Yeni Başlangıçlı Atriyal Fibrilasyon İçin Eozinofil/Lenfosit ve Eozinofil/Monosit Oranının Öngördürücü Değeri

Abstract

Amaç: Hematolojik indeksler, yeni başlangıçlı atriyal fibrilasyonun (YBAF) patogenezinde inflamasyonun önemli rolü nedeniyle sıklıkla araştırılan bir alandır. Çalışmamız ST segment elevasyonlu miyokard enfarktüsü (STEMI) hastalarında eozinofil-lenfosit oranı (ELR) ve eozinofil-monosit oranı (EMR) ile YBAF gelişiminin ilişkisini araştırmayı amaçlamıştır. Gereç ve Yöntem: Bu retrospektif çalışmada, 344 STEMI hastası değerlendirildi ve YBAF gelişimine göre iki gruba ayrıldı (YBAF+: n=36, YBAF-: n=308). Hematolojik parametrelerin ve indekslerin ayırıcı gücü ve bağımsızlığı ROC analizi, lojistik regresyon ve temel bileşen analizi (TBA) kullanılarak değerlendirildi. Bulgular: YBAF’lı hastalarda eozinofil sayıları ve EMR değerleri kontrol grubuna kıyasla anlamlı derecede düşük, ancak monosit sayıları daha yüksekti (tümü p<0,05). EMR ≤0,18, YBAF’ı %80 duyarlılık ve %64 özgüllükle öngördü (AUC: 0.682). Lojistik regresyon analizi, EMR’yi (OR=0,011, p=0,001) ve monosit sayısını (OR=27,67, p=0,012) YBAF’ın bağımsız öngörücüleri olarak ortaya koydu. TBA analizi, EMR ve monosit sayısını YBAF+ ve YBAFgruplarını ayıran ana değişkenler olarak doğruladı. ELR, YBAF+ grubunda daha düşük olmasına rağmen, çok değişkenli modellerde anlamlı bir fark bulunamadı. Sonuç: EMR ve monosit sayısı, STEMI hastalarında yeni başlangıçlı atriyal fibrilasyonun bağımsız ve güçlü öngörücüleridir. Bu düşük maliyetli ve kolay erişilebilir belirteçlerin rutin klinik değerlendirmelere entegre edilmesi erken risk sınıflandırmasını iyileştirebilir ve aritmi izleme ve tedavisine rehberlik edebilir.

Keywords

• STEMI
• Atriyal fibrilasyon
• Eozinofil/Monosit Oranı
• Eozinofil/Lenfosit Oranı
• Biyobelirteçler

Predictive Value of Eosinophil/Lymphocyte and Eosinophil/Monocyte Ratio for New-Onset Atrial Fibrillation

Abstract

Objectives: Hematological indices are a frequently investigated area due to the important role of inflammation in the pathogenesis of new-onset atrial fibrillation (NOAF). Our study aimed to investigate the relationship between eosinophil-to-lymphocyte ratio (ELR) and eosinophil-to-monocyte ratio (EMR) and the development of NOAF in patients with ST-segment elevation myocardial infarction (STEMI). Materials and Methods: In this retrospective study, 344 STEMI patients were evaluated and divided into two groups based on the development of NOAF (NOAF+: n=36, NOAF-: n=308). The discriminatory power and independence of hematological parameters and indices were evaluated using ROC analysis, logistic regression, and principal component analysis (PCA). Results: Patients with NOAF had significantly lower eosinophil counts and EMR values compared to the control group, but higher monocyte counts (all p<0.05). EMR ≤0.18 predicted NOAF with 80% sensitivity and 64% specificity (AUC: 0.682). Logistic regression analysis revealed EMR (OR=0.011, p=0.001) and monocyte count (OR=27.67, p=0.012) as independent predictors of NOAF. PCA analysis confirmed EMR and monocyte count as the main variables distinguishing the NOAF+ and NOAF− groups. Although ELR was lower in the NOAF+ group, no significant differences were found in the multivariate models. Conclusion: EMR and monocyte count are independent and strong predictors of NOAF in STEMI patients. Integrating these low-cost and easily accessible markers into routine clinical assessments can improve early risk stratification and guide arrhythmia monitoring and treatment.

Keywords

• STEMI
• Atrial Fibrillation
• Eosinophil/Monocyte Ratio
• Eosinophil/Lymphocyte Ratio
• Biomarkers

References

1. Salari N, Morddarvanjoghi F, Abdolmaleki A, et al. The global prevalence of myocardial infarction: a systematic review and meta-analysis. BMC Cardiovasc Disord. 2023;23:206.
2. Jabre P, Roger VL, Murad MH, et al. Mortality associated with atrial fibrillation in patients with myocardial infarction: a systematic review and meta-analysis. Circulation. 2011;123:1587-93.
3. Obayashi Y, Shiomi H, Morimoto T, et al. Newly Diagnosed Atrial Fibrillation in Acute Myocardial Infarction. J Am Heart Assoc. 2021;10:e021417.
4. Vermond RA, Van Gelder IC, Crijns HJ, et al. Does myocardial infarction beget atrial fibrillation and atrial fibrillation beget myocardial infarction? Circulation. 2015;131:1824-6
5. Özgen H, Tepetam FM, Bulut İ, et al. The significance of eosinophil and eosinophil lymphocyte ratio (ELR) in predicting response to omalizumab treatment in patients with severe allergic asthma. Tuberk Toraks. 2021;69:39-48.
6. Chen X, Huang W, Zhao L, et al. Relationship Between the Eosinophil/Monocyte Ratio and Prognosis in Decompensated Heart Failure: A Retrospective Study. J Inflamm Res. 2021;14:4687-4696.
7. Wang Q, Huai W, Ye X, et al. Circulating plasma galectin-3 predicts new-onset atrial fibrillation in patients after acute myocardial infarction during hospitalization. BMC Cardiovasc Disord. 2022;22(1):392.
8. Jaakkola S, Paana T, Airaksinen J, et al. Association of CHA2DS2-VASc Score with Long-Term Incidence of New-Onset Atrial Fibrillation and Ischemic Stroke after Myocardial Infarction. J Clin Med. 2022;11:7090.

9. Staerk L, Sherer JA, Ko D, et al. Atrial Fibrillation: Epidemiology, Pathophysiology, and Clinical Outcomes. Circ Res. 2017;120:1501-1517.
10. Dzeshka MS, Lip GY, Snezhitskiy V, et al. Cardiac Fibrosis in Patients With Atrial Fibrillation: Mechanisms and Clinical Implications. J Am Coll Cardiol. 2015;66(8):943-59.
11. Lin K, Luo M, Gu X, et al. Changes in Blood Eosinophil Counts Predict the Death of Patients With Myocardial Infarction After Hospital Discharge. J Am Heart Assoc. 2025;14:e035383.
12. Tosu AR, Kalyoncuoğlu M, Biter Hİ, et al. Association of eosinophil-to-lymphocyte ratio with coronary slow-flow phenomenon in patients undergoing coronary angiography. Arch Med Sci Atheroscler Dis. 2022;7:e29-e35.
13. Branicka O, Rogala B, Glück J. Eosinophil/Neutrophil/Platelet-to-Lymphocyte Ratios in Various Types of Immediate Hypersensitivity to NSAIDs: A Preliminary Study. Int Arch Allergy Immunol. 2020;181:774-782.
14. Yilmaz M, Kayançiçek H, Korkmaz H, et al. A new inflammatory marker: elevated eosinophil-tolymphocyte ratio associated with presence and severity of isolated coronary artery ectasia. Cardiovasc J Afr. 2020;31(5):227-235.
15. Firani NK, Hartanti KD, Purnamasari P. Hematological Parameter as Predictor Mortality in Acute Myocardial Infarction Patients. Int J Gen Med. 2022;15:6757-6763.
16. Deng X, Wang X, Shen L, et al. Association of eosinophil-to-monocyte ratio with 1-month and long-term all-cause mortality in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. J Thorac Dis. 2018;10:5449-5458.
17. Serhatlioglu F, Yilmaz Y, Baran O, et al. Inflammatory Markers and Postoperative New-Onset Atrial Fibrillation: Prognostic Predictions of Neutrophil Percent to Albumin Ratio in Patients with CABG. Diagnostics (Basel). 2025;15:741.
18. Külahçıoğlu Ş,Tokgöz HC, et al. Eosinophil-to-monocyte ratio as a candidate for a novel prognostic marker in acute pulmonary embolism: Is it a consumptive mechanism? Anatol J Cardiol. 2022;26:717-724.
19. Merdler I, Chitturi KR, Chaturvedi A, et al. Coronary microvascular dysfunction and inflammation: Insights from the Coronary Microvascular Disease Registry. Cardiovasc Revasc Med. 2024;69:30-34.
20. Di J, Song L, Liu Y, et al. Eosinophil-to-Lymphocyte Ratio and Eosinophil Count as New Predictive Markers for Osteoarthritis. J Pain Res 2024;17:3803-3815.