Neutrophil-Lymphocyte Ratio (NLR) Reflects Myocardial Inhomogeneities in Hemodialyzed Patients

Abstract

Introduction. Cardiovascular diseases (CVDs) are a leading cause of death in chronically hemodialyzed (HD) patients. In this group, inflammation exerts significant impact on the prevalence of CVD morbidity and mortality. Spatial QRS-T angle is an independent and strong predictor of CV events, including sudden cardiac death (SCD), both in general population and HD patients. Pathogenesis of widened QRS-T angle is complicated and is not well established. Objectives. The study is aimed at evaluating whether inflammation process can contribute to the wide QRS-T angle. Patients and Methods. The retrospective study was performed on 183 HD patients. The control group consisted of 38 patients. Demographic, biochemical, vectorcardiographic, and echocardiographic data were evaluated in all patients. Inflammation process was expressed as neutrophil-lymphocyte ratio (NLR), as well as C-reactive protein (CRP). Results. Both NLR (3.40 vs. 1.95 (p<0.0001)) and spatial QRS-T angle (50.76 vs. 93.56 (p<0.001)) were higher in the examined group, compared to the control group. Similarly, CRP was higher in the examined group than in the control group (8.35 vs. 4.06 (p<0.001), respectively). The QRS-T angle correlated with NLR, CRP, some structural echocardiographic parameters, parathormone (PTH), and calcium (Ca) concentrations. Multiple regression analysis showed that NLR is an independent QRS-T angle predictor (r=0.498, p=0.0027). The ROC curve analysis indicated the cut-off point of NLR equaled 4.59, where the sensitivity and specificity were the highest for predicting myocardial inhomogeneities expressed as widened QRS-T angle. Conclusion. The NLR, as an inflammation marker, may indicate myocardial inhomogeneities in HD patients.

Cryochamber safety – effects of a single session on ECG-derived parameters

“…The spatial QRS-T angle, obtained from the basic 12-lead ECG, is the angle between the vectors of the QRS loops and the T-wave, which indirectly reflects ventricular depolarization and repolarization. An abnormally wide spatial QRS-T angle was defined as > 116° for females and > 130° in males [24,25]. We did not observe significant changes in the the QRS-T angle, which may confirm that a single session in a cryochamber does not significantly affect depolarization and repolarization.…”

The hemoglobin, albumin, lymphocyte, and platelet (HALP) is a potent indicator for the prognosis in hemodialysis patients

“…In fact, recently, it has been reported that HALP can indicate the malnutrition and systemic inflammatory state of chronic diseases, and it turns out to be a relevant outcome symbol for different tumors. [9][10][11][12][13] Interestingly, there are some improved indicators based on blood laboratory tests, such as Neutrophil-Lymphocyte Ratio and Monocyte-lymphocyte ratio, [21,22] which are often mentioned in the analysis of the appraisal of nutritional and inflammatory condition in dialysis subjects.…”

Heat Shock Protein 27 Levels Predict Myocardial Inhomogeneities in Hemodialysis Patients

“…Recent studies have shown that HSP27 may contribute to the reduction of LDL oxidative modification, thus demonstrating that HSP27 plays a protective role in atherogenesis [ 27 , 34 , 35 ]. In addition, our previous study showed that inflammation may play a role in the pathogenesis of myocardial inhomogeneities in HD patients [ 36 ], and HSP27 is known to be involved in modulating inflammation. It is worth emphasizing that the results of ROC analysis revealed that the HSP27 cut-point value predicting abnormal QRS-T angle was similar to the HSP27 value predicting the occurrence of contrast-induced nephropathy [ 24 ].…”