The impact of platelet indices on clinical outcome in heart failure: results from the MyoVasc study

Abstract

Aims: Platelet indices have been associated with traditional cardiovascular risk factors, cardiovascular diseases and all-cause mortality. This study aimed to investigate the role of platelet count, mean platelet volume (MPV) and platelet-to-leukocyte ratio, including platelet-to-monocyte and platelet-to-lymphocyte ratio with cardiac function, heart failure (HF) phenotypes and clinical outcome, worsening of HF.

Methods and results: Univariate and multivariable linear and Cox regression analyses were used to investigate the associations between platelet indices, cardiac function and worsening of HF in 3250 subjects enrolled in the MyoVasc study. Higher MPV, lower platelet count, lower platelet-to-leukocyte and platelet-to-monocyte ratios have been associated with reduced left ventricular ejection fraction (beta estimate [β]_{MPV [fL]} = -0.05 [-0.09; -0.02], β_{platelet count (× 10/L)}⁹ = 3.4 [1.2; 5.6], β_{platelet-to-leukocyte ratio} = 1.4 [1.1; 1.8], β_{platelet-to-monocyte ratio} = 28 [20; 36]) and increased E/E' ratio (β _{MPV [fL]} = 0.04 [0.003; 0.07], β_{platelet count (× 10/L)}⁹ = -3.1 [-5.3; -0.92], β_{platelet-to-leukocyte ratio} = -0.83 [-1.2; -0.46], β_{platelet-to-monocyte ratio} = -20 [-28; -12]), independent of age and sex. Cox regression demonstrated an increased risk for worsening of HF in subjects with MPV > 75th percentile (hazard ratio [HR] = 1.47 [1.16; 1.87]), platelet count < 25th percentile (HR = 1.36 [1.07; 1.74]), platelet-to-leukocyte < 25th percentile (HR = 1.53 [1.20; 1.95]), platelet-to-monocyte < 25th percentile (HR = 1.38 [1.08; 1.77]) and platelet-to-lymphocyte > 75th percentile (HR = 1.50 [1.17; 1.93]) ratios, independent of potential confounders. MPV > 75th percentile and platelet count < 25th percentile were strongly related to outcome in HFpEF vs. HFrEF (P for difference = 0.040). Platelet-to-leukocyte ratios were associated with worse outcome in both HF phenotypes, without a significant difference between HFpEF and HFrEF.

Conclusions: Platelet indices are linked with worse cardiac function and adverse clinical outcome, independent of subjects' underlying cardiovascular profile. This study emphasizes their important value to provide additional information on pathophysiology and risk stratification in HF syndrome.

Keywords: Heart failure; Mean platelet volume; Platelet count; HFrEF; HFpEF; Worsening of heart failure.

Figure 1

Presented are cumulative incidence plots for worsening of HF in the study sample (n = 3220) with a median follow‐up time of 2.24 years (interquartile range: 1.18–3.97 years) according to quartiles of MPV (A), platelet count (B), platelet‐to‐leukocyte ratio (C), platelet‐to‐monocyte ratio (D) and platelet‐to‐lymphocyte ratio (E).

Figure 2

Forest plot presenting the association of MPV > 75th percentile, platelet count < 25th percentile, platelet‐to‐leukocyte ratio < 25th percentile, platelet‐to‐monocyte ratio < 25th percentile and platelet‐to‐lymphocyte ratio > 75th percentile and worsening of HF with hazard ratios (HRs) with 95% confidence interval (CI), adjusted for age and sex and additionally adjusted for CVRFs and cancer in n = 3188 individuals (298 events); Cardiovascular risk factors (CVRFs) are arterial hypertension, diabetes mellitus, smoking, obesity, dyslipidaemia, family history of myocardial infarction/stroke, myocardial infarction, stroke, coronary artery disease, atrial fibrillation, peripheral artery disease and venous thromboembolism; MPV, mean platelet volume.