Bedrettin BOYRAZ, Ferit Onur MUTLUER, Dursun TOPAL, Mehmet DEMİR, Tezcan PEKER, Mustafa YILMAZ, Alkame AKGÜMÜŞ, Erhan TENEKECİOĞLU

Assessment of inflammatory parameters in obstructive coronary artery disease and cardiac syndrome X: an evolving value of neutrophil-lymphocyte ratio

Objectives: Atherosclerosis represents an active inflammation that leukocytes play a major role. Neutrophil-lymphocyte ratio (NLR) has been shown as an indicator of systemic inflammation. Our aim was to evaluate inflammatory markers in obstructive coronary artery disease (CAD) and cardiac syndrome X (CSX) and to evaluate NLR in predicting CAD in patients with typical chest pain and coronary risk factors. Methods: Eighty patients with CSX, 80 patients with obstructive CAD with unstable angina pectoris and a control group of 80 subjects were recruited into the study. Hematologic and biochemical parameters were investigated. Results: High-sensitive C-reactive protein (hs-CRP) was increased in CAD group and CSX group compared to the control group (p < 0.001); however it was comparable between CAD and CSX groups (p = 0.065). Mean NLR was higher in CAD group than CSX group and control group that the lowest value was in the control group. In CAD group, hs-CRP was positively correlated with NLR (r = 0.43, p < 0.001), and Gensini score (r = 0.54, p < 0.001). NLR was also linearly correlated with Gensini score (r = 0.49, p < 0.001). In ROC curve analysis, for the NLR of 2.26, NLR values attained 85.5% sensitivity and 43.9% specificity (p < 0.001). When cut-off value was taken as 3.05 mg/dL for CRP, CRP values attained 78.7% sensitivity and 43.6% specificity (p < 0.001). When cut-off value was taken as 9.5 (×109 /L) for white blood cell (WBC), WBC values attained 58.8% sensitivity and 34.3% specificity (p < 0.001). Conclusions: NLR seems to be usefull in prediction of obstructive CAD and can be implemented in planning for diagnostic procedures in patients with typical chest pain. Increased CRP, WBC and NLR may give insight about main pathology of CSX. Despite absence of obstructive narrowing in epicardial coronaries, it appears be salutary to treat CSX due to the similar underlying pathophysiology with obstructive CAD.

Keywords:

obstructive coronary artery disease, cardiac syndrome X, neutrophil-lymphocyte ratio,

PDF

___

1. Hoffman M, Blum A, Baruch R, Kaplan E, Benjamin M. Leukocytes and coronary heart disease. Atherosclerosis 2004;172:1-6.
2. Gillum RF, Mussolino ME, Madans JH. Counts of neutrophils, lymphocytes, and monocytes, cause-specific mortality and coronary heart disease: the NHANES-I epidemiologic follow-up study. Ann Epidemiol 2005;15:266-71.
3. Libby P. Vascular biology of atherosclerosis: overview and state of the art. Am J Cardiol 2003;91(3A):3A-6A.
4. Nunez J, Nunez E, Bodi V, Sanchis J, Minana G, Mainar L, et al. Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation myocardial infarction. Am J Cardiol 2008;101:747-52.
5. Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR, et al. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol 2005;45:1638-43.
6. Walsh SR, Cook EJ, Goulder F, Justin TA, Keeling NJ. Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol 2005;91:181-4.
7. Duffy BK, Gurm HS, Rajagopal V, Gupta R, Ellis SG, Bhatt DL. Usefulness of an elevated neutrophil to lymphocyte ratio in predicting long-term mortality after percutaneous coronary intervention. Am J Cardiol 2006;97:993-6.
8. Dentali F, Nigro O, Squizzato A, Gianni M, Zuretti F, Grandi AM, et al. Impact of neutrophils to lymphocytes ratio on major clinical outcomes in patients with acute coronary syndromes: A systematic review and meta-analysis of the literature. Int J Cardiol 2018;266:31-7.
9. Kaski JC, Rosano GM, Collins P, Nihoyannopoulos P, Maseri A, Poole-Wilson PA. Cardiac syndrome X: clinical characteristics and left ventricular function. Long-term follow-up study. J Am Coll Cardiol 1995;25:807-14.
10. Al Suwaidi J, Higano ST, Holmes DR Jr, Lerman A. Pathophysiology, diagnosis, and current management strategies for chest pain in patients with normal findings on angiography. Mayo Clin Proc 2001;76:813-22.
11. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;1:307-10.
12. Libby P. Changing concepts of atherogenesis. J Intern Med 2000;247:349-58.
13. Deodhar SD. C-reactive protein: the best laboratory indicator available for monitoring disease activity. Cleve Clin J Med 1989;56:126-30.
14. Cook DG, Mendall MA, Whincup PH, Carey IM, Ballam L, Morris JE, et al. C-reactive protein concentration in children: relationship to adiposity and other cardiovascular risk factors. Atherosclerosis 2000;149:139-50.
15. Mendall MA, Patel P, Ballam L, Strachan D, Northfield TC. C reactive protein and its relation to cardiovascular risk factors: a population based cross sectional study. BMJ 1996;312:1061-5.
16. Sharma S, Ghalaut VS, Dixit R, Kumar S, George PJ. Microalbuminuria and C-reactive protein as a predictor of coronary artery disease in patients of acute chest pain. J Cardiovasc Dis Res 2013;4:37-9.
17. Lekakis JP, Papamichael CM, Vemmos CN, Voutsas AA, Stamatelopoulos SF, Moulopoulos SD. Peripheral vascular endothelial dysfunction in patients with angina pectoris and normal coronary arteriograms. J Am Coll Cardiol 1998;31:541-6.
18. Tondi P, Santoliquido A, Di Giorgio A, Sestito A, Sgueglia GA, Flore R, et al. Endothelial dysfunction as assessed by flow-mediated dilation in patients with cardiac syndrome X: role of inflammation. Eur Rev Med Pharmacol Sci 2011;15:1074-7.
19. Teragawa H, Fukuda Y, Matsuda K, Ueda K, Higashi Y, Oshima T, et al. Relation between C reactive protein concentrations and coronary microvascular endothelial function. Heart 2004;90:750-4.
20. Tousoulis D, Davies GJ, Asimakopoulos G, Homaei H, Zouridakis E, Ahmed N, et al. Vascular cell adhesion molecule-1 and intercellular adhesion molecule-1 serum level in patients with chest pain and normal coronary arteries (syndrome X). Clin Cardiol 2001;24:301-4.
21. Kalay N, Dogdu O, Koc F, Yarlioglues M, Ardic I, Akpek M, et al. Hematologic parameters and angiographic progression of coronary atherosclerosis. Angiology 2012;63:213-7.
22. 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. Am J Cardiol 2008;102:653-7.
23. Azab B, Zaher M, Weiserbs KF, Torbey E, Lacossiere K, Gaddam S, et al. Usefulness of neutrophil to lymphocyte ratio in predicting short- and long-term mortality after non-ST-elevation myocardial infarction. Am J Cardiol 2010;106:470-6.