Assessment of neutrophil / lymphocyte ratio in patients with myocardial bridge

Year 2014, , 24 - 28, 01.03.2014

Abdulkadir Yıldız Mehmet Ata Akil Fetullah Kayan Murat Yuksel Mustafa Oylumlu Mehmet Zihni Bilik Nihat Polat Mesut Aydin Halit Acet Sait Alan

https://doi.org/10.5799/ahinjs.01.2014.01.0353

Abstract

Objective: Myocardial bridge (MB) is a congenital anomaly characterized by systolic narrowing of the epicardial coronary arterial segment while traveling in the myocardium. It is a benign entity but previous studies showed that the proximal portion is prone to an enhanced atherosclerosis. Neutrophil/lymphocyte ratio (NLR) is a sensitive marker of systemic inflammation used as a predictor for adverse cardiovascular outcomes in atherosclerotic heart disease. So in this study, we sought to evaluate the association between NLR and myocardial bridging. Methods: A total of 172 patients (mean age: 50.8 &plusmn; 11.5 years, 77.3% men) with either angiographically proven MB or normal coronary arteries were included in the study. For the entire study population, hematologic parameters were measured using an automatic blood counter. Results: The study population consisted of 71 patients with MB (mean age: 51.4 &plusmn; 11.9 years, 80.3% male) and 101 patients with normal coronary arteries (mean age: 50.5 &plusmn; 11.3 years, 75.2% male). There were no significant differences between groups regarding hemoglobin level, platelet count, glucose and creatinine. Compared to the control group, NLR was significantly higher in patients with MB (2.45 &plusmn; 1.19 vs. 1.72 &plusmn; 0.48; p< 0.001). In ROC analysis, NLR > 1.82 predicted myocardial bridge presence with 70% sensitivity and 71% specificity (ROC area under curve: 0.733, 95% CI: 0.654-0.811, p < 0.001). Conclusion: Our study findings demonstrated that MB is associated with elevated NLR, which is used to assess inflammatory status of the body. J Clin Exp Invest 2014; 5 (1): 24-28

Keywords

Inflammation, neutrophil/lymphocyte ratio, and myocardial bridge

Miyokardiyal kas bandı olan hastalarda nötrofil / lenfosit oranının değerlendirilmesi

Abstract

Amaç: Miyokardiyal kas bandı miyokart içinde seyreden epikardiyal koroner arterlerin sistolde daralması ile seyreden konjenital bir anomalidir. İyi huylu olmasına rağmen önceki çalışmalarda proksimal kesimlerin artmış ateroskleroza eğilimli olduğu gösterilmiştir. Nötrofil/lenfosit oranı (NLO) aterosklerotik kalp hastalıklarında kötü prognozu öngören sistemik enflamasyonun duyarlı bir belirtecidir. Biz bu çalışmada NLO ile miyokardiyal kas bandı arasında bir ilişki var olup olmadığını araştırmayı amaçladık. Metodlar: Anjiyografik olarak tespit edilmiş miyokardiyal kas bandı veya normal koroner arterleri olan 172 hasta (ortalama yaş: 50.8 &plusmn; 11.5 yıl, %77.3 erkek) çalışmaya dahil edildi. Otomatik kan sayacı kullanılarak tüm hastaların hematolojik parametreleri ölçüldü. Bulgular: Çalışma 71 miyokardiyal kas bandı (ortalama yaş: 51,4 &plusmn; 11,9 yıl, %80,3 erkek) ve 101 normal koroner arterleri (ortalama yaş: 50,5 &plusmn; 11,3 yıl, %75.2 erkek) olan hastadan oluşmaktaydı. Hemoglobin, trombosit sayısı, glukoz ve kreatinin açısından gruplar arasında fark saptanmadı. Kontrol grubuna göre miyokardiyal kas bandı grubunda NLO anlamlı olarak daha yüksekti (2,45 &plusmn; 1,19 vs. 1,72 &plusmn; 0,48; p< 0,001). ROC analizinde, NLO > 1,82 miyokardiyal kas bandı varlığını %70 duyarlılık ve %71 özgüllükle öngörmüştür (ROC eğri altında kalan alan: 0.733, 95% güvenlik aralığı: 0.654-0.811, p < 0.001). Sonuç: Çalışmamız miyokardiyal kas bandının vücutta enflamatuar düzeyi gösteren yüksek NLO seviyeleri ile ilişkili olduğunu göstermiştir.

Keywords

İnflamasyon, nötrofil/lenfosit oranı, miyokardiyal kas bandı

References

• Angelini P, Velasco JA, Flamm S. Coronary anomalies: incidence, pathophysiology, and clinical relevance. Circulation 2002;105:2449-2454.
• Faruqui AM, Maloy WC, Felner JM, et al. Symptomatic myocardial bridging of coronary artery. Am J Cardiol 1978;41:1305-1310.
• Irvin RG. The angiographic prevalence of myocardial bridging in man. Chest 1982;81:198-202.
• Li JJ, Shang ZL, Yao M, et al. Angiographic prevalence of myocardial bridging in a defined very large number of Chinese patients with chest pain. Chin Med J (Engl) 2008;121:405-408.
• Cicek D, Kalay N, Muderrisoglu H. Incidence, clinical characteristics, and 4-year follow-up of patients with isolated myocardial bridge: a retrospective, single- center, epidemiologic, coronary arteriographic follow- up study in southern Turkey. Cardiovasc Revascular Med 2011;12:25-28.
• Sun JL, Huang WM, Guo JH, et al. Relationship be- tween myocardial bridging and coronary arteriosclero- sis. Cell Biochem Biophysics 2013;65:485-489.
• Bourassa MG, Butnaru A, Lesperance J, Tardif JC. Symptomatic myocardial bridges: overview of isch- emic mechanisms and current diagnostic and treat- ment strategies. J Am Coll Cardiol 2003;41:351-359.
• Feld H, Guadanino V, Hollander G, et al. Exercise- induced ventricular tachycardia in association with a myocardial bridge. Chest 1991;99:1295-1296.
• Yano K, Yoshino H, Taniuchi M, et al. Myocardial bridg- ing of the left anterior descending coronary artery in acute inferior wall myocardial infarction. Clinical cardi- ology 2001;24:202-208.
• Micic J, Nikolic S, Savic S. Sudden cardiac death caused by complicated atherosclerosis of the anterior intraventricular branch of the left coronary artery with a myocardial muscle bridge. Srpski arhiv za celokup- no lekarstvo 2003;131(3-4):173-175.
• Thej MJ, Kalyani R, Kiran J. Atherosclerosis and myo- cardial bridging: Not a benign combination. An au- topsy case report. Journal of cardiovascular disease research 2012;3:176-178.
• Gibson PH, Cuthbertson BH, Croal BL, et al. Use- fulness of neutrophil/lymphocyte ratio as predictor of new-onset atrial fibrillation after coronary artery by- pass grafting. Am J Cardiol 2010;105:186-191.
• Poludasu S, Cavusoglu E, Khan W, Marmur JD. Neu- trophil to lymphocyte ratio as a predictor of long-term mortality in African Americans undergoing percutane- ous coronary intervention. Clin Cardiol 2009;32:E6- E10.
• Gul M, Uyarel H, Ergelen M, et al. Predictive Value of Neutrophil to Lymphocyte Ratio in Clinical Outcomes of Non-ST Elevation Myocardial Infarction and Unstable Angina Pectoris: A 3-Year Follow-Up. Clin Appl Thromb Hemost 2012. DOI:10.1177/1076029612465669
• Bhat T, Teli S, Rijal J, et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Exp Rev Cardiovascr Ther 2013;11:55-59.
• Loukas M, Von Kriegenbergh K, Gilkes M, et al. Myocardial bridges: A review. Clinical anatomy 2011;24:675-683.
• Ishikawa Y, Akasaka Y, Suzuki K, et al. Anatomic prop- erties of myocardial bridge predisposing to myocardial infarction. Circulation 2009;120:376-383.
• Ishikawa Y, Akasaka Y, Ito K, et al. Significance of anatomical properties of myocardial bridge on ath- erosclerosis evolution in the left anterior descending coronary artery. Atherosclerosis 2006;186:380-389.
• Ge J, Erbel R, Gorge G, et al. High wall shear stress proximal to myocardial bridging and atherosclerosis: intracoronary ultrasound and pressure measure- ments. Br Heart J 1995;73:462-465.
• Ge J, Jeremias A, Rupp A, et al. New signs char- acteristic of myocardial bridging demonstrated by intracoronary ultrasound and Doppler. Eur Heart J 1999;20:1707-1716.
• Caro CG, Fitz-Gerald JM, Schroter RC. Atheroma and arterial wall shear. Observation, correlation and pro- posal of a shear dependent mass transfer mechanism for atherogenesis. Proceedings of the Royal Society of London. Series B, Containing papers of a Biological character. Royal Society1971;177:109-159.
• Ishikawa Y, Ishii T, Asuwa N, Masuda S. Absence of atherosclerosis evolution in the coronary arterial seg- ment covered by myocardial tissue in cholesterol-fed rabbits. Virchows Archiv 1997;430:163-171.
• Scher AM. Absence of atherosclerosis in human in- tramyocardial coronary arteries: a neglected phenom- enon. Atherosclerosis 2000;149:1-3.
• Chatzizisis YS, Giannoglou GD. Myocardial bridges spared from atherosclerosis: overview of the underly- ing mechanisms. Can J Cardiol 2009;25:219-222.
• Kim JW, Seo HS, Na JO, et al. Myocardial bridging is related to endothelial dysfunction but not to plaque as assessed by intracoronary ultrasound. Heart 2008;94:765-769.
• Yildiz A, Kaya H, Ertas F, et al. Association between neutrophil to lymphocyte ratio and pulmonary arterial hypertension. Turk Kardiyol Dern Ars 2013;41:604- 609.
• Acet H, Ertas F, Akil MA, et al. New inflammatory pre- dictors for non-valvular atrial fibrillation: echocardio- graphic epicardial fat thickness and neutrophil to lym- phocyte ratio. Int J Cardiovasc Imaging 2014;30:81- 89.
• Kaya H, Ertas F, Islamoglu Y, et al. Association Be- tween Neutrophil to Lymphocyte Ratio and Severity of Coronary Artery Disease. Clin Appl Thromb Hemost 2014;20:50-54.
• Isik T, Ayhan E, Uyarel H, et al. Association of neu- trophil to lymphocyte ratio with presence of isolated coronary artery ectasia. Turk Kardiyol Dern Ars 2013;41:123-130.
• Erayman A, Sen N. Neutrophil-Lymphocyte Ratio and C-Reactive Protein May Be Correlated in Patients With Coronary Artery Ectasia. Angiology 2014;65:84-85.
• Atmaca Y, Ozdol C, Turhan S, et al. The association of elevated white blood cell count and C-reactive protein with endothelial dysfunction in cardiac syndrome X. Acta Cardiol 2008;63:723-728.
• Demirkol S, Balta S, Unlu M, et al. Neutrophils/Lym- phocytes Ratio in Patients With Cardiac Syndrome X and Its Association With Carotid Intima-Media Thickness. Clin Appl Thromb Hemost 2012. DOI: 10.1177/1076029612467227.
• Turkmen K, Tufan F, Selcuk E, et al. Neutrophil-to- lymphocyte ratio, insulin resistance, and endothelial dysfunction in patients with autosomal dominant poly- cystic kidney disease. Indian journal of nephrology 2013;23:34-40.
• Traub O, Berk BC. Laminar shear stress: mechanisms by which endothelial cells transduce an atheroprotec- tive force. Arterioscl Thromb Vasc Biol 1998;18:677- 685.