THE ROLE OF BASELINE INDIRECT INFLAMMATORY MARKERS IN PREDICTION OF RESPONSE TO CARDIAC RESYNCHRONIZATION THERAPY
K. Balci, M. Balci, U. Canpolat, F. Sen, M.K. Akboga, S. Unal, M. Kara, O. Maden, H. Selcuk, T. Selcuk
Cardiology, Turkiye Yuksek Ihtisas Research and Education Hospital, Ankara, Turkey
Introduction: In many cardiovascular diseases, white blood cell counts with differentials were used to predict adverse events. We assessed the association of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and relative lymphocyte (%L) count with response to CRT.
Methods: A total of 157 patients who underwent CRT implantation at our tertiary referral hospital were retrospectively analyzed.
Results: Among included patients, 50 patients (31.8%) were defined as “non-responders”. Median NLR and PLR were significantly higher in non-responder group and median %L was significantly lower in non-responder group (p<0.001). Correlation analysis demonstrated a positive correlation between paced QRS duration and NLR (p=0.031) and a negative correlation between paced QRS duration and %L (p=0.002). In addition, both NLR and %L showed significant correlation with post-procedural NYHA functional classes (p<0.001; p=0.008, respectively). Patients with a PLR >173.09 had a 2.9 fold and a NLR >3.45 had a 12.2 fold increased risk of CRT non response, respectively.
Conclusions: In the current study non-responders to CRT had higher NLR and PLR and lower %L that may support the deleterious effects of baseline inflammatory condition in advanced HF.
ACEI: angiotensin-converting enzyme inhibitor, ARB: angiotensin receptor II blocker, HT: hypertension, %L: relative lymphocyte count, NLR: neutrophil/lymphocyte ratio, NYHA: New York Heart Association, PCI: percutaneous coronary intervention, PLR: platelet lymphocyte ratio, pQRS: paced QRS.
| Variables | Responders (n=107) | Non-responders (n=50) | p-value |
| Age | 58.8±11.9 | 58.9±10.7 | 0.963 |
| Gender | | | 0.930 |
| Male | 82 (%76.6) | 38 (%76.0) | |
| Female | 25 (%23.4) | 12 (%24.0) | |
| Ejection fraction | 25 (12-35) | 25 (10-35) | 0.867 |
| Etiology | | | 0.033 |
| Ischemic | 49 (%45.8) | 32 (%64.0) | |
| Non- ischemic | 58 (%54.2) | 18 (%36.0) | |
| NYHA | | | 0.659 |
| II | 33 (%31.1) | 17 (%34.7) | |
| III | 73 (%68.9) | 32 (%65.3) | |
| QRS duration pQRS duration | 150 (120-200) 120 (100-160) | 150 (125-180) 120 (90-180) | 0.866 0.036 |
| PCI | 42 (%39.3) | 32 (%64.0) | 0.004 |
| Hypertension | 73 (%68.2) | 40 (%80.0) | 0.126 |
| Diabetes mellitus | 40 (%37.4) | 15 (%70.0) | 0.366 |
| Rhythm | | | 0.509 |
| S?nus rhythm | 94 (%87.9) | 42 (%84.0) | |
| Atrial fibrillation | 13 (%12.1) | 8 (%16.0) | |
| ACEi/ARB | 101 (%94.4) | 48 (%96.0) | 1.000 |
| Statin | 34 (%31.8) | 23 (%46.0) | 0.084 |
| B -blocker | 106 (%99.1) | 49 (%98.0) | 0.537 |
| Amiodarone | 20 (%18.7) | 6 (%12.0) | 0.293 |
| NLR | 2.5 (0.8-8.8) | 3.7 (1.5-26.0) | <0.001 |
| PLR | 125.4 (41.5-243.5) | 161.5 (61.2-432.0) | <0.001 |
| %L | 24.7±8.9 | 18.6±7.6 | <0.001 |
ACEI: angiotensin-converting enzyme inhibitor, ARB: angiotensin receptor II blocker, HT: hypertension, %L: relative lymphocyte count, NLR: neutrophil/lymphocyte ratio, NYHA: New York Heart Association, PCI: percutaneous coronary intervention, PLR: platelet lymphocyte ratio, pQRS: paced QRS.
| Variables | Odds Ratio | 95% Confidence Interval | Wald | p-value |
| Lower | Upper |
| Ischemic etiology | 0.919 | 0.201 | 4.210 | 0.012 | 0.913 |
| PCI | 2.519 | 0.266 | 23.860 | 0.648 | 0.421 |
| HT | 1.168 | 0.439 | 3.111 | 0.097 | 0.756 |
| Statin | 1.307 | 0.500 | 3.413 | 0.298 | 0.585 |
| NLR>3.45 | 12.216 | 2.161 | 69.052 | 8.021 | 0.005 |
| PLR>173.09 | 2.891 | 1.178 | 7.097 | 5.368 | 0.021 |
| %L<19.75 | 0.264 | 0.045 | 1.542 | 2.186 | 0.139 |
