A lower systemic immune-inflammation index level is associated with response to cardiac resynchronization theraphy

Öz

Aim: The systemic immune-inflammation index (SII), a novel inflammation-based biomarker combining platelet, neutrophil and lymphocyte counts, has been shown to be associated with worse clinical outcomes in several malignancies. However, the relationship between SII and response to cardiac resynchronization theraphy (CRT) has not been evaluated yet. The aim of this study was to investigate the association between SII and response to CRT in patients with heart failure (HF).
Material and Methods: A total of 88 patients (54.5% male; mean age 58.9±12.9 years) who underwent CRT device implantation were included in the study. Baseline clinical, demographic, laboratory and echocardiographic data of patients’ were recorded. An echocardiographic CRT response was defined as a decrease in left ventricular end‐systolic volume of ≥15% and/or absolute increase of 5% in left ventricular ejection fraction (LVEF) at 6‐month follow-up after CRT implantation.
Results: Among included patients, a total of 51 (57.9%) patients were defined as ‘’responders’’ after 6 months of CRT implantation. Lymphocyte count, LVEF and QRS width were significantly higher in responders compared to those responders. In addition, baseline creatinine and SII levels were significantly lower in responders than nonresponders. Multivariate logistic regression analysis showed that a SII of ≤973.3, LVEF and QRS width were independent predictors for response to CRT in the study population.
Conclusion: SII may be used as a novel, simple and reliable inflammatory biomarker in the prediction of response to CRT in patients with HF.

Anahtar Kelimeler

• inflammation,neutrophil,cardiac resynchronization therapy

Düşük sistemik immun-inflamasyon indeksi kardiyak resenkronizasyon tedavisine yanıt ile ilişkilidir

Öz

Amaç: Trombosit, nötrofil ve lenfosit sayılarının kominasyonundan oluşan yeni bir inflamasyon belirteci olan sistemik immun-inflamsyon indeksinin (Sİİ) çeşitli malignitelerde kötü klinik sonlanımlarla ilişkili olduğu gösterilmiştir. Bununla birlikte, Sİİ ve kardiyak resenkronizasyon tedavisine (KRT) cevap arasındaki ilişki henüz çalışılmamıştır. Bu çalışmanın amacı, kalp yetersizliği (KY) hastalarında KRT tedavisine cevap ve Sİİ arasındaki ilişkiyi araştırmaktı.
Gereç ve Yöntemler: KRT cihaz implantasyonu yapılan toplam 88 hasta (%54,5 erkek; ortalama yaş 58,9±12,9 yıl) çalışmaya dahil edilmiştir. Hastaların temel klinik, demografik, laboratuar ve ekokardiyografik özellikleri kaydedildi. Ekokardiyografik KRT cevabı; implantasyondan 6 ay sonrasında sol ventrikül sistol sonu volümunde %15 ve üzerinde azalma ve/veya sol ventrikül ejeksiyon fraksiyonunda (SVEF) %5 ve üzerinde artış olması olarak tanımlanmıştır.
Bulgular: Çalışmaya alınan hastalardan 51 tanesi (%57,9) KRT’ye ‘’cevap vermiş’’ olarak tanımlandı. Lenfosit sayısı, SVEF ve QRS genişliği KRT ye cevap veren hastalarda vermeyenlere göre anlamlı olarak daha fazlaydı. Ayrıca, bazal kreatinin ve Sİİ düzeyleri cevap veren hastalarda vermeyenlere göre anlamlı olarak daha düşüktü. Çok değişkenli lojistik regresyon analizinde; çalışma populasyonunda Sİİ’nin 973,3 ve altında olması, SVEF ve QRS genişliği KRT’ye cevabın bağımsız öngördürücüleri olarak saptandı.
Sonuç: KY hastalarında KRT tedavisine cevabın tahmininde Sİİ yeni, basit ve güvenilir bir inflamasyon belirteci olarak kullanılabilir.  

Anahtar Kelimeler

• nötrofil,inflamasyon,kardiyak resenkronizasyon tedavisi

Kaynakça

1. 1-Ponikowski P, Voors AA, Anker SD, et al. ESC Scientific Document Group. 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. Eur Heart J 2016; 37: 2129.
2. 2-St John SM, Linde C, Gold MR, et al. REVERSE Study Group. Left Ventricular Architecture, Long-Term Reverse Remodeling, and Clinical Outcome in Mild Heart Failure With Cardiac Resynchronization: Results From the REVERSE Trial. JACC Heart Fail 2017; 5: 169–78.
3. 3-Foley PW, Chalil S, Khadjooi K, Irwin N, Smith RE, Leyva F. Left ventricular reverse remodelling, long-term clinical outcome, and mode of death after cardiac resynchronization therapy. Eur J Heart Fail 2011; 13: 43-51.
4. 4-van Bommel RJ, Borleffs CJ, Ypenburg C 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. Eur Heart J 2009; 30: 2470–77.
5. 5-Goldenberg I, Hall WJ, Beck CA 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) J Am Coll Cardiol 2011; 58: 729–37.
6. 6-Agacdiken A, Celikyurt U, Sahin T, Karauzum K, Vural A, Ural D. Neutrophil-to-lymphocyte ratio predicts response to cardiac resynchronization therapy. Med Sci Monit 2013; 19: 373-7.
7. 7-Balci KG, Balci MM, Sen F et al. The role of baseline indirect inflammatory markers in prediction of response to cardiac resynchronisation therapy. Kardiol Pol 2016; 74: 119-26.
8. 8-Celikyurt U, Agacdiken A, Sahin T, Kozdag G, Vural A, Ural D. Association between red blood cell distribution width and response to cardiac resynchronization therapy. J Interv Card Electrophysiol 2012; 35: 215-8.

9. 9-Zhang Y, Lin S, Yang X, Wang R, Luo L. Prognostic value of pretreatment systemic immune-inflammation index in patients with gastrointestinal cancers. J Cell Physiol 2019; 234: 5555-63.
10. 10-Zhong JH, Huang DH, Chen ZY. Prognostic role of systemic immune-inflammation index in solid tumors: a systematic review and meta-analysis. Oncotarget 2017; 8: 75381-8.
11. 11-Zhang Y, Chen B, Wang L, Wang R, Yang X. Systemic immune-inflammation index is a promising noninvasive marker to predict survival of lung cancer: A meta-analysis. Medicine (Baltimore) 2019; 98: 13788.
12. 12-Imamoglu GI, Eren T, Baylan B, Karacın C. May High Levels of Systemic Immune-Inflammation Index and Hematologic Inflammation Markers Suggest a Further Stage in Testicular Tumours? Urol Int 2019; 103: 303-10.
13. 13-The Criteria Committee of the New York Heart Association Nomenclature and criteria for diagnosis of diseases of the heart and blood vessels. Boston: Little Brown, 1964.
14. 14-Schiller NB, Shah PM, Crawford M et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr 1989; 2: 358-67.
15. 15-Auger D, van Bommel RJ, Bertini M et al. Prevalence and characteristics of patients with clinical improvement but not significant left ventricular reverse remodeling after cardiac resynchronization therapy. Am Heart J 2010; 160: 737-43.
16. 16-AlJaroudi W, Chen J, Jaber WA, Lloyd SG, Cerqueira MD, Marwick T. Nonechocardiographic imaging in evaluation for cardiac resynchronization therapy. Circ Cardiovasc Imaging 2011; 4: 334-43.
17. 17-Bax JJ, Bleeker GB, Marwick TH et al. Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy. J Am Coll Cardiol 2004; 44: 1834-40.
18. 18-De Maria E, Gallo P, Damiano M et al. Predictive parameters of left ventricular reverse remodeling in response to cardiac resynchronization therapy in patients with severe congestive heart failure. Ital Heart J 2005; 6: 734-9.
19. 19-Santos JF, Parreira L, Madeira J et al. Predictors of response to cardiac resynchronization therapy-importance of left ventricular dyssynchrony. Rev Port Cardiol 2006; 25: 569-81.
20. 20-Rickard J, Michtalik H, Sharma R et al. Predictors of response to cardiac resynchronization therapy: A systematic review. Int J Cardiol 2016; 225: 345-52.
21. 21-Heggermont W, Auricchio A, Vanderheyden M. Biomarkers to predict the response to cardiac resynchronization therapy. Europace 2019; 21: 1609-20.
22. 22-Liu J, Li S, Zhang S et al. Systemic immune-inflammation index, neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio can predict clinical outcomes in patients with metastatic non-small-cell lung cancer treated with nivolumab. J Clin Lab Anal 2019; 33: 22964.
23. 23-Zhang Y, Xiao G, Wang R. Clinical significance of systemic immune-inflammation index (SII) and C-reactive protein-to-albumin ratio (CAR) in patients with esophageal cancer: a meta-analysis. Cancer Manag Res 2019; 11: 4185-200.
24. 24-Kerekanic M, Hudak M, Misikova S, Komanova E, Stancak B. The impact of cardiac resynchronization therapy on serum levels of high sensitivity C-reactive protein in patients with chronic heart failure. Europace 2017; 19: 328.