The importance of the neutrophil-to-lymphocyte ratio in patients with hypertrophic cardiomyopathy

Protein interactions, network pharmacology, and machine learning work together to predict genes linked to mitochondrial dysfunction in hypertrophic cardiomyopathy

This study looked at possible targets for hypertrophic cardiomyopathy (HCM), a condition marked by thickening of the ventricular wall, primarily in the left ventricle. We employed differential gene analysis and weighted gene co-expression network analysis (WGCNA) on samples. We then carried out an enrichment analysis. We also investigated the process of immunological infiltration. We employed six machine learning techniques and two protein-protein interaction (PPI) network gene selection approaches to search for the most characteristic gene (MCG). In the validation ladder, we verified the expression of MCG. Furthermore, we examined the MCG expression levels in HCM animal and cell models. Finally, we performed molecular docking and predicted potential medications for HCM treatment. 7975 differentially expressed genes (DEGs) were found in our study. We also identified 236 genes in the blue module using WGCNA. Screening at the transcriptome and protein levels was used to mine MCG. The final result screened CCAAT/Enhancer Binding Protein Delta (CEBPD) as MCG. We confirmed that MCG expression matched the outcomes of the experimental ladder. The level of CEBPD mRNA and protein was lowered in HCM animal and cellular models. Given that Abt-751 had the highest binding affinity to CEBPD, it might be a projected targeted medication. We found a new target gene for HCM called CEBPD, which is probably going to function by mitochondrial dysfunction. An innovative aim for the management or avoidance of HCM is offered by this analysis. Abt-751 may be a predicted targeted drug for HCM that had the greatest binding affinity with CEBPD.

Multifaceted roles of neutrophils in cardiac disease

Neutrophils, the most abundant leukocytes in human blood, have long been recognized as critical first responders in the innate immune system's defense against pathogens. Some of the more notable innate antimicrobial properties of neutrophils include generation of superoxide free radicals like myeloperoxidase, production of proteases that reshape the extracellular matrix allowing for easier access to infected tissues, and release of neutrophil extracellular traps, extruded pieces of DNA that ensnare bacterial and fungi. These mechanisms developed to provide neutrophils with a vast array of specialized functions to provide the host defense against infection in an acute setting. However, emerging evidence over the past few decades has revealed a far more complex and nuanced role for these neutrophil-driven processes in various chronic conditions, particularly in cardiovascular diseases. The pathophysiology of cardiac diseases involves a complex interplay of hemodynamic, neurohumoral, and inflammatory factors. Neutrophils, as key mediators of inflammation, contribute significantly to this intricate network. Their involvement extends far beyond their classical role in pathogen clearance, encompassing diverse functions that can both exacerbate tissue damage and contribute to repair processes. Here, we consider the contributions of neutrophils to myocardial infarction, heart failure, cardiac arrhythmias, and nonischemic cardiomyopathies. Understanding these complex interactions is crucial for developing novel therapeutic strategies aimed at modulating neutrophil functions in these highly morbid cardiac diseases.

Effect of CBC-Derived Inflammatory Indicators in Predicting Chronic Kidney Disease Risk in Hypertrophic Cardiomyopathy Patients

Background: Hypertrophic cardiomyopathy (HCM) is a prevalent condition that often coexists with chronic kidney disease (CKD), significantly impacting patient prognosis. This study aimed to investigate the predictive value of complete blood cell counts derived inflammatory indicators in assessing CKD risk in HCM patients. Methods: This study enrolled HCM patients and categorized them into CKD and non-CKD group based on discharge diagnoses. Analyzed indicators included systemic inflammation response index (SIRI), systemic immune inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR). Least absolute shrinkage and selection operator (LASSO) logistic and multivariable logistic regression were employed to identified independent risk factors for CKD, which were subsequently utilized to develop a nomogram. Results: A total of 1795 HCM patients were included, including 112 (6.24%) individuals assigned to the CKD group. In univariate analyses, NLR (AUC: 0.755; 95%CI: 0.711-0.800) demonstrated superior accuracy compared to others. Eighteen baseline characteristics exhibiting statistical difference were incorporated into LASSO-logistic regression. Six factors were further selected by multivariable logistic regression. The results identified male gender (OR: 2.622; 95% CI: 1.565-4.393, p < 0.001), Hb (OR: 0.972; 95% CI: 0.962-0.981, p < 0.001), Pro-BNP (OR: 1.000; 95% CI: 1.000-1.000, p < 0.001), SIRI (OR: 1.037; 95% CI: 1.026-1.049, p < 0.001), and SII (OR: 1.000; 95% CI: 1.000-1.001, p = 0.003) as risk factors. These five factors were used to construct a nomogram, which exhibited good accuracy and consistency. Conclusions: Male gender, Hb, Pro-BNP, SIRI, and SII were identified as risk factors for CKD risk in HCM patients. A nomogram was developed using these factors, which may facilitate early identification and management of high-risk individuals.

The Role of Signalling Pathways in Myocardial Fibrosis in Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is the most prevalent hereditary cardiovascular disorder, characterised by left ventricular hypertrophy and cardiac fibrosis. Cardiac fibroblasts, transformed into myofibroblasts, play a crucial role in the development of fibrosis. However, interactions between fibroblasts, cardiomyocytes, and immune cells are considered major mechanisms driving fibrosis progression. While the disease has a strong genetic background, its pathogenetic mechanisms remain complex and not fully understood. Several signalling pathways are implicated in fibrosis development. Among these, transforming growth factor-beta and angiotensin II are frequently studied in the context of cardiac fibrosis. In this review, we summarise the most current evidence on the involvement of signalling pathways in the pathogenesis of HCM. Additionally, we discuss the potential role of monitoring pro-fibrotic molecules in predicting clinical outcomes in patients with HCM.

Neutrophil-to-lymphocyte ratio and red blood cell distribution width to platelet ratio and their relationships with inflammatory and antioxidant status in dogs with different stages of heart failure due to myxomatous mitral valve disease

We aimed to evaluate the red blood cell distribution width-to-platelet ratio (RDW/PLT) with other complete blood cell count (CBC) indices and their correlations with serum proinflammatory cytokines, acute phase proteins (APPs), and antioxidant biomarkers in dogs at different stages of heart failure (HF). A total of 29 dogs were divided into four groups according to the ACVIM Consensus Statement: stage-A (healthy/controls, n = 8), stage-B2 (n = 6), stage-C (n = 10), and stage-D (n = 5). Seventeen CBC indices were calculated and correlated with the measurements of inflammatory, APPs, and antioxidant biomarkers, as well as selected echocardiographic variables in all dogs. At stage-C, CBC indices were evaluated 14 days after the treatment. Statistically significant changes were observed only for RDW/PLT and neutrophil-to-lymphocyte ratio (NLR) between groups. NLR increased, but RDW/PLT deceased in dogs with HF, compared to controls (P < 0.05). There were no statistically differences between pre- and post-treatment CBC indices. There were significantly positive and negative correlations between the CBC indices, serum parameters and selected echocardiographic variables in dogs with HF(P < 0.05). ROC analysis showed the best sensitivity (57% and 68%) and specificity (100% and 57%) for NLR > 5.8 and RDW/PLT ≤ 0.057 for predicting the severity of HF, respectively. Results showed that NLR and RDW/PLT may have potential for monitoring severity of the disease and the effect of treatment in dogs with HF. Imbalances between indices of circulating blood cells can contribute to immunoinflammatory and antioxidant responses in pathogenesis of canine HF, which may provide us alternative targets to develop new diagnostic and therapeutic strategies in veterinary medicine.

High neutrophil-to-lymphocyte ratio is associated with cancer therapy-related cardiovascular toxicity in high-risk cancer patients under immune checkpoint inhibitor therapy

BACKGROUND

Cancer therapy-related cardiovascular toxicity (CTR-CVT) from immune checkpoint inhibitor (ICI) therapy is still incompletely characterized, and patients with pre-existing cardiovascular disease represent a particularly high-risk cohort. Valid parameters for risk stratification of these patients are missing. Neutrophil-to-lymphocyte ratio (NLR) has been shown to predict mortality and adverse events in other cardiovascular cohorts. The present study aims to examine the predictive capacity of NLR for risk stratification of patients particularly vulnerable for CTR-CVT under ICI therapy.

METHODS

We performed an analysis of 88 cancer patients (69 ± 11 years, 25% female) with pre-existing cardiovascular disease under ICI therapy from the prospective Essen Cardio-Oncology Registry (ECoR). NLR was assessed at patient enrollment and the population was divided through receiver operator characteristic (ROC) curve analysis in patients with low (< 4.57) and high (≥ 4.57) NLR. Endpoint was the whole spectrum of CTR-CVT, according to the European guidelines on cardio-oncology. The median follow-up was 357 days (interquartile range (IQR): 150-509 days).

RESULTS

We observed 4 cases of myocarditis, 17 cases of vascular toxicity, 3 cases of arterial hypertension, 22 cases of arrhythmia or QTc prolongation and 17 cases of cardiovascular dysfunction. NLR was associated with overall CTR-CVT by univariable Cox regression (hazard ratio (HR): 1.443; 95% confidence interval (CI) 1.082-1.925; p = 0.013). However, this association was attenuated after adjusting for further confounders.

CONCLUSION

NLR is moderately associated with CTR-CVT in cancer patients with pre-existing cardiovascular disease under ICI therapy. Surveillance of NLR during ICI therapy might be an effective and economically biomarker for risk stratification in these high-risk patients.

Preventing Cardiogenic Thromboembolism in Cats: Literature Gaps, Rational Recommendations, and Future Therapies

Cardiogenic arterial thromboembolism (CATE) is a devastating complication in cats with cardiomyopathies with significant morbidity and mortality. Despite recent advances in the diagnosis and treatment of CATE, its recurrence and mortality remain high. This highlights the urgent need for a greater understanding of CATE pathophysiology so that novel diagnostic tests and therapeutics can be developed. This comprehensive review aims to summarize existing literature on pathophysiology, clinical diagnosis, and current recommendations on the prevention and treatment of CATE. It also identifies and describes knowledge gaps and research priorities in the roles of immunothrombosis and procoagulant platelets in the pathogenesis of CATE.

Inflammation across the spectrum of hypertrophic cardiac phenotypes

The hypertrophic cardiomyopathy phenotype encompasses a heterogeneous spectrum of genetic and acquired diseases characterized by the presence of left ventricular hypertrophy in the absence of abnormal cardiac loading conditions. This "umbrella diagnosis" includes the "classic" hypertrophic cardiomyopathy (HCM), due to sarcomere protein gene mutations, and its phenocopies caused by intra- or extracellular deposits, such as Fabry disease (FD) and cardiac amyloidosis (CA). All these conditions share a wide phenotypic variability which results from the combination of genetic and environmental factors and whose pathogenic mediators are poorly understood so far. Accumulating evidence suggests that inflammation plays a critical role in a broad spectrum of cardiovascular conditions, including cardiomyopathies. Indeed, inflammation can trigger molecular pathways which contribute to cardiomyocyte hypertrophy and dysfunction, extracellular matrix accumulation, and microvascular dysfunction. Growing evidence suggests that systemic inflammation is a possible key pathophysiologic process potentially involved in the pathogenesis of cardiac disease progression, influencing the severity of the phenotype and clinical outcome, including heart failure. In this review, we summarize current knowledge regarding the prevalence, clinical significance, and potential therapeutic implications of inflammation in HCM and two of its most important phenocopies, FD and CA.

The Microenvironment of the Pathogenesis of Cardiac Hypertrophy

Pathological cardiac hypertrophy is a key risk factor for the development of heart failure and predisposes individuals to cardiac arrhythmia and sudden death. While physiological cardiac hypertrophy is adaptive, hypertrophy resulting from conditions comprising hypertension, aortic stenosis, or genetic mutations, such as hypertrophic cardiomyopathy, is maladaptive. Here, we highlight the essential role and reciprocal interactions involving both cardiomyocytes and non-myocardial cells in response to pathological conditions. Prolonged cardiovascular stress causes cardiomyocytes and non-myocardial cells to enter an activated state releasing numerous pro-hypertrophic, pro-fibrotic, and pro-inflammatory mediators such as vasoactive hormones, growth factors, and cytokines, i.e., commencing signaling events that collectively cause cardiac hypertrophy. Fibrotic remodeling is mediated by cardiac fibroblasts as the central players, but also endothelial cells and resident and infiltrating immune cells enhance these processes. Many of these hypertrophic mediators are now being integrated into computational models that provide system-level insights and will help to translate our knowledge into new pharmacological targets. This perspective article summarizes the last decades' advances in cardiac hypertrophy research and discusses the herein-involved complex myocardial microenvironment and signaling components.

Baseline neutrophil-to-lymphocyte ratio and efficacy of SGLT2 inhibition with empagliflozin on cardiac remodelling

AIMS

The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation and plays a critical role in the assessment and prognosis in patients with heart failure. The EMPA-HEART CardioLink-6 trial demonstrated that patients with type 2 diabetes (T2D) and coronary artery disease (CAD) treated with a sodium-glucose transport protein 2 inhibitor for 6 months experienced regression in left ventricular mass. Given this, we evaluated the relationship of baseline NLR and cardiac reverse remodelling in the entire cohort of this trial.

METHODS AND RESULTS

A total of 97 individuals were randomized to receive empagliflozin (10 mg/day) or placebo for 6 months. The primary outcome of the trial was change in left ventricular mass indexed to body surface area (LVMi) from baseline to 6 months as measured by cardiac magnetic resonance imaging. In our analysis, the cohort was stratified above and below an NLR level of 2. To assess the treatment effect on the 6 month change in NLR, we used a linear model adjusting for baseline differences in NLR [analysis of covariance (ANCOVA)] that included an interaction term between the baseline NLR and treatment. To assess the treatment effect on the 6 month change in LVMi in each of the subgroups divided by baseline NLR, we used an ANCOVA adjusting for baseline differences in LVMi that included an interaction term between the subgroups and treatment. The results of the regression models were summarized as adjusted differences with two-sided 95% confidence intervals (CIs). Patients who exhibited an elevated baseline NLR demonstrated higher LVMi and left ventricular end-diastolic volume indexed to body surface area than those with a lower NLR. In patients with an NLR < 2 and NLR ≥ 2, the adjusted difference in LVMi between the empagliflozin- and placebo-treated patients was -2.98 g/m² (95% CI: -6.18 to 0.22 g/m² ) (P value = 0.067) and -4.43 g/m² (95% CI: -8.50 to -1.11 g/m² ), respectively (P_interaction  = 0.60).

CONCLUSIONS

Empagliflozin treatment is associated with consistent reductions in LVMi in patients with T2D and CAD independent of baseline NLR.

Relation between lymphocyte to monocyte ratio and survival in patients with hypertrophic cardiomyopathy: a retrospective cohort study

Background

The lymphocyte-to-monocyte ratio (LMR) has been proposed as a novel prognostic factor in malignancies and cardiovascular diseases. Our study aimed to ascertain whether LMR is a useful biomarker in discriminating the hypertrophic cardiomyopathy (HCM) patients at higher risk of all-cause mortality.

Methods

This retrospective study consisted of 354 adult HCM patients. Cox's proportional hazards regression models were used to analyze the association between LMR and all-cause mortality. Smooth curve fitting was conducted to explore the linear relationship between LMR and all-cause mortality.

Results

During the follow-up, 44 patients reached the study endpoint. The all-cause mortality rate was 7.3 per 100 person-years in the first tertile and decreased across the three tertiles of LMR. With the first tertile as reference, adjusted hazard ratios (HR) for all-cause mortality were 0.43 for the second tertile (95% CI [0.20-0.91], p = 0.027) and 0.39 for the third tertile (95% CI [0.17-0.90], p = 0.028), respectively. Smooth curve fitting exhibited a nonlinear relationship between LMR values and all-cause mortality. For LMR < 6.5, per SD increase resulted in a significantly decreased risk of all-cause mortality by 62% (HR: 0.38, 95% CI [0.21-0.68]). For LMR ≥ 6.5, the all-cause mortality risk did not progressively increase. Stratified and subgroup analyses revealed similar results to the main analyses,andE-value analysis suggested robustness to unmeasured confounding.

Conclusions

The study demonstrated that LMR was an independent predictor of all-cause mortality in HCM patients, and LMR may be useful for identifying HCM patients at high mortality risk.

Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Cats With Hypertrophic Cardiomyopathy

Objective

To assess the prognostic value of neutrophil-to-lymphocyte ratio (NLR) for cardiac death in cats with hypertrophic cardiomyopathy.

Study Design

Prospective observation study.

Animals

Ninety-six client-owned cats.

Methods

Complete blood count samples were collected from 38 healthy and 58 cats with hypertrophic cardiomyopathy (HCM), and the NLR ratios were analyzed. All cats had echocardiographic measurements performed on the same day as blood collection. Spearman rank correlation was used to assess the relationship between echocardiographic measurements and NLR. Long-term outcome data were obtained, and time to cardiac death and variables associated with cardiac death were analyzed using Kaplan–Meier survival curves and Cox proportional hazards models, respectively.

Results

The NLR was significantly higher in cats with confirmed congestive heart failure. When evaluating HCM patients, cats in the third NLR tertile had a significantly higher risk of cardiac death with a hazard ratio of 10.26 (95% CI: 1.84–57.14; p = 0.0001) when compared with that of patients in the first tertile. NLR was significantly associated with echocardiographic measures of left atrial size, left auricular function, the presence of left atrial spontaneous echo contrast (SEC), and thrombus formation.

Conclusions and Clinical Relevance

Increased NLR is a negative prognostic indicator in cats with HCM.

The Clinical Significance of the Neutrophil-to-lymphocyte Ratio in Hemorrhagic Vasculitis Coexisting with Nonalcoholic Steatohepatosis

Hemorrhagic vasculitis (HV) is a systemic disease of widespread inflammation in small vessels, arterioles, small capillaries, and perivascular edema with blood cells infiltration. The pathogenesis of HV are currently not well understood, and insufficient investigators attention is given to this disease. It has been established that patients with HV often have sonographic signs of the liver damage with normal liver tests, which indicates the presence of hepatic steatosis (HS). The ratio of neutrophilic granulocytes to lymphocytes (N/L) is widely used by doctors to determine the activity of the process, but in patients with HV, depending on the presence of HS, it was not evaluated. The objective: to analyze the diagnostic capabilities of the N/L ratio in HV adult patients. Materials and methods. The retrospective analyse of the hospital examination results of 50 patients with HV was performed and included data from 20 men and 30 women aged 45.96±2.04 years. The patients were divided into two groups: the main group – 15 men and 16 women with HS, and the control group – 5 men and 14 women with sonographically and laboratory intact liver, in whom the N/L index was additionally determined. Statistic of the study was performed by use Statistica 6.0 program, correlations were assessed by Pearson method (r); p<0.05 was taken as the significance threshold. Results. In patients with HV, the N/L index was 3.29±0.40. It was slightly higher than in SP (3.48±0.53 vs 2.69±0.34; p>0.05). The N/L index exceeded 3.3 was determined in 38.71% and >3.5 – in 22.6 of HV patients with SP. Such patients had worse structural and functional parameters of the heart. According to the correlation analysis, an increase in the N/L index >3.3–3.5 was associated with hypertrophy and dilatation of the ventricles with stretching of the valves and development of dysfunction, activation of neutrophilic inflammation, and suppression of the immune cellular component. It has been established that an increase in the N/L index can be not only a prognostic sign of gastrointestinal and renal lesions, but also a sign of heart changes – hypertrophy and dilatation with impaired systolic and diastolic functions. Conclusion. The ratio of neutrophilic granulocytes to lymphocytes is a simple and informative indicator of the activity of inflammation which is easily calculated in practice and is associated with the structural and functional changes in heart in patients with hemorrhagic vasculitis and hepatic steatosis.

Acetylsalicylic Acid Reduces Passive Aortic Wall Stiffness and Cardiovascular Remodelling in a Mouse Model of Advanced Atherosclerosis

Acetylsalicylic acid (ASA) is widely used in secondary prevention of cardiovascular (CV) disease, mainly because of its antithrombotic effects. Here, we investigated whether ASA can prevent the progression of vessel wall remodelling, atherosclerosis, and CV complications in apolipoprotein E deficient (ApoE^-/-) mice, a model of stable atherosclerosis, and in ApoE^-/- mice with a mutation in the fibrillin-1 gene (Fbn1^C1039G+/-), which is a model of elastic fibre fragmentation, accompanied by exacerbated unstable atherosclerosis. Female ApoE^-/- and ApoE^-/-Fbn1^C1039G+/- mice were fed a Western diet (WD). At 10 weeks of WD, the mice were randomly divided into four groups, receiving either ASA 5 mg/kg/day in the drinking water (ApoE^-/- (n = 14), ApoE^-/-Fbn1^C1039G+/- (n = 19)) or plain drinking water (ApoE^-/- (n = 15), ApoE^-/-Fbn1^C1039G+/- (n = 21)) for 15 weeks. ApoE^-/-Fbn1^C1039G+/- mice showed an increased neutrophil-lymphocyte ratio (NLR) compared to ApoE^-/- mice, and this effect was normalised by ASA. In the proximal ascending aorta wall, ASA-treated ApoE^-/-Fbn1^C1039G+/- mice showed less p-SMAD2/3 positive nuclei, a lower collagen percentage and an increased elastin/collagen ratio, consistent with the values measured in ApoE^-/- mice. ASA did not affect plaque progression, incidence of myocardial infarction and survival of ApoE^-/-Fbn1^C1039G+/- mice, but systolic blood pressure, cardiac fibrosis and hypertrophy were reduced. In conclusion, ASA normalises the NLR, passive wall stiffness and cardiac remodelling in ApoE^-/-Fbn1^C1039G+/- mice to levels observed in ApoE^-/- mice, indicating additional therapeutic benefits of ASA beyond its classical use.

Identification and verification of promising diagnostic biomarkers in patients with hypertrophic cardiomyopathy associate with immune cell infiltration characteristics

AIMS

To explore immune cell infiltration characteristics of, and hub genes associated with, hypertrophic cardiomyopathy (HCM).

MATERIALS AND METHODS

The GSE130036 dataset was downloaded and the differentially expressed genes (DEGs) were identified. The DEGs were analyzed via the CIBERSORT algorithm to understand the composition of 22 immune cell types between the HCM and normal myocardial tissue specimens. Weighted gene co-expression network analysis (WGCNA) was performed to segregate the DEGs into several modules and explore correlation between the key modules and specific immune cells enriched in the myocardial tissues of HCM patients. The biofunctional and disease enrichment of the genes among the modules was explored, and hub genes serving as potential biomarkers of HCM were identified. These genes were validated by GSE36961 dataset, and the discrimination ability was assessed by receiver operating characteristic curve analysis.

KEY FINDINGS

CIBERSORT analysis showed that neutrophils and B-cells (naive and memory B-cells) were highly abundant in HCM samples, while macrophages (M0, M1, M2) were highly abundant in normal samples. WGCNA analysis of the DEGs yielded seven modules, and the gray and yellow modules were strongly associated with neutrophils and B-cells, and with macrophages, respectively. Yellow module genes were mainly functional in immune and inflammation processes. Gray module genes were mainly functional in the transportation of intercellular substances. SLITRK4 and CD163 showed a notably high area under the curve values in both datasets and may serve as potential biomarkers for HCM.

SIGNIFICANCE

SLITRK4 and CD163 may be promising Diagnostic Biomarkers of Hypertrophic Cardiomyopathy.

Assessing the relationship between systemic immune-inflammation index and mortality in patients with hypertrophic cardiomyopathy

BACKGROUND

This study investigates the predictive value of the systemic immune-inflammation index (SII), which was calculated as platelet × neutrophil/lymphocyte ratio, for all-cause mortality in patients with hypertrophic cardiomyopathy (HCM).

METHODS

A total of 360 HCM patients were enrolled. They were divided into three groups based on the tertiles of baseline SII. The association between SII and all-cause mortality was analyzed.

RESULTS

There were 53 HCM patients who died during a mean follow-up time of 4.8 years (min: 6 days and max: 10.8 years), and the mortality rate was 3.0 per 100 person years. The cumulative mortality rate was significantly different among the three tertiles of SII (P = 0.004), and the mortality rate in tertile 3 was much higher than that in the first two tertiles. In reference to tertile 1, the fully adjusted hazard ratios of all-cause mortality were 1.02 for the tertile 2 (95% confidence interval [CI]: 0.45-2.31, P = 0.966) and 2.31 for tertile 3 (95% CI: 1.10-4.87, P = 0.027). No significant interactions between SII and other variables were observed during subgroup analysis. The discriminative power was better for mid-term outcome than that for short-term or long-term outcomes. Sensitivity analyses including patients with normal platelet and white blood cell count have revealed similar results.

CONCLUSION

SII was a significant risk factor for all-cause mortality in HCM patients. However, the discriminative power was poor to moderate. It could be used in combination with other risk factors in mortality risk stratification in HCM.

Relation between neutrophil-to-lymphocyte ratio and mortality in patients with hypertrophic cardiomyopathy

Aim: We assessed the prognostic value of neutrophil-to-lymphocyte ratio (NLR) for all-cause mortality in patients with hypertrophic cardiomyopathy (HCM). Methods & results: A total of 354 HCM patients were enrolled. There were 44 all-cause mortality in total. Patients in the third tertile of NLR had the highest all-cause mortality rate of 5.2 per 100 person-years. Patients in tertile 3 had a significantly higher risk of all-cause mortality with adjusted hazard ratio of 2.4 (95% CI: 1.0-5.4; p = 0.040) when compared with that of patients in tertile 1. No significant interactions between NLR and other variables were observed during subgroup analysis. Conclusion: NLR was an independent risk factor for all-cause mortality in HCM patients.

Risk stratification in hypertrophic cardiomyopathy

Sudden cardiac death (SCD) is the most devastating complication of hypertrophic cardiomyopathy (HCM). The greatest challenge in the management of HCM is identifying those at increased risk, since an implantable cardioverter-defibrillator (ICD) is a potentially life-saving therapy. We sought to summarize the available data on SCD in HCM and provide a clinical perspective on the current differing and somewhat conflicting data on risk stratification, with balanced guidance regarding rational clinical decision-making. Additionally, we sought to determine the status of the current implementation of guidelines compiled by HCM experts worldwide. The HCM Risk-SCD model helps improve the risk stratification of HCM patients for primary prevention of SCD by calculating an individual risk estimate that contributes to the clinical decision-making process. Improved risk stratification is important for decision-making before ICD implantation for the primary prevention of SCD.

Neutrophil-to-lymphocyte ratio used as prognostic factor marker for dilated cardiomyopathy in childhood and adolescence

Objective

The objective of this study is to evaluate the neutrophil-to-lymphocyte ratio (NLR) and platelet-lymphocyte ratio, from the hemograms obtained from children and adolescents with dilated cardiomyopathy (DCM), and to correlate them with the levels of B-type natriuretic peptide (BNP) and with the clinical evolution of these patients in the long term.

Materials and Methods

Follow-up of 57 patients with DCM was made retrospectively, with hemogram and BNP level determination being performed after optimized therapy for heart failure. We compared the findings of the patients' examinations that progressed with stability in relation to the occurrence of transplant listing, cardiac transplantation, or evolution to death.

Results

The average age was 48 months, and the follow-up was 64 months. The average of the levels of neutrophils was greater in poor evolution group (7026 vs. 3903; P = 0.011) as well as the average of NLR (5.5 vs. 1.9; P = 0.034). The averages of hemoglobin, total leukocytes, lymphocytes, and platelets were similar in the groups. The area under the receiver operating characteristic curve for NLR in relation to the poor evolution was of 72.9%, being the best cutoff point of NLR ≥5.2 (sensitivity: 93.8% and specificity: 87.8%). Kaplan-Meier curves demonstrate that patients with NLR ≤5.2 (P = 0.001) and BNP <1000 pg/dl (P < 0.0001) presented greater survival.

Conclusions

NLR (≥5.2) and lymphopenia (≤1000 lymphocyte/μL) were associated with a poor prognosis and a higher chance of evolution to death or cardiac transplant, similar to the findings for BNP.

Assessment of the relationship between the ambulatory electrocardiography-based micro T-wave alternans and the predicted risk score of sudden cardiac death at 5 years in patients with hypertrophic cardiomyopathy

OBJECTIVE

Micro T-wave alternans (MTWA) has been associated with poor arrhythmic prognosis in various cardiac disorders. The aim of this study was to assess the relationship between the presence of MTWA and the predicted 5-year risk of sudden cardiac death (HCM Risk-SCD) among patients with hypertrophic cardiomyopathy (HCM).

METHODS

A total of 117 consecutive HCM patients were included in this prospective observational study. Patients were divided into two groups, according to the presence [MTWA (+) group (n=44)] or absence [MTWA (-) group (n=73)] of MTWA on ambulatory (Holter) electrocardiography.

RESULTS

The risk of HCM Risk-SCD (%), the rate of high-risk patients (HCM Risk-ECG >6%), the requirement for cardiopulmonary resuscitation, and implanted cardioverter defibrillator therapy, the percentage of some clinical, echocardiographic, and Holter findings were all statistically higher in the MTWA (+) group than in the MTWA (-) group (all p<0.05). Both in the univariate and multivariate analyses, T-wave alternans (+) and the New York Heart Association's functional classification assigned that the HCM Risk-SCD is an independent predictor of high risk. In the receiver operating characteristic curve analysis, the HCM Risk-SCD >4.9% was identified as an effective cutoff point in the MTWA (+) for HCM. The HCM Risk-SCD value of more than 4.9 yielded a sensitivity of 93.2% and a specificity of 84.5%.

CONCLUSION

The presence of the MTWA on ambulatory electrocardiogram seems to be significantly associated with increasing percentages of the predicted HCM Risk-SCD score in patients with HCM. The MTWA was determined as an independent high-risk indicator for HCM Risk-SCD.

Simple Markers for Systemic Inflammation in Pediatric Atopic Dermatitis Patients

Background:

Atopic dermatitis is a dermatological disease characterized by chronic inflammation. In recent years, systemic inflammation is also mentioned along with local inflammation for its pathogenesis. Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and mean platelet volume (MPV) are nonspecific indicators of systemic inflammation, and they were shown to be associated with the disease and its prognosis in allergic or nonallergic diseases.

Aims and Objectives:

The aim of this study was to evaluate the values of NLR, PLR, and MPV in atopic dermatitis patients and also to investigate the associations of them with the atopic dermatitis disease severity and duration.

Materials and Methods:

Two hundred and fifty-two atopic dermatitis patients and 75 control group individuals were included in the study. Mean/median values of NLR, PLR, and MPV were compared among patients and controls, severity groups classified according to SCORing Atopic Dermatitis (SCORAD) and intrinsic and extrinsic groups. Correlation of disease duration and SCORAD with NLR, PLR, and MPV values were examined. Disease duration and its association with NLR were evaluated by correlation and linear regression analysis.

Results:

Mean NLR and median PLR values of atopic dermatitis patients were higher than those of controls (0.97 ± 0.69 and 80.86 [59.86–108.23], respectively). NLR and PLR values were found to be positively correlated with disease duration and NLR was positively associated with disease duration after adjustment. NLR value was also higher in the extrinsic group than the intrinsic group.

Conclusion:

Presence of systemic inflammation in the pathogenesis of atopic dermatitis was considered to be associated with increased NLR and PLR values. These parameters were also associated with disease duration and might vary between subtypes of atopic dermatitis. NLR and PLR were cheaper and easily accessible alternatives to the systemic inflammation biomarkers that were expensive and not accessible for all laboratories, particularly in economically disadvantaged countries.