Impact of Cardiac Resynchronization Therapy on Indirect Inflammatory Markers

Yıl 2020, Cilt: 1 Sayı: 1, 28 - 33, 22.09.2020

Metin Çoksevim Mustafa Yenerçağ , Onur Osman Şeker

https://doi.org/10.47482/acmr.2020.5

Öz

Background: Cardiac resynchronization therapy (CRT) is an established treatment for patients with symptomatic chronic heart failure with reduced ejection fraction (HFrEF) and prolonged QRS despite optimal pharmacological therapy. Inflammation plays a crucial role in the pathogenesis and progression of cardiovascular disease. The role of CRT pre-implantation inflammatory condition assessed using routine laboratory tests has been rarely investigated. In this study we aimed to evaluate the effect of CRT on indirect inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to- the monocyte (LMR) ratio.

Methods: 75 CRT patients were included in the study retrospectively. Before the CRT implantation, clinical and demographic data were recorded from all patients. NLR, PLR and LMR ratio were measured before CRT implantation. The patients were reevaluated minimum six months after CRT; the above-mentioned parameters were measured again and compared to the pre-CRT period.

Results: Compared to the period before CRT, laboratory findings such as white blood cell (3.5 ± 2.2 103 uL vs. 3.2 ± 2.4 103 uL; p = 0.006), neutrophyl (1.9 ± 0.4 103 uL; vs. 1.4 ± 0.4 103 uL; p = 0.002), NLR (3.8 ± 0.3 103 uL; vs. 1.7 ± 0.1 103 uL; p <0.001), PLR (490.2 ± 199 103 uL; vs. 381 ± 105 103 uL; p < 0.001) levels were significantly lower after 6 months of CRT implantation. Lymphocyte counts (0.5 ± 0.3 103 uL vs. 0.8 ± 0.2 103 uL; p = 0.001) were significantly higher in the post CRT group. A significant and positive correlation of the reduction in NLR (rs = 0.362, p = 0.001) and PLR (rs = 0.562, p <0.001) was found with the increased six minute walking test (6-MWT).

Conclusion: The NLR, PLR and MLR were decreased after CRT implantation. The modest decrease in these parameters demonstrates the effect of restoring the heart’s electromechanical synchrony after CRT on inflammation.

Anahtar Kelimeler

Congestive Heart Failure, Cardiac Resynchronization Therapy, İnflammatory Markers.

Kaynakça

• 1.Degertekin M, Erol Ç, Ergene O, Tokgözoðlu L, Aksoy M, Erol MK, et al. Heart failure prevalence and predictors in Turkey: HAPPY study. Archives of the Turkish Society of Cardiology. 2012;40(4):298-308.
• 2. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European heart journal. 2016;37(27):2129-200.
• 3. Cleland JG, Abraham WT, Linde C, Gold MR, Young JB, Claude Daubert J, et al. An individual patient meta-analysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure. European heart journal. 2013;34(46):3547-56.
• 4. Van Bommel RJ, Bax JJ, Abraham WT, Chung ES, Pires LA, Tavazzi L, et al. Characteristics of heart failure patients associated with good and poor response to cardiac resynchronization therapy: a PROSPECT (Predictors of Response to CRT) sub-analysis. European heart journal. 2009;30(20):2470-7.
• 5. Goldenberg I, Hall WJ, Beck CA, Moss AJ, Barsheshet A, McNitt S, et al. Reduction of the risk of recurring heart failure events with cardiac resynchronization therapy: MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy). Journal of the American College of Cardiology. 2011;58(7):729-37.
• 6. Braunwald E. Biomarkers in heart failure. New England Journal of Medicine. 2008;358(20):2148-59.
• 7. Singh JP, Gras D. Biventricular pacing: current trends and future strategies. European heart journal. 2012;33(3):305-13.
• 8. Vaduganathan M, Greene SJ, Butler J, Sabbah HN, Shantsila E, Lip GY, et al. The immunological axis in heart failure: importance of the leukocyte differential. Heart failure reviews. 2013;18(6):835-45.
• 9. Maisel A, Knowlton K, Fowler P, Rearden A, Ziegler M, Motulsky H, et al. Adrenergic control of circulating lymphocyte subpopulations. Effects of congestive heart failure, dynamic exercise, and terbutaline treatment. The Journal of clinical investigation. 1990;85(2):462-7.
• 10. Cho JH, Cho H-J, Lee H-Y, Ki Y-J, Jeon E-S, Hwang K-K, et al. Neutrophillymphocyte ratio in patients with acute heart failure predicts in-hospital and long-term mortality. Journal of clinical medicine. 2020;9(2):557.
• 11. Tang WW, Tong W, Troughton RW, Martin MG, Shrestha K, Borowski A, et al. Prognostic value and echocardiographic determinants of plasma myeloperoxidase levels in chronic heart failure. Journal of the American College of Cardiology. 2007;49(24):2364-70.
• 12. Yıldız A, Yüksel M, Oylumlu M, Polat N, Akıl MA, Acet H. The association between the neutrophil/lymphocyte ratio and functional capacity in patients with idiopathic dilated cardiomyopathy. Anatolian journal of cardiology. 2015;15(1):13.
• 13. Agacdiken A, Celikyurt U, Sahin T, Karauzum K, Vural A, Ural D. Neutrophil-to-lymphocyte ratio predicts response to cardiac resynchronization therapy. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 2013;19:373.
• 14. Balci KG, Balci MM, Sen F, Canpolat U, Akboga MK, Unal S, et al. The role of baseline indirect inflammatory markers in prediction of response to cardiac resynchronisation therapy. Kardiologia Polska (Polish Heart Journal). 2016;74(2):119-26.