Neutrophil to lymphocyte ratio as a predictor of myocardial damage and cardiac dysfunction in acute coronary syndrome patients

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.

Keywords: Acute myocardial infarction; Dysfunction; Lymphocyte; Myocardial damage; Neutrophil.

Fig. 1

Correlation of neutrophil-to-lymphocyte ratio (NLR) with CK-mB (A), EF (B) and FS (C). Pearson rank correlation was used to evaluate the relation between NLR and other parameters.

Fig. 2

Plasma level of IL-10 and TGF-β in ACS patients at two levels of NLR. (A) IL-10 was significantly increased when NLR > 4.6 (p = 0.05). (B) TGF-b was significantly increased when NLR was >4 (p = 0.05).

Fig. 3

Comparison of CK-mB, EF and FS in NLR > 2.76 and NLR > 4 to all patients's data. (A) CK-mB in all patients, NLR > 2.76 and NLR > 4. CK-mB was significantly increased in NLR > 2.76 and in NLR > 4 groups compare to all patients group (p < 0.001, p < 0.001, n = 193, n = 112 and n = 715, respectively). CK-mB was greater in NLR > 4 compare to that in NLR > 2.76 (p < 0.003). (B) EF was significantly lower in NLR > 2.76 and NLR > 4 compare to all patients group (p < 0.001 and p = 0.02). EF was not different between NLR > 2.76 and NLR > 4 (p = 0.6). (C) FS was not different among groups (p = 0.4, p = 0.5 and p = 0.2, respectively).