Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
권호 표지
DOI QR코드

DOI QR Code

Neutrophil Lymphocyte Ratio as a Predictor of Left Ventricular Apical Thrombus in Patients with Myocardial Infarction

  • Ertem, Ahmet Goktug (Department of Cardiology, Ataturk Training and Research Hospital) ;
  • Ozcelik, Filiz (Department of Cardiology, Ataturk Training and Research Hospital) ;
  • Kasapkara, Haci Ahmet (Department of Cardiology, Yildirim Beyazit University) ;
  • Koseoglu, Cemal (Department of Cardiology, Ataturk Training and Research Hospital) ;
  • Bastug, Serdal (Department of Cardiology, Ataturk Training and Research Hospital) ;
  • Ayhan, Huseyin (Department of Cardiology, Yildirim Beyazit University) ;
  • Sari, Cenk (Department of Cardiology, Ataturk Training and Research Hospital) ;
  • Bayram, Nihal Akar (Department of Cardiology, Yildirim Beyazit University) ;
  • Bilen, Emine (Department of Cardiology, Ataturk Training and Research Hospital) ;
  • Durmaz, Tahir (Department of Cardiology, Yildirim Beyazit University) ;
  • Keles, Telat (Department of Cardiology, Yildirim Beyazit University) ;
  • Bozkurt, Engin (Department of Cardiology, Yildirim Beyazit University)
  • Received : 2016.01.04
  • Accepted : 2016.02.23
  • Published : 2016.11.30
⟨ Previous Next ⟩

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 (${\beta}$: 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.

Keywords

References

  1. Sharma ND, McCullough PA, Philbin EF, et al. Left ventricular thrombus and subsequent thromboembolism in patients with severe systolic dysfunction. Chest 2000;117:314-20. https://doi.org/10.1378/chest.117.2.314
  2. Schneider C, Bahlmann E, Heuser C, et al. Images in cardiovascular medicine. Unusual biventricular thrombus formation in acute myeloid leukemia and factor V Leiden mutation. Circulation 2003;107:e114-6. https://doi.org/10.1161/01.CIR.0000061023.00510.BF
  3. Thomson SP, Gibbons RJ, Smars PA, et al. Incremental value of the leukocyte differential and the rapid creatine kinase-MB isoenzyme for the early diagnosis of myocardial infarction. Ann Intern Med 1995;122:335-41. https://doi.org/10.7326/0003-4819-122-5-199503010-00003
  4. Delewi R, Zijlstra F, Piek JJ. Left ventricular thrombus formation after acute myocardial infarction. Heart 2012;98:1743-9. https://doi.org/10.1136/heartjnl-2012-301962
  5. Johannessen KA, Nordrehaug JE, von der Lippe G. Increased occurrence of left ventricular thrombi during early treatment with timolol in patients with acute myocardial infarction. Circulation 1987;75:151-5. https://doi.org/10.1161/01.CIR.75.1.151
  6. Asinger RW, Mikell FL, Elsperger J, Hodges M. Incidence of leftventricular thrombosis after acute transmural myocardial infarction. Serial evaluation by two-dimensional echocardiography. N Engl J Med 1981;305:297-302. https://doi.org/10.1056/NEJM198108063050601
  7. Visser CA, Kan G, Lie KI, Durrer D. Left ventricular thrombus following acute myocardial infarction: a prospective serial echocardiographic study of 96 patients. Eur Heart J 1983;4:333-7. https://doi.org/10.1093/oxfordjournals.eurheartj.a061470
  8. Han YC, Yang TH, Kim DI, et al. Neutrophil to Lymphocyte ratio predicts long-term clinical outcomes in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Korean Circ J 2013;43:93-9. https://doi.org/10.4070/kcj.2013.43.2.93
  9. Arruda-Olson AM, Reeder GS, Bell MR, Weston SA, Roger VL. Neutrophilia predicts death and heart failure after myocardial infarction: a community-based study. Circ Cardiovasc Qual Outcomes 2009;2:656-62. https://doi.org/10.1161/CIRCOUTCOMES.108.831024
  10. Rudiger A, Burckhardt OA, Harpes P, Muller SA, Follath F. The relative lymphocyte count on hospital admission is a risk factor for longterm mortality in patients with acute heart failure. Am J Emerg Med 2006;24:451-4. https://doi.org/10.1016/j.ajem.2005.10.010
  11. Looney MR, Su X, Van Ziffle JA, Lowell CA, Matthay MA. Neutrophils and their Fc gamma receptors are essential in a mouse model of transfusion-related acute lung injury. J Clin Invest 2006;116:1615-23. https://doi.org/10.1172/JCI27238
  12. Rapaport SI, Rao LV. The tissue factor pathway: how it has become a "prima ballerina". Thromb Haemost 1995;74:7-17.
  13. Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification. Eur J Echocardiogr 2006;7:79-108. https://doi.org/10.1016/j.euje.2005.12.014
  14. Roberts WC, Siegel RJ, McManus BM. Idiopathic dilated cardiomyopathy: analysis of 152 necropsy patients. Am J Cardiol 1987;60:1340-55. https://doi.org/10.1016/0002-9149(87)90618-7
  15. Bakalli A, Georgievska-Ismail L, Kocinaj D, Musliu N, Krasniqi A, Pllana E. Prevalence of left chamber cardiac thrombi in patients with dilated left ventricle at sinus rhythm: the role of transesophageal echocardiography. J Clin Ultrasound 2013;41:38-45.
  16. Papa A, Emdin M, Passino C, Michelassi C, Battaglia D, Cocci F. Predictive value of elevated neutrophil-lymphocyte ratio on cardiac mortality in patients with stable coronary artery disease. Clin Chim Acta 2008;395:27-31. https://doi.org/10.1016/j.cca.2008.04.019
  17. Momiyama Y, Kawaguchi A, Kajiwara I, et al. Prognostic value of plasma high-sensitivity C-reactive protein levels in Japanese patients with stable coronary artery disease: the Japan NCVC-Collaborative Inflammation Cohort (JNIC) Study. Atherosclerosis 2009;207:272-6. https://doi.org/10.1016/j.atherosclerosis.2009.04.015
  18. Dogdu O, Akpek M, Yarlioglues M, et al. Relationship between hematologic parameters and left ventricular systolic dysfunction in stable patients with multi-vessel coronary artery disease. Turk Kardiyol Dern Ars 2012;40:706-13. https://doi.org/10.5543/tkda.2012.82429
  19. Jala VR, Haribabu B. Leukotrienes and atherosclerosis: new roles for old mediators. Trends Immunol 2004;25:315-22. https://doi.org/10.1016/j.it.2004.04.003
  20. Ommen SR, Hodge DO, Rodeheffer RJ, McGregor CG, Thomson SP, Gibbons RJ. Predictive power of the relative lymphocyte concentration in patients with advanced heart failure. Circulation 1998;97:19-22. https://doi.org/10.1161/01.CIR.97.1.19
  21. Horne BD, Anderson JL, John JM, et al. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol 2005;45:1638-43. https://doi.org/10.1016/j.jacc.2005.02.054
  22. Dogan M, Akyel A, Cimen T, et al. Relationship between neutrophilto-lymphocyte ratio and saphenous vein graft disease in patients with coronary bypass. Clin Appl Thromb Hemost 2015;21:25-9. https://doi.org/10.1177/1076029613488935
  23. Tokgoz S, Kayrak M, Akpinar Z, et al. Neutrophil lymphocyte ratio as a predictor of stroke. J Stroke Cerebrovasc Dis 2013;22:1169-74. https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.01.011
  24. Yilmaz M, Tenekecioglu E, Arslan B, et al. White blood cell subtypes and neutrophil-lymphocyte ratio in prediction of coronary thrombus formation in non-ST-segment elevated acute coronary syndrome. Clin Appl Thromb Hemost 2015;21:446-52. https://doi.org/10.1177/1076029613507337
  25. Gazi E, Bayram B, Gazi S, et al. Prognostic Value of the Neutrophil-Lymphocyte Ratio in Patients With ST-Elevated Acute Myocardial Infarction. Clin Appl Thromb Hemost 2015;21:155-9. https://doi.org/10.1177/1076029613492011
  26. Yayla C, Canpolat U, Akyel A, et al. Association Between Platelet to Lymphocyte Ratio and Saphenous Vein Graft Disease. Angiology 2016;67:133-8. https://doi.org/10.1177/0003319715578258

Cited by

  1. Predictive value of neutrophil to lymphocyte ratio in patients with acute ST segment elevation myocardial infarction after percutaneous coronary intervention: a meta-analysis vol.18, pp.None, 2018, https://doi.org/10.1186/s12872-018-0812-6