Objective: The neutrophil -to-lymphocyte ratio (NLR) is a new predictor for cardiovascular risk and mortality. The SYNTAX score is an angiographic tool used in grading the complexity of coronary artery disease (CAD). However, its relation with CAD severity and complexity is not yet known. We hypothesized that NLR would be associated with a greater complexity of CAD as assessed using the SYNTAX score. Methods: This cross-sectional observational study included 106 patients who had undergone coronary angiography for stable angina pectoris and 69 patients who had normal coronary angiogram. Baseline NLR was measured by dividing neutrophil count to lymphocyte count. The patients were classified two groups as CAD (-) (n=69) and CAD (+) (n=106), then patients in CAD (+) group were divided into 3 groups according to SYNTAX scores (SYNTAX score 1-22, 23-32, >32) as pointed in European Society of Cardiology (ESC) revascularization guideline. Statistical analysis was performed using the Mann-Whitney U and Kruskal-Wallis tests, and multiple logistic regression analysis was used to identify the independent predictors of complexity of CAD-SYNTAX score. Results: Patients with CAD had a significantly higher value of NLR [1.6 median (1.2-3.3 IQR) vs. 2.3 median (1.8-3.0 IQR) p<0.001]. The group with high SYNTAX scores (>32) more frequently had diabetes mellitus (DM), hypercholesterolemia (HL), were of older age, and also had significantly elevated NLR values [2.4 (1.3-2.6), 2.6 (2.3-3.9), 2.0 (1.5-2.6) p=0.006]. In univariate analysis, age, DM, HL, creatinine, neutrophil count and NLR were predictors of high SYNTAX score. In the multiple logistic regression analysis, only NLR [odds ratio (OR)=2.1, 95% confidence interval (CI) 1.2-3.8, p=0.09], was identified as independent predictor of a high SYNTAX score. Conclusion: NLR is a strong clinical laboratory value that is associated with presence and complexity of CAD. (Anadolu Kardiyol Derg 2013; 13: 662-7) Key words: Neutrophil -to-lymphocyte ratio, complexity, coronary artery disease, regression analysis, sensitivity, specificity Original Investigation Özgün Araşt›rma 662ÖZET Amaç: Nötrofil lenfosit oranı (NLO) kardiovasküler risk ve mortalite için yeni bir öngördürücüdür. SYNTAX skoru koroner arter hastalığı (KAH) karmaşıklığını derecelendirmede anjiyografik bir yöntemdir. NLO ile KAH varlığı ve karmaşıklığı arasındaki ilişki henüz ortaya konmamıştır. Biz SYNTAX skorunu kullanarak NLO ile KAH varlığı ve karmaşıklığı arasında daha güçlü bir ilişki olabileceği tezini öne sürdük. Yöntemler: Bu enine kesit gözlemsel çalışmaya 106 koroner anjiyografisi yapılmış stabil angina pectoris hastası ve 69 normal koronere sahip hastalar dahil edildi. Bazal NLO nötrofil sayısının lenfosit sayısına oranı olarak hesaplandı. Hastalar KAH olan ve olmayan şeklinde iki gruba ayrıldı. KAH grubu SYNTAX skoruna göre Avrupa Kardiyoloji Cemiyeti miyokardiyal girişim kılavuzuna dayanarak 3 gruba ayrıldı (23)(24)(25)(26)(27)(28)(29)(30)(31)(32) >32). İstatistiksel analiz Mann-Whitney U ve Kruskal-Wal...

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Preoperative RDW level predicts new-onset AF after CABG in patients without histories of AF.

BackgroundStructural remodeling is associated with the fibroinflammatory process in the atrial extracellular matrix. In the present study we aimed to investigate whether serum levels of new circulating remodeling markers differ in patients with atrial fibrillation (AF) compared to patients with sinus rhythm.Material/MethodsThe study population included 52 patients diagnosed with non-valvular AF and 33 age-matched patients with sinus rhythm. Serum levels of Galectin-3, matrix metalloproteinase-9 (MMP-9), lipocalin-2 (Lcn2/NGAL), N-terminal propeptide of type III procollagen (PIIINP), Hs-Crp, and neutrophil-to-lymphocyte ratio (NLR) were measured. The left atrial volume (LAV) was calculated by echocardiographic method and LAV index was calculated.ResultsGalectin-3, MMP-9, and PIIINP levels were significantly higher in AF patients except NGAL levels (1166 pg/ml (1126–1204) and 1204 pg/ml (1166–1362) p=0.001, 104 (81–179) pg/ml and 404 (162–564) pg/ml p<0.0001, and 1101 (500–1960) pg/ml and 6710 (2370–9950) pg/ml p<0.0001, respectively). The NLR and Hs-CRP levels were also higher in AF (2.1±1.0 and 2.7±1.1 p=0.02 and 4.2±1.9 mg/L and 6.0±4.7 mg/L p=0.04, respectively). In correlation analyses, NLR showed a strongly significant correlation with LAVi, but Hs-CRP did not (p=0.007 r=0.247, Pearson test and p=0.808 r=0.025, Pearson test, respectively). Moreover, Galectin-3, MMP-9, and PIIINP had a strong positive correlation with LAVi (p=0.021 r=640, Spearman test and p=0.004 r=0.319 Pearson test, and p=0.004 r=0.325 Pearson test, respectively).ConclusionsNovel fibrosis and inflammation markers in AF are correlated with atrial remodeling. Several unexplained mechanisms of atrial remodeling remain, but the present study has taken the first step in elucidating the mechanisms involving fibrosis and inflammation markers.

Platelet distribution width (PDW) measures the variability in platelet size and is a marker of platelet activation. We investigated whether PDW is associated with the extent of coronary artery disease (CAD) and coronary total occlusions (CTOs). We studied 162 patients: 108 had a coronary lesion with a diameter stenosis of ≥50%, the CAD(+) group, and 54 patients had normal coronary anatomy, the CAD(-) group. The CAD(+) group was subdivided into CAD(+) CTO(+) and CAD(+) CTO(-) groups. Among patients with CAD, the CTO(+) group had a significantly greater PDW (%) than the CTO(-) group (16.9 ± 2.8, 15.4 ± 3.0, and 15.4 ± 1.9, respectively; P = .008). In a receiver-operating characteristic analysis, a PDW cut point of 15.7% was identified in patients with CTO(+) (area under curve = 0.64, 95% confidence interval 0.54-0.75). A PDW value of more than 15.7% demonstrated a sensitivity of 64% and a specificity of 66%. The PDW is a simple platelet index that may predict the presence of CTO.