Association Between Neutrophil to Lymphocyte Ratio and Left Ventricle Global Longitudinal Strain in Acute Myocardial Infarction

Alfa Alfin Nursidiq; Niniek Purwaningtyas; Trisulo Wasyanto

doi:10.22146/aci.40852

Association Between Neutrophil to Lymphocyte Ratio and Left Ventricle Global Longitudinal Strain in Acute Myocardial Infarction

https://doi.org/10.22146/aci.40852

Alfa Alfin Nursidiq^(1*), Niniek Purwaningtyas⁽²⁾, Trisulo Wasyanto⁽³⁾

(1) Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Negeri Sebelas Maret, Surakarta, Central Java.
(2) 1. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Negeri Sebelas Maret, Surakarta,Central Java 2. Dr. Moewardi General Hospital, Surakarta, Central Java
(3) 1. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Negeri Sebelas Maret, Surakarta,Central Java 2. Dr. Moewardi General Hospital, Surakarta, Central Java
(*) Corresponding Author

Abstract

Background: High neutrophil to lymphocyte ratio (NLR) is independently associated with lower EF, in hospital complications, and higher mortality rates in acute myocardial infarction (AMI). Global longitudinal strain (GLS) measurement after AMI demonstrated specific benefit compared with LVEF in evaluation of the extent of post MI left ventricular myocardial injury. The aim of this study was to determine the association between NLR and left ventricular GLS in AMI patients.

Methods: An analytic observational study was conducted on August-December 2017 to patients who admited to Dr. Moewardi General Hospital which diagnosed STEMI or NSTEMI. Blood examination and transthoracic echocardiography were performed. They were divided into two groups according to GLS measurement result, GLS>-13.8% and GLS≤-13.8%. The cut-off value of NLR to predict GLS>-13.8%was determined by ROC curve analysis. Bivariate and multivariate analysis to assess whether high NLR was associated with GLS>-13.8% were performed.

Results: As many as 57 patients were included in this study, 24 patients (mean age 56,21±9,43) in GLS ≤-13.8% group and 33 patients (mean age 56.67±8.24) in GLS >-13.8%. NLR was significantly higher in GLS>-13.8% group 6.06 (5.36-6.86) compare 4.20 (3.49-5.04),in GLS≤-13.8%, p=0.001. The cut-off value of NLR was 4.69. The bivariate analysis showed that NLR>4.69 associated with GLS>-13.8%, OR 2.70 (CI 95% 1.41-5.17, p=0.001). Multivariate analysis shown that higher NLR have more probability to develop GLS>-13.8%, OR 8.53 (CI 95% 2.38-30.60, p<0.001).

Conclusion: There is an association between NLR and left ventricular GLS in AMI patients. AMI patients with high NLR are more likely to have worse GLS.

Keywords

neutrophil to lymphocyte ratio; global longitudinal strain; acute myocardial infarction.

Full Text:

PDF

References

Reed G.W., Rossi J.E., Cannon CP. 2016. Acute myocardial infarction. Lancet, 389(10065):197–210.

Anderson J.L., Morrow D.A. 2017. Acute myocardial infarction. N Engl J Med, 376(21):2053–64.

Prabhu S.D., Frangogiannis N.G. 2016. The biological basis for cardiac repair after from inflammation to fibrosis. Circ Res, 119(1):91–112.

Fang L., Moore X., Dart A.M., Wang L. 2015. Systemic inflammatory response following acute myocardial infarction. J Geriatr Cardiol, 12(3):305−312.

Núñez J., Núñez E., Bodí V., SanchisJ., Miñana G., Mainar L., et al. 2008. Usefulness of the neutrophil tolymphocyte ratio in predicting longterm mortality in st segment elevation myocardial infarction. Am J Cardiol, 101(6):747–752.

Arbel Y., Shacham Y., Ziv-baran T., Perl M.L., Finkelstein A., Halkin A., et al. 2014. Higher Neutrophil/Lymphocyte Ratio is related to lower ejection fraction and higher long term all-cause mortality in STEMI patients undergoing primary PCI. Can J Cardiol, 30(10):1177–1182.

Diao K., Yang Z., Ma M., He Y., Zhao Q., Liu X., et al. 2017. The diagnostic value of Global Longitudinal Strain (GLS) on myocardial infarction size by echocardiography : A systematic review and meta-analysis. Sci Rep, 7:1–8.

Moller J.E., Hillis G.S., Oh J.K.,Reeder G.S., Gersh B.J., Pellikka P.A., et al. 2006. Wall motion score indexand ejection fraction for risk stratification after acute myocardial infarction. Am Hear J, 151(2):419–425.

Joyce E., Hoogslag G.E., Leong D.P., Debonnaire P., Katsanos S., Boden H., et al. 2013. Association between left ventricular global longitudinal strain and adverse left ventricular dilatation after ST-Segment elevation myocardial infarction. Circ Cardiovasc Imaging, 7(1):74–81.

Hoit B.D. 2011. Strain and strain rate echocardiography and coronary artery disease. Circ Cardiovasc Imaging, 4(2):179–190.

Ismail A.M., Samy W., Aly R., Fawzy S., Hussein K. 2015. Longitudinal strain in patients with STEMI using speckle tracking echocardiography. Correlation with peak infarction mass and ejection fraction. Egypt J Crit Care Med, 3:45–53.

Eek C., Grenne B., Brunvand H., Aakhus S. 2010. Strain echocardiography and wall motion score index predicts final infarct size in patients with non ST Segment elevation myocardial infarction. Circ Cardiovasc Imaging, 3(2):187–194.

Miller T.D., Christian T.F., Hopfenspirger M.R., Hodge D.O., Gersh B.J., Gibbons R.J. 1995. Infarct size after acute myocardial infarction measured by quantitative tomographic 99mTc sestamibi imaging predicts subsequent mortality. Circulation, 92(3):334–341.

Kalkan M.E., Taş M.H., Açar G., Demir S., Alizade E., Avcı A., et al. 2014. Association of neutrophil-to-lymphocyte ratio with myocardial infarct size and clinical outcomes after successful primary percutaneous coronary intervention for anterior STEMI. Am J Cardiol, 113(7):S4–5.

Zuin M., Rigatelli G., Picariello C., Marcantoni L., Pastore G., Carraro M., et al. 2017. Cardiovascular revascularization medicine original article correlation and prognostic role of neutrophil to lymphocyte ratio and SYNTAX score in patients with acute myocardial infarction treated with percutaneous coronary intervention : A six-year experie. Cardiovasc Revasc Med,18(8):565–571.

Horne B.D., Anderson J.L., John J.M., Weaver A., Bair T.L., Jensen K.R., et al. 2005. Which white blood cell subtypes predict increased cardiovascular risk ? J Am Coll Cardiol, 45(10):1638–1643.

Bhat T., Bhat H., Raza M., Khoueiry G., Meghani M., Akhtar M. 2013. Neutrophil to lymphocyte ratio and cardiovascular diseases : a review. Expert Rev Cardiovasc Ther, 11(1):55–59.

Hartopo A.B., Puspitawati I., Setianto B.Y. 2015. On-admission high neutrophil to lymphocyte ratio as predictor of in-hospital adverse cardiac event in ST-elevation myocardial infarction. Acta Med Indones, 47(1):3– 10.

Blum A., Sclarovsky S., Rehavia E., Shohat B. 1994. Levels of Tlymphocyte subpopulations, and soluble interleukin-2 receptor in acute myocardial infarction. Am Hear J. 127(5):1226–1230.

DOI: https://doi.org/10.22146/aci.40852