Zafer BÜYÜKTERZİ, KADRİ MURAT GÜRSES, Sami ERDEM, Mehmet Akif BOR, Mehmet Sertaç APAYDIN, Ahmet Lütfi SERTDEMİR, Pelin ALBAYRAK

Mean neutrophil volume is elevated in patients suffering from acute coronary syndrome

INTRODUCTION: Neutrophils are the key inflammatory cells in the acute phase of myocardial infarction(MI). Parameters related to absolute or relative number of circulating neutrophils have been reported to be increased in previous studies. Mean neutrophil volume(MNV) has emerged as a new marker of activated neutrophils. In this study, we aimed to evaluate MNV in subjects suffering from myocardial infarction. METHODS: For this purpose, we included age and gendermatched consecutive patients undergoing either elective coronary angiography following ischemia- guided assessment of patients with stable coronary artery disease (SCAD) (n= 82) or percutaneous coronary angiography due to MI(Group 3, n= 39) between May- August 2016. Among those undergoing elective coronary angiography, 40 patients were found to have normal epicardial coronary arteries(Group 1) and remaining 42 patients were classified as SCAD group(Group 2). RESULTS: A total of 121 subjects(mean age 61.18 years, 49.59% male) were recruited in this study. White blood cell count (p= 0.485) did not differ among three groups. MNV was found to be significantly elevated in Group 3 (174.80 [9.30]), compared to both Group 1 (147.40 [14.80]) (p< 0.001) and 2 (162.30 [14.72]) (p< 0.001). MNV was also significantly higher in Group 2 when compared to Group 1(p< 0.001). DISCUSSION AND CONCLUSION: Our findings suggest that neutrophil composition shows alterations in MI in the lack of quantitative changes. The spectrum of morphological changes in neutrophils, expressed in terms of MNV, merits further evaluation for its predictive value for early diagnosis of ACS and the extent of post- MI ischemic damage.

Akut Koroner Sendromlu Hastalarda Ortalama Nötrofil Hacmi Artar

GİRİŞ ve AMAÇ: Nötrofiller akut koroner sendromların (AKS) erken döneminde anahtar rol oynayan inflamatuvar hücrelerdir. Geçmiş çalışmalar, AKS’de dolaşımdaki nötrofil miktarı ile ilişkili değişkenlerde artış olduğunu ortaya koymuştur. Ortalama nötrofil hacmi (ONH) nötrofil aktivasyonunun yeni bir belirteci olarak kabul edilmektedir. Bu çalışmada, AKS hastalarında ONH değerlerinin incelenmesi hedeflenmiştir. YÖNTEM ve GEREÇLER: Mayıs-Ağustos 2016 tarihleri arasında iskemi değerlendirmesini takiben stabil koroner arter hastalığı (SKAH) ön tanısı alan ve elektif koroner anjiyografi uygulanan hastalar (n=82) ile; bu hastalarla yaş ve cinsiyet açısından eşlenik, AKS nedeniyle acil koroner anjiyografi yapılan hastalar (n=39) çalışmaya dahil edilmiştir. Elektif koroner anjiyografi uygulanan hastalardan 40’ında epikardiyal koroner arterler normal olarak bulunmuş ve bu hastalar kontrol grubu olarak kabul edilmiştir. Kalan 42 hasta ise SKAH grubunu oluşturmuştur. BULGULAR: Çalışmaya toplam 121 hasta (ortalama yaş 61.18 yıl, %49.59 erkek) dahil edilmiştir. Beyaz küre sayıları (p=0.485) gruplar arasında farklılık göstermemiştir. ONH değerleri, AKS grubunda hem kontrol grubuna, hem de SKAH grubuna kıyasla anlamlı şekilde artmış olarak bulundu (her ikisi için p

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1. http://www.who.int/news-room/factsheets/detail/the-top-10-causes-of-death [Available from: http://www.who.int/newsroom/fact-sheets/detail/the-top-10-causes-ofdeath

2. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction (2018). European heart journal. 2018.

3. Pellizzon GG, Dixon SR, Stone GW, Cox DA, Mattos L, Boura JA, et al. Relation of admission white blood cell count to long-term outcomes after primary coronary angioplasty for acute myocardial infarction (The Stent PAMI Trial). The American journal of cardiology. 2003;91(6):729-31.

4. Tamura A, Watanabe T, Nasu M. Association between neutrophil counts on admission and left ventricular function in patients successfully treated with primary coronary angioplasty for first anterior wall acute myocardial infarction. The American journal of cardiology. 2001;88(6):678-80.

5. Sabatine MS, Morrow DA, Cannon CP, Murphy SA, Demopoulos LA, DiBattiste PM, et al. Relationship between baseline white blood cell count and degree of coronary artery disease and mortality in patients with acute coronary syndromes: a TACTICS-TIMI 18 (Treat Angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy- Thrombolysis in Myocardial Infarction 18 trial)substudy. Journal of the American College of Cardiology. 2002;40(10):1761-8.

6. Huang G, Zhong XN, Zhong B, Chen YQ, Liu ZZ, Su L, et al. Significance of white blood cell count and its subtypes in patients with acute coronary syndrome. European journal of clinical investigation. 2009;39(5):348-58.

7. Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. The American journal of cardiology. 2008;102(6):653-7.

8. Machado GP, Araujo GN, Carpes CK, Lech M, Mariani S, Valle FH, et al. Comparison of neutrophil-to-lymphocyte ratio and mean platelet volume in the prediction of adverse events after primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction. Atherosclerosis. 2018;274:212-7.

9. Monteiro Junior JGM, Torres DOC, da Silva M, Martins CMH, da Silva IK, do Nascimento MEM, et al. Prognostic value of hematological parameters in patients with acute myocardial infarction: Intrahospital outcomes. PloS one. 2018;13(4):e0194897.

10. Ayca B, Akin F, Celik O, Yuksel Y, Ozturk D, Tekiner F, et al. Platelet to lymphocyte ratio as a prognostic marker in primary percutaneous coronary intervention. Platelets. 2015;26(7):638- 44.

11. Uyarel H, Ergelen M, Cicek G, Kaya MG, Ayhan E, Turkkan C, et al. Red cell distribution width as a novel prognostic marker in patients undergoing primary angioplasty for acute myocardial infarction. Coronary artery disease. 2011;22(3):138-44.

12. Adam AM, Rizvi AH, Haq A, Naseem R, Rehan A, Shaikh AT, et al. Prognostic value of blood count parameters in patients with acute coronary syndrome. Indian heart journal. 2018;70(2):233- 40.

13. Carbone F, Nencioni A, Mach F, Vuilleumier N, Montecucco F. Pathophysiological role of neutrophils in acute myocardial infarction. Thrombosis and haemostasis. 2013;110(3):501-

14. Li DB, Hua Q, Liu Z, Li J, Xu LQ, Wang S, et al. Association between inflammatory mediators and angiographic morphologic features indicating thrombus formation in patients with acute myocardial infarction. Chinese medical journal. 2009;122(15):1738-42.

15. Kurup RP, S. Neutrophils in acute coronary syndrome. EMJ Cardiol. 2017;5(1):9.

16. Baysal E, Burak C, Cay S, Aksu T, Altintas B, Yaylak B, et al. The neutrophil to lymphocyte ratio is associated with severity of rheumatic mitral valve stenosis. J Blood Med. 2015;6:151- 6.

17. Baysal E, Cetin M, Yaylak B, Altntas B, Altndag R, Adyaman S, et al. Roles of the red cell distribution width and neutrophil/lymphocyte ratio in predicting thrombolysis failure in patients with an ST-segment elevation myocardial infarction. Blood Coagul Fibrinolysis. 2015;26(3):274-8.

18. Bagdasaryan R, Zhou Z, Tierno B, Rosenman D, Xu D. Neutrophil VCS parameters are superior indicators for acute infection. Lab Hematol. 2007;13(1):12-6.

19. Bhargava M, Saluja S, Sindhuri U, Saraf A, Sharma P. Elevated mean neutrophil volume+CRP is a highly sensitive and specific predictor of neonatal sepsis. Int J Lab Hematol. 2014;36(1):e11-4.

20. Mardi D, Fwity B, Lobmann R, Ambrosch A. Mean cell volume of neutrophils and monocytes compared with C-reactive protein, interleukin-6 and white blood cell count for prediction of sepsis and nonsystemic bacterial infections. Int J Lab Hematol. 2010;32(4):410-8.

21. Zhu Y, Cao X, Zhang K, Xie W, Xu D, Zhong C. Delta mean neutrophil volume (DeltaMNV) is comparable to procalcitonin for predicting postsurgical bacterial infection. J Clin Lab Anal. 2014;28(4):301-5.

22. Lam SW, Leenen LP, van Solinge WW, Hietbrink F, Huisman A. Comparison between the prognostic value of the white blood cell differential count and morphological parameters of neutrophils and lymphocytes in severely injured patients for 7-day in-hospital mortality. Biomarkers. 2012;17(7):642-7.

23. van Hout GP, van Solinge WW, Gijsberts CM, Teuben MP, Leliefeld PH, Heeres M, et al. Elevated mean neutrophil volume represents altered neutrophil composition and reflects damage after myocardial infarction. Basic research in cardiology. 2015;110(6):58.