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Lekkala SP, Mellacheruvu SP, Gill KS, Khela PS, Singh G, Jitta SR, Patel M, Hingora MJ, Desai R. Association between preablation and postablation neutrophil-lymphocyte ratio and atrial fibrillation recurrence: A meta-analysis. J Arrhythm 2024; 40:214-221. [PMID: 38586846 PMCID: PMC10995595 DOI: 10.1002/joa3.12996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/29/2023] [Accepted: 01/14/2024] [Indexed: 04/09/2024] Open
Abstract
Atrial fibrillation (AF) recurrence has become common in patients who have undergone catheter ablation. High neutrophil lymphocyte ratios (NLR) have been linked to an increased risk of recurrent AF. The research is, however, not conclusive. This meta-analysis addressed the value of easily accessible and affordable pre- and postablation NLR levels as indicators of AF recurrence in patients who had undergone ablation. We searched PubMed, SCOPUS, and Google Scholar for pertinent studies through May 2023. Using random effects models, the aggregated odds ratio (OR) of pre- and post-NLR and AF recurrence was estimated. Inter-study heterogeneity was described using I 2 statistics and leave-one-out sensitivity analysis. A p-value < .05 was considered statistically significant. The literature search yielded 270 studies, seven of which were included in this meta-analysis of 1923 patients who experienced AF recurrence after undergoing ablation. There are five retrospective and two prospective studies with a mean follow-up of 20.5 months. The unadjusted odds ratio (OR) of AF recurrence for preablation NLR was 1.33 (95% CI: 1.04-1.71, p < .01, I 2 = 95.49%), while the adjusted OR was 1.45 (95% CI: 0.87-2.43, p < .01, I 2 = 95.1%). The unadjusted odds ratio (OR) for postablation NLR was 1.21 (95% CI: 1.09-1.36, p < .01, I 2 = 85.9%), and the adjusted odds ratio (OR) was 1.28 (95% CI: 0.93-1.76), demonstrating significant heterogeneity (I 2 = 95.32%) with a p-value < .01. NLR was significantly associated with AF recurrence prediction. To detect AF recurrence, we recommend that clinicians add a simple NLR blood test to their diagnostic modalities.
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Affiliation(s)
| | | | - Karanvir Singh Gill
- Department of Internal MedicineSri Guru Ram Das Institute of Medical Sciences and ResearchAmritsarPunjabIndia
| | - Puneeteshwar Singh Khela
- Department of Internal MedicineSri Guru Ram Das Institute of Medical Sciences and ResearchAmritsarPunjabIndia
| | - Gurjot Singh
- Department of Internal MedicineSri Guru Ram Das Institute of Medical Sciences and ResearchAmritsarPunjabIndia
| | | | - Manali Patel
- Department of Internal MedicineGastroenterology and Internal Medicine SpecialistsIllinoisUSA
| | - Mohmed Junaid Hingora
- Department of Internal MedicinePandit Deendayal Upadhyay Medical CollegeRajkotGujaratIndia
| | - Rupak Desai
- Independent Outcomes ResearcherAtlantaGeorgiaUSA
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Gao X, Jiang X, Wu Z, Chen N, Gong M, Zhao X, Liu Y, Guo R. Effect of Neutrophil-to-Lymphocyte Ratio on Post-TAVR Mortality and Periprocedural Pulmonary Hypertension. J Interv Cardiol 2024; 2024:4512655. [PMID: 38415185 PMCID: PMC10898951 DOI: 10.1155/2024/4512655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/27/2024] [Accepted: 02/06/2024] [Indexed: 02/29/2024] Open
Abstract
Aims To evaluate the impact of neutrophil-to-lymphocyte ratio (NLR) on periprocedural pulmonary hypertension (PH) and 3-month all-cause mortality in patients with aortic stenosis (AS) who underwent transcatheter aortic valve replacement (TAVR) and to develop a nomogram for predicting the mortality for these patients. Methods and Results 124 patients undergoing TAVR were categorized into three groups according to systolic pulmonary artery pressure (sPAP): Group I (no PH, n = 61) consisted of patients with no pre- and post-TAVR PH; Group II (improved PH, n = 35) consisted of patients with post-TAVR systolic pulmonary artery pressure (sPAP) decreased by more than 10 mmHg compared to pre-TAVR levels; and Group III (persistent PH, n = 28) consisted of patients with post-TAVR sPAP no decrease or less than 10 mmHg, or new-onset PH after the TAVR procedure. The risk of all-cause mortality within 3 months tended to be higher in Group II (11.4%) and Group III (14.3%) compared to Group I (3.3%) (P=0.057). The multinomial logistic regression analysis demonstrated a positive correlation between NLR and both improved PH (OR: 1.182, 95% CI: 1.036-1.350, P=0.013) and persistent PH (OR: 1.181, 95% CI: 1.032-1.352, P=0.016). Kaplan-Meier analysis revealed a significant association between higher NLR and increased 3-month all-cause mortality (16.1% vs. 3.1% in lower NLR group, P=0.021). The multivariable Cox regression analysis confirmed that NLR was an independent predictor for all-cause mortality within 3 months, even after adjusting for clinical confounders. A nomogram incorporating five factors (BNP, heart rate, serum total bilirubin, NLR, and comorbidity with coronary heart disease) was developed. ROC analysis was performed to discriminate the ability of the nomogram, and the AUC was 0.926 (95% CI: 0.850-1.000, P < 0.001). Conclusions Patients with higher baseline NLR were found to be at an increased risk of periprocedural PH and all-cause mortality within 3 months after TAVR.
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Affiliation(s)
- Xin Gao
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaoxiao Jiang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zonglei Wu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Na Chen
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Minghui Gong
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xu Zhao
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yan Liu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ran Guo
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Du P, Gao X, Sun Q, Gong M, Pan Y, Guo Q, Zhao X, Guo R, Liu Y. Association between uric acid and cardiac outcomes mediated by neutrophil-to-lymphocyte ratio in patients with left ventricular diastolic dysfunction and pulmonary hypertension. Sci Rep 2024; 14:2751. [PMID: 38302600 PMCID: PMC10834525 DOI: 10.1038/s41598-024-53077-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/27/2024] [Indexed: 02/03/2024] Open
Abstract
To evaluate the association of uric acid (UA) with adverse outcomes and its potential mediator in patients with left ventricular diastolic dysfunction (LVDD) and pulmonary hypertension (PH). We retrospectively analyzed 234 patients with LVDD and PH. The baseline characteristics of patients with low UA (≤ 330 µmol/L) group were compared with high UA (> 330 µmol/L) group. Adverse outcomes included all-cause mortality, cardiac death and heart failure (HF) hospitalization. Their association with UA and the mediator were evaluated using Cox regression and mediation analysis. The mediation proportion was further quantified by the R mediation package. During a mean follow-up of 50 ± 18 months, there were 27 all-cause deaths, 18 cardiovascular deaths and 41 incidents of HF hospitalization. Multivariable Cox regression analysis showed UA was an independent risk factor of adverse outcomes in LVDD and PH patients, even after adjusting for age, sex, body mass index, medical histories, systolic blood pressure, fasting blood glucose, total cholesterol, triglyceride, eGFR, BNP and medications. The hazard ratios (HRs) for UA (per 10 µmol/L increase) were as below: for all-cause mortality, HR 1.143, 95% CI 1.069-1.221, P < 0.001; for cardiac death, HR 1.168, 95% CI 1.064-1.282, P = 0.001; for HF hospitalization, HR 1.093, 95% CI 1.035-1.155, P = 0.001. Neutrophil-to-lymphocyte ratio (NLR) played a partial mediation role in the association, and the mediation proportion for NLR on the UA-adverse outcomes were 21%, 19% and 17%, respectively. In patients of LVDD with PH, higher UA level was independently correlated with adverse outcomes. Furthermore, NLR partially mediated the effect of UA on the risk of all-cause mortality, cardiac death and HF hospitalization.
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Affiliation(s)
- Ping Du
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xin Gao
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qiaobing Sun
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Minghui Gong
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yu Pan
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qinpeng Guo
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xu Zhao
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ran Guo
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
| | - Yan Liu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
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Luo Y, Tang Y, Huang W, Xiong S, Long Y, Liu H. Age, creatinine, and ejection fraction (ACEF) score as predictive values for late non-valvular atrial fibrillation recurrence after radiofrequency ablation. Clin Exp Hypertens 2023; 45:2207784. [PMID: 37161316 DOI: 10.1080/10641963.2023.2207784] [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: 05/11/2023]
Abstract
The clinical risk factors associated with late recurrence in patients with non-valvular atrial fibrillation (AF) (NVAF) undergoing radiofrequency catheter ablation (RFCA) remain unknown. Furthermore, the current prognostic risk score system is commonly used in such patients as a noninvasive method to assess late AF recurrence. According to recent research, the Age, creatinine, and ejection fraction (ACEF) score is a useful risk score for cardiovascular morbidity and mortality. As a result, we hypothesized that pre-ablation ACEF score could be used to assess late recurrence in patients with NVAF. We included 325 NVAF patients undergoing RFCA. During a median follow-up period of 12 months, patients with late AF recurrence had higher ACEF scores (P < .001). The pre-ablation ACEF score was a risk factor for late AF recurrence after RFCA (P = .027). The ACEF score was a predictor of late AF recurrence after RFCA, with an AUC of 0.624 (P = .001). Moreover, the AUC of left atrial diameter (LAD) was 0.7 (P < .001), which was higher than the ACEF score, but no significant difference was found (P = .104). The ACEF score was positively correlated with LAD, advanced age, and B-type natriuretic peptide. In patients with NVAF, the pre-ablation ACEF score is a valuable risk score for assessing late AF recurrence after RFCA, as with LAD.
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Affiliation(s)
- Yan Luo
- The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Yan Tang
- The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Wenchao Huang
- The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Shiqiang Xiong
- The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Yu Long
- The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Hanxiong Liu
- The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
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Lee YH. Reassessing the role of the neutrophil-to-lymphocyte ratio in chronic kidney disease patients. Korean J Intern Med 2023; 38:579-580. [PMID: 37680094 PMCID: PMC10493453 DOI: 10.3904/kjim.2023.328] [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: 08/08/2023] [Accepted: 08/19/2023] [Indexed: 09/09/2023] Open
Affiliation(s)
- Yu Ho Lee
- Division of Nephrology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Zweiker D, Pogran E, Gargiulo L, Abd El-Razek A, Lechner I, Vosko I, Rechberger S, Bugger H, Christ G, Bonderman D, Kunschitz E, Czedik-Eysenberg C, Roithinger A, Weihs V, Kaufmann CC, Zirlik A, Bauer A, Metzler B, Lambert T, Steinwender C, Huber K. Neutrophile-Lymphocyte Ratio and Outcome in Takotsubo Syndrome. BIOLOGY 2022; 11:biology11081154. [PMID: 36009781 PMCID: PMC9404721 DOI: 10.3390/biology11081154] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/27/2022]
Abstract
Background: Takotsubo syndrome (TTS) is an important type of acute heart failure with significant risk of acute complications and death. In this analysis we sought to identify predictors for in-hospital clinical outcome in TTS patients and present long-term outcomes. Methods: In this analysis from the Austrian national TTS registry, univariable and multivariable analyses were performed to identify significant predictors for severe in-hospital complications requiring immediate invasive treatment or leading to irreversible damage, such as cardiogenic shock, intubation, stroke, arrhythmias and death. Furthermore, the influence of independent predictors on long-term survival was evaluated. Results: A total of 338 patients (median age 72 years, 86.9% female) from six centers were included. Severe in-hospital complications occurred in 14.5% of patients. In multivariable analysis, high neutrophile-lymphocyte-ratio (NLR; OR 1.04 [95% CI 1.02−1.07], p = 0.009) and low LVEF (OR 0.92 [0.90−0.95] per %, p < 0.001) were significant predictors of severe in-hospital complications. Both the highest NLR tercile and the lowest LVEF tercile were significantly associated with reduced 5-year survival. Conclusions: Low LVEF and high NLR at admission were independently associated with increased in-hospital complications and reduced long-term survival in TTS patients. NLR is a new easy-to-measure tool to predict worse short- and long-term outcome after TTS.
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Affiliation(s)
- David Zweiker
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), 1160 Vienna, Austria; (E.P.); (V.W.); (C.C.K.); (K.H.)
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.V.); (H.B.); (A.Z.)
- Correspondence: ; Tel.: +43-664-8650460; Fax: +43-1-49150-2309
| | - Edita Pogran
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), 1160 Vienna, Austria; (E.P.); (V.W.); (C.C.K.); (K.H.)
- Faculty of Medicine, Sigmund Freud University, 1020 Vienna, Austria; (L.G.); (A.A.E.-R.); (A.R.)
| | - Laura Gargiulo
- Faculty of Medicine, Sigmund Freud University, 1020 Vienna, Austria; (L.G.); (A.A.E.-R.); (A.R.)
| | - Ahmed Abd El-Razek
- Faculty of Medicine, Sigmund Freud University, 1020 Vienna, Austria; (L.G.); (A.A.E.-R.); (A.R.)
| | - Ivan Lechner
- Clinic of Internal Medicine III—Cardiology and Angiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (I.L.); (A.B.); (B.M.)
| | - Ivan Vosko
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.V.); (H.B.); (A.Z.)
| | - Stefan Rechberger
- Department of Cardiology and Intensive Medicine, Kepler University Clinic, 4020 Linz, Austria; (S.R.); (T.L.); (C.S.)
| | - Heiko Bugger
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.V.); (H.B.); (A.Z.)
| | - Günter Christ
- 5th Medical Department for Cardiology, Clinic Favoriten, 1100 Vienna, Austria; (G.C.); (D.B.)
| | - Diana Bonderman
- 5th Medical Department for Cardiology, Clinic Favoriten, 1100 Vienna, Austria; (G.C.); (D.B.)
| | | | | | - Antonia Roithinger
- Faculty of Medicine, Sigmund Freud University, 1020 Vienna, Austria; (L.G.); (A.A.E.-R.); (A.R.)
| | - Valerie Weihs
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), 1160 Vienna, Austria; (E.P.); (V.W.); (C.C.K.); (K.H.)
- Core Facility, Medical University of Vienna, 1090 Vienna, Austria;
| | - Christoph C. Kaufmann
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), 1160 Vienna, Austria; (E.P.); (V.W.); (C.C.K.); (K.H.)
| | - Andreas Zirlik
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.V.); (H.B.); (A.Z.)
| | - Axel Bauer
- Clinic of Internal Medicine III—Cardiology and Angiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (I.L.); (A.B.); (B.M.)
| | - Bernhard Metzler
- Clinic of Internal Medicine III—Cardiology and Angiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (I.L.); (A.B.); (B.M.)
| | - Thomas Lambert
- Department of Cardiology and Intensive Medicine, Kepler University Clinic, 4020 Linz, Austria; (S.R.); (T.L.); (C.S.)
| | - Clemens Steinwender
- Department of Cardiology and Intensive Medicine, Kepler University Clinic, 4020 Linz, Austria; (S.R.); (T.L.); (C.S.)
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), 1160 Vienna, Austria; (E.P.); (V.W.); (C.C.K.); (K.H.)
- Faculty of Medicine, Sigmund Freud University, 1020 Vienna, Austria; (L.G.); (A.A.E.-R.); (A.R.)
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