of whom had left ventricular apical thrombus (AT) after a large anterior MI, were enrolled in the study. A detailed clinical history was taken of each participant, biochemical inflammatory markers, which were obtained during admission, were analyzed and an echocardiographical and angiographical evaluation of specific parameters were performed. RESULTS There were no statistically significant differences in terms of age, gender, and history of hypertension, diabetes mellitus, and atrial fibrillation between both groups (p>0.05). Similarly there were no statistically significant differences in terms of biochemical and echocardiographic parameters (p>0.05). However, there were significant differences in terms of neutrophil lymphocyte ratio (p=0.032). After a multivariate regression analysis, neutrophil lymphocyte ratio (NLR) was an independent predictor of thrombus formation (β: 0.296, p=0.024). The NLR >2.74 had a 78% sensivity and 61% specifity in predicting thrombus in patients with a low left ventricular ejection fraction. CONCLUSION In this study, neutrophil lymphocyte ratios were significantly higher in patients with apical thrombus.
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Affiliation(s)
- Ahmet Goktug Ertem
- Department of Cardiology, Ataturk Training and Research Hospital, Ankara, Turkey
| | - Filiz Ozcelik
- Department of Cardiology, Ataturk Training and Research Hospital, Ankara, Turkey
| | | | - Cemal Koseoglu
- Department of Cardiology, Ataturk Training and Research Hospital, Ankara, Turkey
| | - Serdal Bastug
- Department of Cardiology, Ataturk Training and Research Hospital, Ankara, Turkey
| | - Huseyin Ayhan
- Department of Cardiology, Yildirim Beyazit University, Ankara, Turkey
| | - Cenk Sari
- Department of Cardiology, Ataturk Training and Research Hospital, Ankara, Turkey
| | - Nihal Akar Bayram
- Department of Cardiology, Yildirim Beyazit University, Ankara, Turkey
| | - Emine Bilen
- Department of Cardiology, Ataturk Training and Research Hospital, Ankara, Turkey
| | - Tahir Durmaz
- Department of Cardiology, Yildirim Beyazit University, Ankara, Turkey
| | - Telat Keles
- Department of Cardiology, Yildirim Beyazit University, Ankara, Turkey
| | - Engin Bozkurt
- Department of Cardiology, Yildirim Beyazit University, Ankara, Turkey
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15
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El índice neutrófilo/linfocito como marcador de disfunción sistémica endotelial en sujetos asintomáticos. Nefrologia 2016; 36:397-403. [DOI: 10.1016/j.nefro.2015.10.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 09/30/2015] [Accepted: 10/28/2015] [Indexed: 11/20/2022] Open
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16
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Yayla Ç, Canpolat U, Akyel A, Yayla KG, Yilmaz S, Açikgöz SK, Özcan F, Turak O, Doğan M, Yeter E, Aydoğdu S. Association Between Platelet to Lymphocyte Ratio and Saphenous Vein Graft Disease. Angiology 2016; 67:133-138. [PMID: 25818104 DOI: 10.1177/0003319715578258] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Atherosclerosis plays an important role in saphenous vein graft disease (SVGD). Previous trials showed that inflammatory blood cells play a role in this process. The platelet to lymphocyte ratio (PLR) has been proposed as a novel predictor for cardiovascular risk and indicator of atherosclerosis. The aim of this study was to assess the relationship between SVGD and PLR. A total of 220 patients with SVG were enrolled (n = 87 with SVGD and n = 133 with patent SVG). A ≥ 50% stenosis within the SVG was defined as clinically significant. Median PLR (P < .001) and mean platelet volume (MPV; P = .043) were significantly higher in patients with SVGD. Also, PLR showed significantly positive correlation with age of SVG (P < .05). Median age of SVGs was also higher in the SVGD group (P = .025). In multivariate logistic regression analyses, the PLR and MPV were independent predictors of SVGD. Using a cutoff level of 106.3, the PLR predicted SVGD with a sensitivity of 87.4% and a specificity of 80.3%. To the best of our knowledge, this study showed, for the first time, that PLR was independently associated with SVGD. Both PLR and MPV might predict SVGD.
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Affiliation(s)
- Çağrı Yayla
- Cardiology Clinic, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Uğur Canpolat
- Cardiology Clinic, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Ahmet Akyel
- Cardiology Clinic, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Kadriye Gayretli Yayla
- Cardiology Clinic, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Samet Yilmaz
- Cardiology Clinic, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Sadık Kadri Açikgöz
- Cardiology Clinic, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Fırat Özcan
- Cardiology Clinic, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Osman Turak
- Cardiology Clinic, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Mehmet Doğan
- Cardiology Clinic, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Ekrem Yeter
- Cardiology Clinic, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Sinan Aydoğdu
- Cardiology Clinic, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
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17
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Akyel A, Yayla Ç, Erat M, Çimen T, Doğan M, Açıkel S, Aydoğdu S, Yeter E. Neutrophil-to-lymphocyte ratio predicts hemodynamic significance of coronary artery stenosis. Anatol J Cardiol 2015; 15:1002-7. [PMID: 25880055 PMCID: PMC5368453 DOI: 10.5152/akd.2015.5909] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective: Coronary artery disease is closely linked with inflammation, and the neutrophil-to-lymphocyte ratio (NLR) has emerged as a new inflammatory marker. Fractional flow reserve (FFR) is a well-established method for determining hemodynamic significance of coronary artery stenosis. In this study, we aimed to investigate the relationship between NLR and hemodynamic significance of coronary artery lesion as assessed by FFR. Methods: A total of 134 patients with FFR measurement between January 2012 and December 2013 were enrolled in this retrospective study. Patients with single intermediate-grade coronary artery stenosis were enrolled, and those with second intermediate or severe coronary artery stenosis were excluded from study. Patients’ NLR were calculated. An FFR value of <0.80 was accepted for hemodynamic significance. Statistical analysis was performed by the chi-square test, Student’s t-test, Mann–Whitney U test, logistic regression analysis, and ROC curve analysis. Results: Patients with hemodynamically significant lesions had higher NLR values (3.3±1.2 vs. 2.0±0.9, p<0.001). White blood cell count, male gender, high-density lipoprotein levels, platelet-to-lymphocyte ratio, and NLR were found to be possible confounding factors predicting hemodynamically significant coronary artery stenosis. In multiple logistic regression analysis, NLR remained as the only independent predictor for hemodynamically significant coronary artery stenosis. An NLR value of 2.4 had 87.5% sensitivity and 78.4% specificity for prediction of hemodynamically significant coronary artery stenosis. Conclusion: In present study, we showed that NLR was significantly higher in patients with hemodynamically significant coronary artery stenosis. We also found NLR to be an independent predictor of hemodynamically significant coronary artery stenosis as measured by FFR. Further studies are needed to find a causal relationship.
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Affiliation(s)
- Ahmet Akyel
- Department of Cardiology, Dışkapı Yıldırım Beyazıt Education and Research Hospital; Ankara-Turkey.
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18
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Akboğa MK, Akyel A, Şahinarslan A, Yayla Ç, Alsancak Y, Gökalp G, Nurkoç S, Abacı A. Neutrophil-to-lymphocyte ratio is increased in patients with rheumatic mitral valve stenosis? Anatol J Cardiol 2014; 15:380-4. [PMID: 25430404 PMCID: PMC5779174 DOI: 10.5152/akd.2014.5399] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The role of systemic and chronic inflammatory processes in the pathophysiology of rheumatic heart valve disease is well known. The neutrophil-to-lymphocyte ratio (NLR) was shown to be an indicator of systemic inflammation. In this study, we aimed to investigate relationship between NLR as a marker of systemic inflammation and rheumatic mitral valve stenosis (RMVS). METHODS This is a retrospective study. Among patients who underwent transthoracic echocardiography between January 2008-March 2013, 314 patients with RMVS were included retrospectively in the study. The control group included 57 healthy persons who underwent transthoracic echocardiography during the study period. Basal characteristics and NLR were compared between the two groups. Independent predictors of RMVS were determined by logistic regression analysis. RESULTS Basal characteristics were similar among the groups (age, 50.2 ± 14.2 vs. 49.2 ± 13.0, p=0.60). The NLR was significantly higher in patients with RMVS [2.9 (0.6-13.0) vs. 2.1 (0.7-5.8), p<0.001]. Besides, C-reactive protein (CRP) was also higher in the RMVS group [5.99 (0.3-23.7) vs. 2.98 (0.6-6.3), p=0.001]. In the regression analysis, NLR (OR: 2.24, p=0.04), CRP (OR: 1.34, p=0.03), and left atrial diameter (OR: 1.21, p=0.001) were independent predictors of RMVS. In the correlation analysis, there was a significant positive correlation between NLR and CRP (r=0.43, p<0.001). CONCLUSION We found that NLR was significantly increased in RMVS. Furthermore, NLR was an independent predictor of the presence of RMVS in our study population. According to these findings, NLR can be used as a predictor of RMVS. Since it is an easily available and cheap method, it can easily be used in daily clinical practice. Increased NLR can also be a sign of ongoing chronic inflammation in patients with RMVS.
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Affiliation(s)
- Mehmet Kadri Akboğa
- Department of Cardiology, Ministry of Health Etimesgut State Hospital; Ankara-Turkey.
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