Predictive value of elevated neutrophil-lymphocyte ratio for left ventricular systolic dysfunction in patients withnon ST-elevated acute coronary syndrome

We aimed to study the predictive value of the neutrophil-lymphocyte ratio [NLR] for left ventricular systolic dysfunction [LVSD] in patients with non ST-elevated acute coronary syndrome [NST-ACS]. A total of 405 patients [mean age 62 years and 75% male] with NST-ACS were included in the study. The study population was divided into tertiles based on admission NLR values. The low, medium and high tertiles defined as NLR 3.2 [n=135], respectively. The patients in the high NLR group were older [p<0.001], have higher rate of diabetes mellitus [p=0.028] and non-ST elevated myocardial infarction [NSTEMI] [p<0.001] and have lower left ventricular ejection fraction [LVEF] [p<0.001]. Baseline WBC [p=0.02] and neutrophil [p<0.001] levels and NLR [p<0.001] were significantly higher, baseline hemoglobin [p=0.044], hematocrit [p=0.019] and lymphocyte [p<0.001] levels were significantly lower in the high NLR group. NLR was negatively correlated with LVEF in correlation analysis. An NLR >3.2 and age >/= 70 were found to be an independent predictor of systolic dysfunction in multivariate analyses. An NLR >3.2 is a useful predictor for LVSD in patients with NST-ACS. The practice of using an NLR count on admission may be useful for identifying high-risk patients and their associated treatment methods

Fragmented QRS and prediction of paroxysmal atrial fibrillation episodes

Prior studies have demonstrated the relationship between cardiovascular diseases and fragmented QRS [fQRS]. fQRS was also associated with ventricular arrhythmias. Our objective was to find out the relationship between fQRS and paroxysmal atrial fibrillation [PAF]. A total of 301 patients without overt structural heart disease were prospectively included in the study. Patients were divided in to 2 groups according to presence of fQRS. Multivariate logistic regression analysis was used to assess the predictive value of fQRS for predicting PAF. One hundred and three patients had fQRS. Patients with fQRS were older [53 +/- 16.8 vs 45.3 +/- 17.2, p < 0.001], with larger left atrium [LA] [33.2 +/- 5.9 vs 30.1 +/- 5.9 mm, p=0.001], with thicker interventricular septum [IVS] [10.2 +/- 1.9 vs 9.5 +/- 2.3 mm, p=0.032], more diabetic [19.8 vs 10.6%, p=0.029] and have more PAF episodes [22.3 vs 4.1%, p < 0.001] in comparison with patients without fQRS. fQRS was an independent predictor of detecting PAF episode [odds ratio, 9.69; 95% confidence interval, 2.46-38.15, p=0.001]. Hypertension and diabetes mellitus were also predictive. The presence of fQRS independently predicted PAF episodes in holter monitoring [HM]. Further studies are needed to clarify the clinical implications of this finding

Intercellular adhesion molecule-1 K469E and angiotensinogen T207M polymorphisms in coronary slow flow

To investigate intercellular adhesion molecule-1 [ICAM1] and angiotensinogen [AGT] gene polymorphisms, as related to atherosclerosis and endothelial dysfunction, in coronary slow flow [CSF]. The participants in this study were 48 patients with CSF and 67 patients with normal coronary flow as controls. The K469E polymorphism of ICAM1 [rs5498] and the T207M polymorphism of AGT [rs4762] were determined using the polymerase chain reaction amplification method. Baseline demographic parameters were similar in both groups. The mean thrombolysis in myocardial infarction frame count was significantly higher in patients with CSF [23.8 +/- 5.1] compared to the controls [13.3 +/- 2.6, p < 0.001]. A significant association was found between the ICAM1 K allele and CSF [OR: 1.96, 95% CI: 1.15-3.35, p = 0.013]. There was no difference in the frequency of AGT T207M genotypes in the patients with CSF and the control subjects. This study showed that K469E polymorphisms of ICAM1 that play a role in atherosclerotic pathogenesis are related to CSF