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Leow AST, Goh FQ, Tan BYQ, Ho JSY, Kong WKF, Foo RSY, Chan MYY, Yeo LLL, Chai P, Geru A, Yeo TC, Chan SP, Zhou X, Lip GYH, Sia CH. Clinical Phenotypes and Outcomes of Patients with Left Ventricular Thrombus: An Unsupervised Cluster Analysis. Hellenic J Cardiol 2024:S1109-9666(24)00178-7. [PMID: 39208930 DOI: 10.1016/j.hjc.2024.08.010] [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: 06/08/2024] [Revised: 08/12/2024] [Accepted: 08/18/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Left ventricular thrombus (LVT) can develop in a diverse group of patients with various underlying causes resulting in divergent natural histories and trajectories with treatment. Our aim was to utilise cluster analysis to identify unique clinical profiles among LVT patients and then compare their clinical characteristics, treatment strategies, and outcomes. METHODS We conducted a retrospective study involving 472 LVT patients whose data was extracted from a tertiary center's echocardiography database, from March 2011 to January 2021. We employed the TwoStep cluster analysis method, examining 19 variables. RESULTS Our analysis of the 472 LVT patients revealed two distinct patient clusters. Cluster 1, comprising 247 individuals (52.3%), was characterized by younger patients with a lower incidence of traditional cardiovascular risk factors and relatively fewer comorbidities, compared to Cluster 2. Most patients had LVT attributed to an underlying ischaemic condition, with a larger proportion in Cluster 1 being due to post-acute myocardial infarction (68.8%), and Cluster 2 due to ischaemic cardiomyopathy (57.8%). Notably, patients in Cluster 2 exhibited a reduced likelihood of LVT resolution (HR 0.58, 95% CI 0.44 - 0.77, p < 0.001) and a higher risk of all-cause mortality (HR 2.27, 95% CI 1.43 - 3.60, p = 0.001). These associations persisted even after adjusting for variables like anticoagulation treatment, the presence of left ventricular aneurysms, and specific LVT characteristics such as mobility, protrusion, and size. CONCLUSIONS Through TwoStep cluster analysis, we identified two distinct clinical phenotypes among LVT patients, each distinguished by unique baseline clinical attributes and varying prognoses.
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Affiliation(s)
- Aloysius S T Leow
- Department of Medicine, National University Health System, Singapore
| | - Fang Qin Goh
- Department of Medicine, National University Health System, Singapore
| | - Benjamin Y Q Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Jamie S Y Ho
- Department of Medicine, National University Health System, Singapore
| | - William K F Kong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre, Singapore
| | - Roger S Y Foo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cardiovascular Metabolic Disease Translational Research Programme, National University of Singapore, Singapore
| | - Mark Y Y Chan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre, Singapore
| | - Leonard L L Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Ping Chai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre, Singapore
| | - A Geru
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Tiong-Cheng Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre, Singapore
| | - Siew Pang Chan
- Centre for Behavioural & Implementation Science Interventions, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xin Zhou
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre, Singapore.
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Che Y, Huang S, Zhou W, Shi S, Ye F, Ji Y, Huang J. Association between neutrophil-to-lymphocyte ratio and outcomes in hospitalized patients with left ventricular thrombus. Coron Artery Dis 2024; 35:397-404. [PMID: 38563191 PMCID: PMC11198952 DOI: 10.1097/mca.0000000000001363] [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: 01/12/2024] [Accepted: 03/16/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Left ventricular thrombus (LVT) is a severe cardiovascular complication occurring in approximately 10% of patients with acute anterior ST-segment elevation myocardial infarction. This study aimed to evaluate the association between neutrophil-to-lymphocyte ratio (NLR) and in-hospital major adverse cardiovascular and cerebrovascular events (MACCE) in patients with LVT. MATERIAL AND METHODS This multicenter retrospective study was conducted between January 2000 and June 2022 in hospitalized patients with LVT. The outcome included in-hospital MACCE. The association between NLR and in-hospital MACCE was measured by odds ratios (ORs). The restricted cubic spline model was used for dose-response analysis. RESULTS A total of 197 LVT patients from four centers were included for analysis in this study. MACCE occurred in 13.7% (27/197) of the patients. After adjusting for estimated glomerular filtration rate (eGFR), D-dimer, and age, the OR for MACCE comparing first to the third tertile of NLR was 13.93 [95% confidence interval: 2.37-81.77, P = 0.004, P -trend = 0.008]. When further adjusting for etiology and heart failure with reduced ejection fraction (HFrEF), the association remained statistically significant. Spline regression models showed an increasing trend in the incidence of MACCEs with NLR both in crude and adjusted models. Subgroup analyses showed that a high NLR may be correlated with poorer outcomes for LVT patients older than 65 years, or with hypertension, dyslipidemia, low ejection fraction, liver, and renal dysfunctions. CONCLUSION In conclusion, these findings suggested that higher NLR may be associated with an increased risk of in-hospital MACCE in patients with LVT.
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Affiliation(s)
| | - Shenglan Huang
- Department of Cardiology, the Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou
| | - Wei Zhou
- Department of Cardiology, Yixing People’s Hospital, Yixing
| | - Shunyi Shi
- Department of Cardiology, the Third Affiliated Hospital of Soochow University, Changzhou
| | - Fei Ye
- Department of Cardiology, Nanjing First Hospital, Nanjing
| | - Yuan Ji
- Department of Cardiology, the Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou
| | - Jun Huang
- Department of Echocardiology, the Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, China
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Zehir R, Yılmaz AS, Çırakoğlu ÖF, Kahraman F, Duman H. Modified Glasgow Prognostic Score Predicted High-Grade Intracoronary Thrombus in Acute Anterior Myocardial Infarction. Angiology 2024; 75:454-461. [PMID: 36799537 DOI: 10.1177/00033197231157929] [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] [Indexed: 02/18/2023]
Abstract
High-grade intracoronary thrombus (ICT) burden leads to greater myocardial injury following anterior myocardial infarction (MI). The modified Glasgow prohgnostic score (mGPS) is a novel immune-inflammatory index, calculated by using C-reactive protein (CRP) and albumin levels, was shown to have prognostic value in heart diseases. The present study investigated the role of mGPS in predicting high grade ICT in patients with acute anterior MI admitted between February 2017 and March 2020. Blood samples were obtained at admission and mGPS was calculated. The ICT burden was evaluated visually from angiographic images. Patients were divided into 2 groups according to the ICT burden as high and low. A total of 1132 patients were enrolled: a mean age 61 ± 12.4 years and 370 males (32.7%). Serum albumin was lower, whereas mGPS and CRP were higher in high grade ICT group. CRP (odds ratio (OR): 1.404 95% CI: 1.312-1.502; P < .001), albumin (OR: .486; 95% CI: .301-.782 P < .001), and mGPS (0 vs ≥ 1) (OR: 7.391; 95% CI: 3.910-13.972; P < .001) were independent predictors of high-grade ICT burden in the left anterior descending coronary artery. The mGPS is a novel predictor of high-grade ICT burden and may be useful for risk stratification in patients with acute anterior MI.
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Affiliation(s)
- Regayip Zehir
- Department of Cardiology, University of Medical Sciences, İstanbul, Turkey
| | | | - Ömer Faruk Çırakoğlu
- Department of Cardiology, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turkey
| | - Fatih Kahraman
- Department of Cardiology, Evliya Çelebi Training and Research Hospital, Kütahya, Turkey
| | - Hakan Duman
- Department of Cardiology, Recep Tayyip Erdogan University, Rize, Turkey
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4
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Fardman A, Massalha E, Natanzon SS, Brodov Y, Goitein O, Chernomordik F, Herscovici R, Grupper A, Kuperstein R, Mazin I, Matetzky S, Beigel R. Clinical predictors of left ventricular thrombus after myocardial infarction as detected by magnetic resonance imaging. Front Cardiovasc Med 2024; 10:1275390. [PMID: 38292454 PMCID: PMC10824980 DOI: 10.3389/fcvm.2023.1275390] [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] [Received: 08/09/2023] [Accepted: 12/29/2023] [Indexed: 02/01/2024] Open
Abstract
Background The diagnosis of a left ventricular (LV) thrombus in patients with ST-segment elevation myocardial infarction (STEMI) remains challenging. The aim of the current study is to characterize clinical predictors for LV thrombus formation, as detected by cardiac magnetic resonance imaging (CMRI). Methods We retrospectively evaluated 337 consecutive STEMI patients. All patients underwent transthoracic echocardiography (TTE) and CMRI during their index hospitalization. We developed a novel risk stratification model (ThrombScore) to identify patients at risk of developing an LV thrombus. Results CMRI revealed the presence of LV thrombus in 34 patients (10%), of whom 33 (97%) had experienced an anterior wall myocardial infarction (MI), and the majority (77%) had at least mildly reduced left ventricular ejection fraction (LVEF < 45%). The sensitivity for thrombus formation of the first and second TTE was 5.9% and 59%, respectively. Multivariate logistic regression model revealed that elevated C-reactive protein levels, lack of ST-segment elevation (STe) resolution, elevated creatine phosphokinase levels, and STe in anterior ECG leads are robust independent predictors for developing an LV thrombus. These variables were incorporated to construct the ThrombScore: a simple six-point risk model. The odds ratio for developing thrombus per one-point increase in the score was 3.2 (95% CI 2.1-5.01; p < 0.001). The discrimination analysis of the model revealed a c-statistic of 0.86 for thrombus development. The model identified three distinct categories (I, II, and III) with corresponding thrombus incidences of 0%, 1.6%, and 27.6%, respectively. Conclusion ThrombScore is a simple and practical clinical model for risk stratification of thrombus formation in patients with STEMI.
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Affiliation(s)
- Alexander Fardman
- The Cardiovascular Division, Sheba Medical Center, Tel-Hashomer, Affiliated to The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Eias Massalha
- The Cardiovascular Division, Sheba Medical Center, Tel-Hashomer, Affiliated to The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | | | - Yafim Brodov
- The Cardiovascular Division, Sheba Medical Center, Tel-Hashomer, Affiliated to The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Orly Goitein
- The Cardiovascular Division, Sheba Medical Center, Tel-Hashomer, Affiliated to The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Fernando Chernomordik
- The Cardiovascular Division, Sheba Medical Center, Tel-Hashomer, Affiliated to The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Romana Herscovici
- The Cardiovascular Division, Sheba Medical Center, Tel-Hashomer, Affiliated to The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Avishay Grupper
- The Cardiovascular Division, Sheba Medical Center, Tel-Hashomer, Affiliated to The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Rafael Kuperstein
- The Cardiovascular Division, Sheba Medical Center, Tel-Hashomer, Affiliated to The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Israel Mazin
- The Cardiovascular Division, Sheba Medical Center, Tel-Hashomer, Affiliated to The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Shlomi Matetzky
- The Cardiovascular Division, Sheba Medical Center, Tel-Hashomer, Affiliated to The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Roy Beigel
- The Cardiovascular Division, Sheba Medical Center, Tel-Hashomer, Affiliated to The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Saygi M, Tanalp AC, Tezen O, Pay L, Dogan R, Uzman O, Karabay CY, Tanboga IH, Kacar FO, Karagoz A. The prognostic importance of the Naples prognostic score for in-hospital mortality in patients with ST-segment elevation myocardial infarction. Coron Artery Dis 2024; 35:31-37. [PMID: 37990558 DOI: 10.1097/mca.0000000000001285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
BACKGROUND The Naples prognostic score (NPS) is an effective inflammatory and nutritional scoring system widely applied as a prognostic factor in various cancers. However, the prognostic significance of NPS is unknown in ST-segment elevation myocardial infarction (STEMI). We aimed to analyze the prognostic value of the NPS in-hospital mortality in patients with STEMI. METHODS The study consisted of 3828 patients diagnosed with STEMI who underwent primer percutaneous coronary intervention. As the primary outcome, in-hospital mortality was defined as all-cause deaths during hospitalization. The included patients were categorized into three groups based on NPS (group 1:NPS = 0,1,2; group 2:NPS = 3; group 3:NPS = 4). RESULTS Increased NPS was associated with higher in-hospital mortality rates( P < 0.001). In the multivariable logistic regression analysis, the relationship between NPS and in-hospital mortality continued after adjustment for age, male sex, diabetes, hypertension, Killip score, SBP, heart rate, left ventricular ejection fraction, myocardial infarction type and postprocedural no-reflow. A strong positive association was found between in-hospital mortality and NPS by multivariable logistic regression analysis [NPS 0-1-2 as a reference, OR = 1.73 (95% CI, 1.04-2.90) for NPS 3, OR = 2.83 (95% CI, 1.76-4.54) for NPS 4]. CONCLUSION The present study demonstrates that the NPS could independently predict in-hospital mortality in STEMI. Prospective studies will be necessary to confirm the performance, clinical applicability and practicality of the NPS for in-hospital mortality in STEMI.
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Affiliation(s)
- Mehmet Saygi
- Department of Cardiology, Hisar Intercontinental Hospital, Istanbul
| | | | - Ozan Tezen
- Department of Cardiology, Dr. Siyami Ersek Thoracic And Cardiovascular Surgery Education Research Hospital, Istanbul
| | - Levent Pay
- Department of Cardiology, Ardahan Public Hospital, Ardahan
| | - Remziye Dogan
- Department of Cardiology, Hisar Intercontinental Hospital, Istanbul
| | - Osman Uzman
- Department of Cardiology, Dr. Siyami Ersek Thoracic And Cardiovascular Surgery Education Research Hospital, Istanbul
| | - Can Yucel Karabay
- Department of Cardiology, Dr. Siyami Ersek Thoracic And Cardiovascular Surgery Education Research Hospital, Istanbul
| | - Ibrahim Halil Tanboga
- Department of Biostatistics and Cardiology, Nisantasi University Medical School, Istanbul
| | - Flora Ozkalayci Kacar
- Department of Biostatistics and Cardiology, Nisantasi University Medical School, Istanbul
| | - Ali Karagoz
- Department of Cardiology, Kosuyolu Education Research Hospital, Istanbul, Turkey
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Bayam E, Çakmak EÖ, Yıldırım E, Kalçık M, Bilen Y, Güner A, Küp A, Kahyaoğlu M, Çelik M, Öcal L, Avcı A, Zehir R. The relationship between CHA2DS2VASc score and left ventricular apical thrombus formation in patients with acute anterior ST segment elevation myocardial infarction. Acta Cardiol 2023; 78:24-31. [PMID: 34714216 DOI: 10.1080/00015385.2021.1991667] [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: 01/04/2023]
Abstract
BACKGROUND Left ventricular apical thrombus (LVAT) formation is a well-known complication of acute anterior myocardial infarction (AMI). The CHA2DS2VASc is a scoring system that has been used to estimate the risk of thromboembolism in patients with nonvalvular atrial fibrillation. This score has also been used for other clinical conditions. The aim of this study was to investigate the relationship between CHA2DS2VASc score and development of LVAT in patients with AMI. METHOD The study population included 378 patients (mean age: 56.5 ± 12.3 years, male: 318) presenting with AMI between January 2016 and January 2020. Primary percutaneous coronary intervention procedure was performed in all patients. Initial echocardiogram was performed within 7 days of admission. All patients were evaluated with echocardiography at 3rd, 6th and 12th months. Patients were divided into two groups according to the presence of LVAT on echocardiography. RESULTS The incidence of the LVAT was 8.5% (n = 32) during a mean follow-up time of 233.1 ± 66.7 days. The mean CHA2DS2VASc score was notably higher in patients with LVAT compared to patients in the control group (3.1 ± 1.9 vs. 1.9 ± 1.2, p < 0.001). In Cox regression analysis, high CHA2DS2VASc score, low left ventricular ejection fraction (LVEF) and the presence of LV apical akinesis/aneurysm were the independent predictors for LVAT formation. All of these parameters were associated with higher cumulative incidence of LVAT formation in Kaplan-Meier analyses (p < 0.001 for all). CONCLUSION High CHA2DS2VASc score, low LVEF and the presence of LV apical akinesis/aneurysm may be used for LVAT risk prediction among patients presenting with AMI.
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Affiliation(s)
- Emrah Bayam
- Depertament of Cardiology, University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, İstanbul, Turkey
| | - Ender Özgün Çakmak
- Depertament of Cardiology, University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, İstanbul, Turkey
| | - Ersin Yıldırım
- Depertament of Cardiology, University of Medical Sciences, Umraniye Training and Research Hospital, İstanbul, Turkey
| | - Macit Kalçık
- Depertament of Cardiology, Hitit University, Faculty of Medicine, Çorum, Turkey
| | - Yusuf Bilen
- Depertament of Cardiology, University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, İstanbul, Turkey
| | - Ahmet Güner
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ayhan Küp
- Depertament of Cardiology, University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, İstanbul, Turkey
| | - Muzaffer Kahyaoğlu
- Department of Cardiology, Abdülkadir Yüksel State Hospital, Gaziantep, Turkey
| | - Mehmet Çelik
- Depertament of Cardiology, University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, İstanbul, Turkey
| | - Lütfi Öcal
- Depertament of Cardiology, University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, İstanbul, Turkey
| | - Anıl Avcı
- Depertament of Cardiology, University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, İstanbul, Turkey
| | - Regayip Zehir
- Depertament of Cardiology, University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, İstanbul, Turkey
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7
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Ma S, Bai L, Liu P, She G, Deng XL, Song AQ, Du XJ, Lu Q. Pathogenetic Link of Cardiac Rupture and Left Ventricular Thrombus Following Acute Myocardial Infarction: A Joint Preclinical and Clinical Study. Front Cardiovasc Med 2022; 9:858720. [PMID: 35757352 PMCID: PMC9218188 DOI: 10.3389/fcvm.2022.858720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/25/2022] [Indexed: 12/01/2022] Open
Abstract
Background Cardiac rupture (CR) and left ventricular thrombus (LVT) remain important complications of acute myocardial infarction (MI), and they are currently regarded as independent events. We explored the pathogenetic link between CR and LVT by investigating a murine model of MI with a high frequency of CR and in patients with acute MI. Methods MI was induced in mice, the onset of CR was monitored, and the hearts of mice with or without fatal CR were histologically examined. Between 2015 and 2022, from patients admitted due to acute MI, the data of patients with CR or LVT were retrospectively collected and compared to uncomplicated patients (control). Results A total of 75% of mice (n = 65) with MI developed CR 2–4 days after MI. A histological examination of CR hearts revealed the existence of platelet-rich intramural thrombi in the rupture tunnel, which was connected at the endocardial site to platelet-fibrin thrombi within an LVT. In CR or non-CR mouse hearts, LV blood clots often contained a portion of platelet-fibrin thrombi that adhered to the infarct wall. In non-CR hearts, sites of incomplete CR or erosion of the infarct wall were typically coated with platelet thrombi and dense inflammatory cells. Of 8,936 patients with acute MI, CR and LVT occurred in 102 (1.14%) and 130 (1.45%) patients, respectively, with three cases having both complications. CR accounted for 32.8% of in-hospital deaths. The majority of CR (95%) or LVT (63%, early LVT) occurred within 7 days. In comparison to the control or LVT-late groups, patients with CR or early LVT reported increased levels of cellular and biochemical markers for inflammation or cardiac injury. Conclusion CR and LVT after MI are potentially linked in their pathogenesis. LVT occurring early after MI may be triggered by a thrombo-inflammatory response following wall rupture or endocardial erosion.
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Affiliation(s)
- Shan Ma
- Department of Internal Medicine-Cardiovascular, Cardiovascular Hospital, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Ling Bai
- Department of Internal Medicine-Cardiovascular, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Ping Liu
- Department of Internal Medicine-Cardiovascular, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Gang She
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi’an Jiaotong University, Xi’an, China
| | - Xiu-Ling Deng
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi’an Jiaotong University, Xi’an, China
| | - An-Qi Song
- Department of Internal Medicine-Cardiovascular, Cardiovascular Hospital, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Xiao-Jun Du
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi’an Jiaotong University, Xi’an, China
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- *Correspondence: Xiao-Jun Du,
| | - Qun Lu
- Department of Internal Medicine-Cardiovascular, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Qun Lu,
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8
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Çolak TS, Kekeç AF. Does the pre-operative neutrophil-lymphocyte ratio have a predictive value in detecting infection in type 3 open tibia diaphysis fractures? ULUS TRAVMA ACIL CER 2022; 28:693-697. [PMID: 35485467 PMCID: PMC10442988 DOI: 10.14744/tjtes.2021.31766] [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: 08/20/2020] [Accepted: 02/16/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND This retrospective study was aimed to investigate whether the pre-operative neutrophil-lymphocyte (N/L) ratio has a predictive value in terms of evaluating the development of infection in patients with type 3 open fractures of the tibia diaphysis. METHODS A total of 72 patients with type 3 open tibia fractures who consulted to the emergency service at the Necmettin Er-bakan University Meram Faculty of Medicine, during the period between 2015 and 2020 were retrospectively examined. A total of 39 patients who underwent external fixator in the first treatment were included in the study. The information pertaining to the patients such as the patient demographic data, type of injury, wound cultures, and N/L rates during the pre-operative period were recorded. Patients were divided into two groups based on the presence of infection: Group 1 (12 patients) consisted of patients who had infec-tion, and Group 2 (27 patients) consisted of patients who had no infection. RESULTS 34 (87.2%) of the patients were male and 5 (12.8%) were women. The mean age of these patients was 43.18±18.67 (19-80). Infection was detected in 12 (30.8%) out of 39 patients. Of these patients, 9 (75%) were monomicrobial, and 3 (25%) were polymicrobial. The most common mechanism of the injury was gunshot injury in 16 (41%) of all patients. However, there was no sig-nificant difference between the groups in terms of mechanism of injury (p=0.445). When all patients were examined in terms of N/L rates and presence of infection, there was no significant difference between Group 1 and Group 2 (p=0.976). CONCLUSION Although N/L ratio of the blood in the pre-operative period has a predictive value for chronic diseases, we believe that it has no predictive value for detecting infection in patients with type 3 acute open tibia fractures.
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Affiliation(s)
- Tahsin Sami Çolak
- Department of Orthopaedics and Traumatology, Necmettin Erbakan University Meram Faculty of Medicine, Konya-Turkey
| | - Ahmet Fevzi Kekeç
- Department of Orthopaedics and Traumatology, Necmettin Erbakan University Meram Faculty of Medicine, Konya-Turkey
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9
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Association between inflammation and left ventricular thrombus formation following ST-elevation myocardial infarction. Int J Cardiol 2022; 361:1-6. [DOI: 10.1016/j.ijcard.2022.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/10/2022] [Accepted: 05/04/2022] [Indexed: 12/11/2022]
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10
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Camaj A, Fuster V, Giustino G, Bienstock SW, Sternheim D, Mehran R, Dangas GD, Kini A, Sharma SK, Halperin J, Dweck MR, Goldman ME. Left Ventricular Thrombus Following Acute Myocardial Infarction: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 79:1010-1022. [PMID: 35272796 DOI: 10.1016/j.jacc.2022.01.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/13/2022] [Accepted: 01/13/2022] [Indexed: 12/11/2022]
Abstract
The incidence of left ventricular (LV) thrombus following acute myocardial infarction has markedly declined in recent decades caused by advancements in reperfusion and antithrombotic therapies. Despite this, embolic events remain the most feared complication of LV thrombus necessitating systemic anticoagulation. Mechanistically, LV thrombus development depends on Virchow's triad (ie, endothelial injury from myocardial infarction, blood stasis from LV dysfunction, and hypercoagulability triggered by inflammation, with each of these elements representing potential therapeutic targets). Diagnostic modalities include transthoracic echocardiography with or without ultrasound-enhancing agents and cardiac magnetic resonance. Most LV thrombi develop within the first 2 weeks post-acute myocardial infarction, and the role of surveillance imaging appears limited. Vitamin K antagonists remain the mainstay of therapy because the efficacy of direct oral anticoagulants is less well established. Only meager data support the routine use of prophylactic anticoagulation, even in high-risk patients.
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Affiliation(s)
- Anton Camaj
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA. https://twitter.com/acamajmd
| | - Valentin Fuster
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA. https://twitter.com/g_giustinomd
| | - Solomon W Bienstock
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA. https://twitter.com/swbienmd
| | - David Sternheim
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA. https://twitter.com/drroxmehran
| | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA. https://twitter.com/georgedangas
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA. https://twitter.com/doctorkini
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jonathan Halperin
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Martin E Goldman
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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11
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Seo WW, Park MS, Kim SE, Lee JH, Park DG, Han KR, Oh DJ, Hyon MS. Neutrophil-Lymphocyte Ratio as a Predictor of Venous Thromboembolism after Total Knee Replacement. J Knee Surg 2021; 34:171-177. [PMID: 31394586 DOI: 10.1055/s-0039-1694043] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Venous thromboembolism (VTE) is a potentially serious complication after total knee replacement (TKR), and recent guideline recommends thromboprophylaxis for VTE after TKR. The neutrophil-lymphocyte ratio (NLR) has emerged as a simple and new prognostic biomarker for several cardiovascular diseases. This study was performed to investigate the precise incidence of postoperative VTE and the role of NLR for predicting VTE in patients receiving thromboprophylaxis after TKR. We retrospectively enrolled 264 patients undergoing TKR who underwent routine screening enhanced pulmonary artery and lower extremity venography computed tomography (CT) scan within 7 postoperative days. Biochemical tests were performed within 2 weeks prior to surgery, and the NLR was defined as the absolute neutrophil count in peripheral blood divided by lymphocyte count. All patients received thromboprophylaxis with enoxaparin postoperatively. Of 264 patients, 102 (38.6%) were diagnosed with deep vein thrombosis (DVT) or pulmonary embolism on CT scan. Preoperative NLR was significantly higher in patients with postoperative VTE compared with that in patients without VTE (2.57 ± 1.59 vs. 2.11 ± 1.10, p = 0.011). Receiver operating characteristic curve analysis showed that a preoperative NLR of 1.90 was the best cutoff value for the prediction of postoperative VTE (sensitivity 57.8%, specificity 55.6%, and area under curve 0.589). In the multivariate analysis, a preoperative NLR ≥1.90 was a sole independent predictor of postoperative VTE (odds ratio: 1.95, 95% computed tomography: 1.16-3.31, p = 0.013). The present study shows a higher incidence of VTE (38.6%) after TKR in patients receiving thromboprophylaxis than that reported in previous studies. Furthermore, preoperative NLR was significantly higher in patients with postoperative VTE, and a high preoperative NLR (≥1.90) was an independent predictor of VTE after TKR. NLR measurement may be a simple and useful method for the prediction of VTE in patients undergoing TKR.
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Affiliation(s)
- Won-Woo Seo
- Division of Cardiology, Kangdong Sacred Heart Hospital, Seoul, South Korea.,Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea.,Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, South Korea
| | - Myung-Soo Park
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea.,Division of Cardiology, Dongtan Sacred Heart Hospital, Dongtan, South Korea
| | - Sung Eun Kim
- Division of Cardiology, Kangdong Sacred Heart Hospital, Seoul, South Korea.,Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea
| | - Jun-Hee Lee
- Division of Cardiology, Kangdong Sacred Heart Hospital, Seoul, South Korea.,Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea
| | - Dae-Gyun Park
- Division of Cardiology, Kangdong Sacred Heart Hospital, Seoul, South Korea.,Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea
| | - Kyoo-Rok Han
- Division of Cardiology, Kangdong Sacred Heart Hospital, Seoul, South Korea.,Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea
| | - Dong-Jin Oh
- Division of Cardiology, Kangdong Sacred Heart Hospital, Seoul, South Korea.,Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea
| | - Min-Su Hyon
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, South Korea.,Division of Cardiology, Soonchunhyang University Hospital, Seoul, South Korea
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12
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Koseoglu C, Kurmus O. Association between Mean Platelet Volume-to-Lymphocyte Ratio and the Presence of Apical Mural Thrombus in Post-Myocardial Infarction Patients. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2020. [DOI: 10.36660/ijcs.20190140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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13
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Massussi M, Scotti A, Lip GYH, Proietti R. Left ventricular thrombosis: new perspectives on an old problem. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 7:158-167. [PMID: 32569361 DOI: 10.1093/ehjcvp/pvaa066] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/07/2020] [Accepted: 06/12/2020] [Indexed: 12/14/2022]
Abstract
Left ventricular thrombosis (LVT) is a major risk factor for systemic thromboembolism and might complicate both the acute and the chronic phase of ischaemic heart disease after myocardial infarction and, less frequently, non-ischaemic cardiomyopathies. The pathophysiology of thrombus formation is complex and involves the three aspects of Virchow's triad: blood stasis, prothrombotic state, and tissue injury. Advances in technology have improved the detection rate of intracardiac thrombi, but several uncertainties still remain regarding the optimal treatment strategy within daily clinical practice. Of note, anticoagulation therapy with heparin and vitamin K antagonists decreases the risk of embolic stroke though exposing patients to an undeniable risk of bleeding complications. Although limited data on the off-label use of direct oral anticoagulants have reported safety and efficacy for LVT resolution, yet more evidence is needed to justify their use in clinical practice.
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Affiliation(s)
- Mauro Massussi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Via Giustiniani 2, 35128 Padua, Italy
| | - Andrea Scotti
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Via Giustiniani 2, 35128 Padua, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Chest and Heart Hospital, William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX, UK
| | - Riccardo Proietti
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Via Giustiniani 2, 35128 Padua, Italy
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14
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Sia CH, Leow AST, Tan BYQ, Low CJ, Kaur R, Yeo TC, Chan MYY, Tay ELW, Yeo LLL, Yap ES, Loh JPY. The neutrophil-lymphocyte ratio and platelet-lymphocyte ratio predict left ventricular thrombus resolution in acute myocardial infarction without percutaneous coronary intervention. Thromb Res 2020; 194:16-20. [PMID: 32559523 DOI: 10.1016/j.thromres.2020.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/18/2020] [Accepted: 06/01/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Left ventricular thrombosis (LVT) is a potentially devastating complication in post-acute myocardial infarction (AMI) patients. Previous studies have demonstrated that inflammation may contribute to thrombus formation, but its role on thrombus resolution is uncertain. The neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are easily accessible haematological markers of inflammation. OBJECTIVES We aimed to identify differences between post-AMI LVT patients with and without LVT resolution, and to evaluate the utility of NLR and PLR in predicting LVT resolution. METHODS We included 289 consecutive post-AMI patients with LVT. Acute LVT was diagnosed based on echocardiogram. Patients were stratified based on LVT resolution. Logistic regression was performed to evaluate for independent predictors of thrombus resolution. RESULTS Compared to post-AMI patients with eventual LVT resolution, those with unresolved LVT had more co-morbidities such as hypertension (p = 0.003) and ischaemic heart disease (p < 0.001), fewer underwent percutaneous coronary intervention (PCI) (p < 0.001) or were treated with triple therapy (p < 0.001). NLR (p = 0.064) and PLR (p = 0.028) were higher in unresolved LVT patients. In non-PCI patients, NLR (OR 0.818, 95% CI 0.674-0.994, p = 0.043) and PLR (OR 0.989, 95% CI 0.979-0.999, p = 0.026) were independent predictors of thrombus resolution after adjustment for age and anticoagulation use. CONCLUSIONS Post-AMI patients not receiving PCI may have a greater inflammatory response and a higher NLR and PLR, which is associated with less LVT resolution despite anticoagulation. Further studies are required to study this association.
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Affiliation(s)
- Ching-Hui Sia
- Department of Cardiology, National University Heart Centre, Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | | | | | | | - Rajinderdeep Kaur
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre, Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark Yan-Yee Chan
- Department of Cardiology, National University Heart Centre, Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Edgar Lik-Wui Tay
- Department of Cardiology, National University Heart Centre, Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Leonard Leong-Litt Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Eng-Soo Yap
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | - Joshua Ping-Yun Loh
- Department of Cardiology, National University Heart Centre, Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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15
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Zhang S, Diao J, Qi C, Jin J, Li L, Gao X, Gong L, Wu W. Predictive value of neutrophil to lymphocyte ratio in patients with acute ST segment elevation myocardial infarction after percutaneous coronary intervention: a meta-analysis. BMC Cardiovasc Disord 2018; 18:75. [PMID: 29716535 PMCID: PMC5930503 DOI: 10.1186/s12872-018-0812-6] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 04/20/2018] [Indexed: 01/11/2023] Open
Abstract
Background The neutrophil to lymphocyte ratio (NLR) is an indicator of systemic inflammation and a prognostic marker in patients with acute coronary syndrome (ACS). This study aims to investigate the value of NLR to predict the in-hospital and long-term prognosis in patients with ST segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI) by meta-analysis. Method The studies related to the prognosis of NLR and STEMI patients published in the Pubmed, Embase, and Ovid databases before June 2017 were retrieved. The relevant data were extracted. Review Manager Version 5.3 was used for meta-analysis. Results A total of 14 studies of 10,245 patients with STEMI after PCI were included. A significant difference was observed for mortality (P < 0.001; relative risk (RR) 3.32; 95% confidence interval (CI) 2.45–4.49), hospital cardiac mortality(P < 0.001; RR 3.22; 95% CI 2.25–4.60), all mortality (P < 0.001; RR 3.23; 95% CI 2.28–4.57), major adverse cardiovascular events (MACE) (P < 0.001; RR 2.00; 95% CI 1.62–2.46), in-stent thrombosis (P < 0.001; RR 2.72 95% CI 1.66–4.44), nonfatal myocardial infarction(MI) (P < 0.001; RR 1.93; 95%CI 1.43–2.61), angina (P = 0.007; RR 1.67; 95%CI 1.15–2.41), advanced heart failure (AHF) (P < 0.001; RR 1.81; 95% CI 1.48–2.21), arrhythmia (P = 0.002; RR 1.38; 95% CI 1.13–1.69), no reflow (P < 0.001; RR 2.28; 95% CI 1.46–3.57), long-term all mortality (P < 0.001; RR 3.82; 95% CI 2.94–4.96), cardiac mortality (P = 0.004; RR 3.02; 95% CI 1.41–6.45), MACE (P < 0.001; RR 2.49; 95% CI 1.47–4.23), and nonfatal MI (P = 0.46; RR 1.32; 95% CI 0.63–2.75). Conclusions Meta-analysis shows that NLR is a predictor of hospitalization and long-term prognosis in patients with STEMI after PCI, but requires further confirmation by large randomized clinical trials. Electronic supplementary material The online version of this article (10.1186/s12872-018-0812-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sai Zhang
- Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jun Diao
- Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Chunmei Qi
- Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jingjing Jin
- Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Li Li
- Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xingjuan Gao
- Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Lei Gong
- Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Weiheng Wu
- Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China. .,The Second Affiliated Hospital of Xuzhou Medical University, 32th Meijian Road, 221000, Xuzhou, Jiangsu, People's Republic of China.
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16
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Chen C, Cong BL, Wang M, Abdullah M, Wang XL, Zhang YH, Xu SJ, Cui L. Neutrophil to lymphocyte ratio as a predictor of myocardial damage and cardiac dysfunction in acute coronary syndrome patients. Integr Med Res 2018; 7:192-199. [PMID: 29984180 PMCID: PMC6026362 DOI: 10.1016/j.imr.2018.02.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 02/26/2018] [Accepted: 02/28/2018] [Indexed: 12/22/2022] Open
Abstract
Background Neutrophil to lymphocyte ratio (NLR) in peripheral blood is established to correlate with the morbidity and mortality of heart disease patients. We aimed to define the severity of inflammation (NLR) by observing the association of NLR with cardiac functions or myocardial damage parameters in patients with acute myocardial infarction. Methods Data from 715 patients who underwent percutaneous coronary intervention (PCI) within 72 hours of incidence in 2016 were analysed retrospectively. Results The NLR ranges from 0.50 to 46 (medium ± SD, 2.76 ± 2.96) in 715 patients. NLR positively correlated with myocardial damage (NLR vs. CK-mB: p < 0.0001) but negatively correlated with myocardial function (NLR vs. EF: p < 0.0001; NLR vs. FS: p < 0.0001). Myocardial damage markers (CK, CK-mB, ASL, LDH) were significantly increased, and cardiac contractile parameters (EF and FS) were reduced at NLR > 2.76 compared to those of NLR < 2.76. ELISA analysis has shown that IL-10 was significantly increased when NLR ≥ 4.6 and TGF-β was increased at NLR > 4. The correlation was diminished between NLR and CK-mB at NLR > 2.76 or at NLR > 4, but that of NLR and EF or FS was maintained in NLR > 2.76 and at NLR > 4. EF and FS were comparable between NLR > 2.76 and NLR > 4. But myocardial damage parameters increased significantly at NLR > 4 compared to those of NLR > 2.76. Conclusion NLR is a strong predictor of myocardial damage in acute myocardial patients. High NLR are associated with myocardial dysfunction in all the patients. Severe inflammation (NLR) can predict the consequence of the heart in patients with coronary syndrome.
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Affiliation(s)
- Chen Chen
- Department of Cardiology, Yanbian University Hospital, Yanji, China
| | - Bai Lin Cong
- Department of Cardiology, Yanbian University Hospital, Yanji, China
| | - Min Wang
- Department of Cardiology, Yanbian University Hospital, Yanji, China
| | | | - Xiao Long Wang
- Department of Cardiology, Yanbian University Hospital, Yanji, China
| | - Yin Hua Zhang
- Department of Cardiology, Yanbian University Hospital, Yanji, China
| | - Shun Ji Xu
- Department of Cardiology, Yanbian University Hospital, Yanji, China
| | - Lan Cui
- Department of Cardiology, Yanbian University Hospital, Yanji, China
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17
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叶 涛, 杨 银, 王 凯, 王 梅, 孙 嘉, 杜 越, 陈 新. [Neutrophil to lymphocyte ratio as a predictor for type 2 diabetes mellitus in patients with chronic obstructive pulmonary disease: a cohort study of 404 cases]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:1308-1314. [PMID: 29070459 PMCID: PMC6743952 DOI: 10.3969/j.issn.1673-4254.2017.10.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To assess the value of neutrophil?to?lymphocyte ratio (NLR) for predicting type 2 diabetes mellitus (T2DM) in patients with chronic obstructive pulmonary disease (COPD). METHODS A cohort of 404 non?diabetic patients diagnosed with stable COPD between January, 2010 and December, 2012 at Zhujiang Hospital were enrolled and followed up for 3 years, during which fast blood glucose (FBG) was monitored every 6 months. The primary endpoint was the occurrence of T2DM, and the cumulative incidence of T2DM in this cohort was calculated. The patients who developed T2DM and those without T2DM at the end of the follow?up were compared for clinical parameters to identify the potential predictors for T2DM in patients with stable COPD. RESULTS After follow?up for a mean of 2.1 years, 41 (10.1%) patients with COPD developed T2DM, who showed significantly higher baseline NLR levels than those without T2DM (P<0.001). The receiver?operating characteristic (ROC) analysis revealed that the optimum cut?off value for NLR was 5.626. Spearman rank correlation analysis suggested that the incidence of T2DM in the patients was positively correlated with the number of hospital admissions for acute exacerbation of COPD in the past year (r=0.136, P=0.006), hypertension (r=0.151, P=0.002) and NLR (r=0.340, P<0.001). Logistic regression analysis identified triglyceride (TG) (P=0.047) and NLR (P<0.001) as the independent risk factors for T2DM in patients with COPD. CONCLUSION The occurrence of T2DM in COPD patients is closely related to NLR level, which may serve as an early predictor for T2DM in these patients.
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Affiliation(s)
- 涛 叶
- 南方医科大学珠江医院呼吸内科, 广东 广州 510282Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - 银 杨
- 南方医科大学珠江医院呼吸内科, 广东 广州 510282Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - 凯 王
- 南方医科大学珠江医院呼吸内科, 广东 广州 510282Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - 梅 王
- 南方医科大学珠江医院呼吸内科, 广东 广州 510282Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - 嘉 孙
- 南方医科大学珠江医院内分泌科, 广东 广州 510282Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - 越 杜
- 南方医科大学公共卫生学院生物统计学系, 广东 广州 510515Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou 510515, China
| | - 新 陈
- 南方医科大学珠江医院呼吸内科, 广东 广州 510282Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
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