Plasma Viscosity and NLR in Young Subjects with Myocardial Infarction: Evaluation at the Initial Stage and at 3 and 12 Months

Abstract

In the “Sicilian study on juvenile myocardial infarction,” we had evaluated plasma viscosity (PV) and neutrophil/lymphocyte ratio (NLR) in patients with acute myocardial infarction (AMI) at the age of ⩽45 years. Now, we examined the relationship between these 2 parameters in 120 subjects (109 men and 11 women) aged ⩽45 years with recent AMI. The patients were classified according to the number of cardiovascular risk factors, the electrocardiographic criteria (ST-segment elevation myocardial infarction [STEMI] or non-ST-segment elevation myocardial infarction [NSTEMI]), and the extent of coronary stenosis, evaluated with coronary angiography. On fasting venous blood, we measured PV at the shear rate of 450 s −1 and NLR. The control group included 50 healthy subjects (mean age = 35.1 ± 7.8 years). At the initial stage, PV and NLR were significantly increased in comparison with controls. Subdividing AMI patients according to the median value of NLR, in the group with high NLR PV was significantly higher, whereas subdividing the patients according to the PV median value, NLR was not different between the 2 groups; 3 and 12 months after AMI, we observed only a significant decrease in NLR. Only PV was discriminant regarding the cardiovascular complications registered during an 18-month follow-up. The evaluation of PV may be of prognostic value in juvenile AMI.

Assessment of Inflammatory Hematological Ratios (NLR, PLR, MLR, LMR and Monocyte/HDL–Cholesterol Ratio) in Acute Myocardial Infarction and Particularities in Young Patients

“…In patients diagnosed with NSTEMI, an elevated NLR was found to be correlated with a higher incidence of atrial fibrillation and heart failure, a reduced left ventricular ejection fraction and increased rates of coronary artery bypass grafting (CABG). Others have shown that NLR following hospitalization is a significant and autonomous indicator of both one-year reinfarction and mortality rates among individuals with AMI who also have diabetes [ 5 , 6 , 7 , 8 , 9 ]. NLR was shown to be a prognostic factor for hospitalization and long-term prognosis in patients with STEMI receiving PCI in two meta-analyses that included more than 10,000 patients each [ 10 , 11 ].…”

“…Nevertheless, when assessed alongside other factors such as hemorheological determinants, plasma markers of platelet and neutrophil activation, oxidative stress, elastase and protein oxidation, it was found to be a valuable indicator [ 2 ]. In the same line, two parameters, NLR and plasma viscosity (PV), which were examined concurrently in a prospective study which included young AMI subjects at 3 and 12 months following AMI, exhibited distinct patterns, indicating a substantial decrease in NLR during the follow-up period, while PV did not exhibit a similar change, being the only variable that demonstrated discriminant ability in relation to the cardiovascular complications observed over an 18-month follow-up [ 6 ]. NLR is subject to the influence of both diet and physical exercise.…”

“…Limited data NLR have no prognostic significance in predicting future mortality or early risk stratification [ 6 ].…”

“…Generally, hematological parameters measured in routine blood tests mainly include quantifying and classifying the white and red blood cells, and also platelets. Recent studies have shown that red blood cells distribution width (RDW), mean platelet volume (MPV), the neutrophil/lymphocyte ratio (NLR, neutrophil count/lymphocyte count), platelet/lymphocyte ratio (PLR, platelet count/lymphocyte count) and monocyte/lymphocyte ratio (MLR, monocyte count/lymphocyte count) are accessible and cost-effective inflammatory markers that reflect the degree of inflammation [ 5 , 6 , 7 ]. It is known that coronary artery disease is characterized by a high inflammatory burden, and several studies demonstrated that these hematological parameters are associated with the severity and prognosis of coronary artery disease [ 8 , 9 ].…”

Red Cell Distribution Width and Elongation Index in a Cohort of Patients With Juvenile Acute Myocardial Infarction

“…However, we have not disregarded neither the behavior of erythrocyte deformability nor the red cell distribution width (RDW), although in part of the entire cohort of these patients, we have previously observed a reduction in erythrocyte deformability, explored with whole blood filtration and diffractometric technique, with respect to the group of healthy volunteers. 11 The erythrocyte deformability is dependent on the surface/ volume ratio of the erythrocyte, on internal viscosity related mainly to the concentration of cytosolic calcium, on erythrocyte organic phosphates (ATP and 2.3 DPG), and changes in hemoglobin, and it is also dependent on the dynamic membrane properties, related to the protein and lipid composition. In addition to allowing the erythrocyte to easily cross microvascular districts of a few microns, so much lower than the geometric characteristics of the red blood cell (RBC), the deformability plays a specific role in the supply to oxygen to tissues.…”